Scientific Article|Articles in Press

Biomechanical Comparison of 5 Different Fixation Constructs in a Trapeziometacarpal Joint Arthrodesis Model

Published:February 09, 2023DOI:


      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.


      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.


      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.


      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Haara M.M.
        • Heliövaara M.
        • Kröger H.
        • et al.
        Osteoarthritis in the carpometacarpal joint of the thumb. Prevalence and associations with disability and mortality.
        J Bone Joint Surg Am. 2004; 86: 1452-1457
        • Sodha S.
        • Ring D.
        • Zurakowski D.
        • Jupiter J.B.
        Prevalence of osteoarthrosis of the trapeziometacarpal joint.
        J Bone Joint Surg Am. 2005; 87: 2614-2618
        • Armstrong A.L.
        • Hunter J.B.
        • Davis T.R.
        The prevalence of degenerative arthritis of the base of the thumb in post-menopausal women.
        J Hand Surg Br. 1994; 19: 340-341
        • Martou G.
        • Veltri K.
        • Thoma A.
        Surgical treatment of osteoarthritis of the carpometacarpal joint of the thumb: a systematic review.
        Plast Reconstr Surg. 2004; 114: 421-432
        • Wajon A.
        • Vinycomb T.
        • Carr E.
        • Edmunds I.
        • Ada L.
        Surgery for thumb (trapeziometacarpal joint) osteoarthritis.
        Cochrane Database Syst Rev. 2015; 2015: CD004631
        • Vermeulen G.M.
        • Slijper H.
        • Feitz R.
        • Hovius S.E.R.
        • Moojen T.M.
        • Selles R.W.
        Surgical management of primary thumb carpometacarpal osteoarthritis: a systematic review.
        J Hand Surg Am. 2011; 36: 157-169
        • Bamberger H.B.
        • Stern P.J.
        • Kiefhaber T.R.
        • McDonough J.J.
        • Cantor R.M.
        Trapeziometacarpal joint arthrodesis: a functional evaluation.
        J Hand Surg Am. 1992; 17: 605-611
        • Omokawa S.
        • Hojo J.
        • Iida A.
        • et al.
        Partial trapeziotrapezoid resection and thumb range of movement after trapeziometacarpal joint fusion—a biomechanical study.
        J Hand Surg Am. 2021; 46: 1126.e1-1126.e7
        • Piacenza A.
        • Vittonetto D.
        • Rossello M.I.
        • Testa M.
        Arthrodesis versus arthroplasty in thumb carpometacarpal osteoarthritis: impact on maximal voluntary force, endurance, and accuracy of pinch.
        J Hand Surg Am. 2022; 47: 90.e1-90.e7
        • Kazmers N.H.
        • Hippensteel K.J.
        • Calfee R.P.
        • et al.
        Locking plate arthrodesis compares favorably with lrti for thumb trapeziometacarpal arthrosis: early outcomes from a longitudinal cohort study.
        HSS J. 2017; 13: 54-60
        • Fulton D.B.
        • Stern P.J.
        Trapeziometacarpal arthrodesis in primary osteoarthritis: a minimum two-year follow-up study.
        J Hand Surg Am. 2001; 26: 109-114
        • Rizzo M.
        • Moran S.L.
        • Shin A.Y.
        Long-term outcomes of trapeziometacarpal arthrodesis in the management of trapeziometacarpal arthritis.
        J Hand Surg Am. 2009; 34: 20-26
        • Muller G.M.
        Arthrodesis of the trapezio-metacarpal joint for osteoarthritis.
        J Bone Joint Surg Br. 1949; 31B: 540-542
        • Kenniston J.A.
        • Bozentka D.J.
        Treatment of advanced carpometacarpal joint disease: arthrodesis.
        Hand Clin. 2008; 24 (vii): 285
        • Ganhewa A.D.
        • Wu R.
        • Chae M.P.
        • et al.
        Failure rates of base of thumb arthritis surgery: a systematic review.
        J Hand Surg Am. 2019; 44: 728-741.e10
        • Spekreijse K.R.
        • Selles R.W.
        • Kedilioglu M.A.
        • et al.
        Trapeziometacarpal arthrodesis or trapeziectomy with ligament reconstruction in primary trapeziometacarpal osteoarthritis: a 5-year follow-up.
        J Hand Surg Am. 2016; 41: 910-916
        • Mureau M.A.
        • Rademaker R.P.
        • Verhaar J.A.
        • Hovius S.E.
