Purpose
Trapeziometacarpal joint (TMC) arthrodesis has a high rate of nonunion. This biomechanical
analysis sought to determine the stiffness of 5 fixation methods in a TMC joint arthrodesis
model.
Methods
Five fixation constructs were tested in a validated porcine model: crossed 1.1-mm
K-wires, crossed 1.6-mm K-wires, crossed headless compression screws (HCSs), compression
plating (CP), and locked compression plating (LCP). The cantilever bending stiffness
was measured in abduction, adduction, flexion, and extension. Samples were loaded
to failure in extension, and the mode of failure was examined.
Results
The crossed HCSs performed consistently well in all tests. Loading to failure resulted
in screw pullout. In abduction and adduction, HCS and 1.6-mm K-wires were significantly
stiffer than the other constructs. The mean load to failure in extension was similar
in the HCS, CP, and LCP groups (304 N/mm, 311 N/mm, and 293 N/mm, respectively). There
were no differences between CP and LCP in any biomechanical tests, and the mode of
failure was through plate bending. The crossed 1.1-mm K-wires performed poorly in
all tests.
Conclusions
Crossed HCS displayed the greatest overall stability. Standard plating in compression
mode and LCP had a similar biomechanical performance.
Clinical relevance
The ideal construct stiffness required for the successful union after TMC joint arthrodesis
is unknown, but HCS has the best overall biomechanical performance and, therefore,
might be considered the best choice for this clinical setting.
Key Words
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Article info
Publication history
Published online: February 09, 2023
Accepted:
December 12,
2022
Received:
June 22,
2022
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly to this article.
Identification
Copyright
© 2023 by the American Society for Surgery of the Hand. All rights reserved.
