FINDINGS AND PROCEDURE:
After consent was obtained from the patient, he was marked in the
preoperative holding there was taken to the operating room. Time-out
was performed. Antibiotic was given. The extremity was then prepped
and draped in usual surgical fashion. Tourniquet was inflated to 250
mmHg. A longitudinal incision was made along the dorsal aspect of the
base of the thumb CMC joint which was carried through skin and
subcutaneous tissue. Superficial vessels were cauterized. The nerves
were identified and preserved. The CMC joint was exposed. The dorsal
radial artery was visualized and preserved. An ulnarly based
capsulotomy was performed which was elevated. The CMC joint was
exposed. The synovitis was then dissected and removed. The dorsal
aspect of the periosteum of the metacarpal was elevated. The
insertion of the Ph was preserved. A reduction clamp was placed along
the base of the metacarpal. Then using an oscillating saw, an
osteotomy was performed at the base of the metacarpal excising
approximately 6 mm off the metacarpal base. We were able to obtain a
really nice, transverse cut.
The next step was to perform a trapezioplasty which was removing all
the osteophytes on the volar aspect of the trapezium to allow
placement of the implant. I used a combination of the periosteum
elevator and a windshield rasper to fully remove and expose the area.
Osteotome was used to remove all the osteophytes. He did have quite
large osteophytes volarly. Then a sizer was used to measure which
implant was served for the trapezium. A size 4 fit really well and he
could also be a size #5.
Then under fluoroscopy, an awl was used to guide the medullary canal
of the metacarpal which was centralized. Then I used a broacher and I
broached to a size #4, and I felt it was very really nice and tight at
the canal.
Prior to insertion of the trial, I used a planar to make sure it was
nice and flat at the osteotomy site. A size #4 was then placed with
the help of a bone dampener. The joint was then reduced. I then
manipulated the joint with full palmar abduction and opposition. We
had no dislocation or subluxation of the implant. This was performed
under fluoroscopy.
I was happy with the size #4. Then a final implant was opened from
the CMC stablyx set. A #4 opening was then placed in the bone which
was nice and press fit. The joint was then reduced and a Stablyx was
placed. The joint was then manipulated without any subluxation.
The wound was irrigated. The capsule was then closed with a 2-0
Vicryl. I did final manipulation and x-rays were obtained.
Tourniquet was discontinued. The incision was closed in layers with 3
and 4-0 Monocryl and a thumb spica splint was applied keeping the IP
joint covered. The patient tolerated the procedure well.