        Tendon interposition arthroplasty versus arthrodesis for the treatment of trapeziometacarpal arthritis: a retrospective comparative follow-up study.
        J Hand Surg Am. 2001; 26: 869-876
        • Vermeulen G.M.
        • Brink S.M.
        • Slijper H.
        • et al.
        Trapeziometacarpal arthrodesis or trapeziectomy with ligament reconstruction in primary trapeziometacarpal osteoarthritis: a randomized controlled trial.
        J Bone Joint Surg Am. 2014; 96: 726-733
        • Hartigan B.J.
        • Stern P.J.
        • Kiefhaber T.R.
        Thumb carpometacarpal osteoarthritis: arthrodesis compared with ligament reconstruction and tendon interposition.
        J Bone Joint Surg Am. 2001; 83: 1470-1478
        • Hippensteel K.J.
        • Calfee R.
        • Dardas A.Z.
        • Gelberman R.
        • Osei D.
        • Wall L.
        Functional outcomes of thumb trapeziometacarpal arthrodesis with a locked plate versus ligament reconstruction and tendon interposition.
        J Hand Surg Am. 2017; 42: 685-692
        • Singh H.P.
        • Hoare C.
        • Beresford-Cleary N.
        • Anakwe R.
        • Hayton M.
        Nonunion after trapeziometacarpal arthrodesis: comparison between K-wire and internal fixation.
        J Hand Surg Eur. 2015; 40: 351-355
        • Raven E.E.J.
        • Kerkhoffs G.M.M.J.
        • Rutten S.
        • Marsman A.J.W.
        • Marti R.K.
        • Albers G.H.R.
        Long term results of surgical intervention for osteoarthritis of the trapeziometacarpal joint: comparison of resection arthroplasty, trapeziectomy with tendon interposition and trapezio-metacarpal arthrodesis.
        Int Orthop. 2007; 31: 547-554
        • Taylor E.J.
        • Desari K.
        • D’Arcy J.C.
        • Bonnici A.V.
        A comparison of fusion, trapeziectomy and Silastic replacement for the treatment of osteoarthritis of the trapeziometacarpal joint.
        J Hand Surg Br. 2005; 30: 45-49
        • Forseth M.J.
        • Stern P.J.
        Complications of trapeziometacarpal arthrodesis using plate and screw fixation.
        J Hand Surg Am. 2003; 28: 342-345
        • Galán A.
        • Arenas J.R.
        • del Águila B.
        • Guerado E.
        • Andrés-Cano P.
        Trapezio-metacarpal arthrodesis: procedure and results.
        Eur J Orthop Surg Traumatol. 2015; 25: 483-488
        • Ochman S.
        • Doht S.
        • Paletta J.
        • Langer M.
        • Raschke M.J.
        • Meffert R.H.
        Comparison between locking and non-locking plates for fixation of metacarpal fractures in an animal model.
        J Hand Surg Am. 2010; 35: 597-603
        • Massengill J.B.
        • Alexander H.
        • Langrana N.
        • Mylod A.
        A phalangeal fracture model—quantitative analysis of rigidity and failure.
        J Hand Surg Am. 1982; 7: 264-270
        • Waris E.
        • Ashammakhi N.
        • Raatikainen T.
        • Tormala P.
        • Santavirta S.
        • Konttinen Y.T.
        Self-reinforced bioabsorbable versus metallic fixation systems for metacarpal and phalangeal fractures: a biomechanical study.
        J Hand Surg Am. 2002; 27: 902-909
        • Massengill J.B.
        • Alexander H.
        • Parson J.R.
        • Schecter M.J.
        Mechanical analysis of Kirschner wire fixation in a phalangeal model.
        J Hand Surg Am. 1979; 4: 351-356
        • Pearce A.I.
        • Richards R.G.
        • Milz S.
        • Schneider E.
        • Pearce S.G.
        Animal models for implant biomaterial research in bone: a review.
        Eur Cell Mater. 2007; 13: 1-10
        • Hansen T.B.
        • Hengst D.
        • Mortensen J.
        • Amstrup A.L.
        Fixation of trapezial implants in a trapeziometacarpal total joint prosthesis tested in a model of porcine bone.
        J Plast Surg Hand Surg. 2011; 45: 263-266
        • Duerinckx J.
        • Wolff T.W.
        A new concept for thumb basal joint arthrodesis: the v-shaped osteotomy.
        Tech Hand Up Extrem Surg. 2010; 14: 73-76
        • Kuo L.C.
        • Lin C.J.
        • Chen G.P.
        • et al.
        In vivo analysis of trapeziometacarpal joint kinematics during pinch tasks.
        Biomed Res Int. 2014; 2014157295
        • Stokel E.A.
        • Tencer A.F.
        • Driscoll H.L.
        • Trumble T.E.
        A biomechanical comparison of four methods of fixation of the trapeziometacarpal joint.
        J Hand Surg Am. 1994; 19: 86-92
        • Athlani L.
        • Bergere M.
        • Motte D.
        • Prandi B.
        • Beaulieu J.Y.
        • Moissenet F.
        Trapeziometacarpal joint loading during key pinch grip: a cadaver study.
        Hand Surg Rehabil. 2022; 41: 204-209
        • Capo J.T.
        • Melamed E.
        • Shamian B.
        • et al.
        Biomechanical evaluation of 5 fixation devices for proximal interphalangeal joint arthrodesis.
        J Hand Surg Am. 2014; 39: 1971-1977
        • Avery III, D.M.
        • Klinge S.
        • Dyrna F.
        • et al.
        Headless compression screw versus Kirschner wire fixation for metacarpal neck fractures: a biomechanical study.
        J Hand Surg Am. 2017; 42: 392.e1-392.e6
        • Chen H.
        • Wu D.
        • Pan T.
        • Pan J.
        • Zhang R.
        • Shi X.
        Comparison of three different fixation constructs for radial neck fractures: a biomechanical study.
        J Orthop Surg Res. 2017; 12: 175
        • Capo J.T.
        • Svach D.
        • Ahsgar J.
        • Orillaza N.S.
        • Sabatino C.T.
        Biomechanical stability of different fixation constructs for ORIF of radial neck fractures.
        Orthopedics. 2008; 31
        • Politi J.
        • John H.
        • Njus G.
        • Bennett G.L.
        • Kay D.B.
        First metatarsal-phalangeal joint arthrodesis: a biomechanical assessment of stability.
        Foot Ankle Int. 2003; 24: 332-337
        • Doht S.
        • Jansen H.
        • Meffert R.
        • Frey S.
        Higher stability with locking plates in hand surgery? Biomechanical investigation of the TriLock system in a fracture model.
        Int Orthop. 2012; 36: 1641-1646
        • Trease C.
        • McIff T.
        • Toby E.B.
        Locking versus nonlocking T-plates for dorsal and volar fixation of dorsally comminuted distal radius fractures: a biomechanical study.
        J Hand Surg Am. 2005; 30: 756-763
        • Roth K.E.
        • Peters J.
        • Schmidtmann I.
        • Maus U.
        • Stephan D.
        • Augat P.
        Intraosseous fixation compared to plantar plate fixation for first metatarsocuneiform arthrodesis: a cadaveric biomechanical analysis.
        Foot Ankle Int. 2014; 35: 1209-1216
        • Willmott H.
        • Al-Wattar Z.
        • Halewood C.
        • Dunning M.
        • Amis A.
        Evaluation of different shape-memory staple configurations against crossed screws for first metatarsophalangeal joint arthrodesis: a biomechanical study.
        Foot Ankle Surg. 2018; 24: 259-263
        • Pflibsen L.R.
        • Noland S.S.
        • Eells A.C.
        • Smith A.A.
        Addition of an oblique interfragmentary screw to t-plate fixation decreases nonunion rate in trapeziometacarpal arthrodesis.
        Hand (N Y). 2022; 17: 447-451
        • Jiménez-Díaz V.
        • Cecilia-López D.
        • Porras-Moreno M.Á.
        • Muñoz-Sánchez G.
        • García-Lamas L.
        • Jara-Sánchez F.
        Arthrodesis of the thumb carpometacarpal joint using a quadrangular plate: surgical technique and long-term results of 70 patients.
        Eur J Orthop Surg Traumatol. 2017; 27: 909-915
        • Vanderzanden J.C.
        • Adams B.D.
        • Guan J.J.
        MCP arthrodesis using an intramedullary interlocking device.
        Hand (N Y). 2014; 9: 209-213
        • Nakanishi A.
        • Kawamura K.
        • Omokawa S.
        • Shimizu T.
        • Tanaka Y.
        Vascularized bone graft from the second metacarpal base for trapeziometacarpal joint arthrodesis.
        Case Reports Plast Surg Hand Surg. 2018; 5: 45-48
        • Lansinger Y.C.
        • Lehman T.P.
        Nonunion following trapeziometacarpal arthrodesis with plate and screw fixation.
        J Hand Surg Am. 2015; 40: 2310-2314