Arthroscopically assisted arthrodesis screw fixation for the treatment of Eaton-Glickel stage II and III first carpometacarpal arthritis

To investigate the clinical efficacy of arthroscopic-assisted arthrodesis and screw fixation in the treatment of thumb first carpometacarpal arthritis.

From February 2021 to December 2023, we used arthroscopic-assisted arthrodesis and screw fixation to treat 7 patients with osteoarthritis of the first carpometacarpal joint, including 2 males and 5 females. The mean age was 55 years ( range, 45-65 years ). There were 2 cases of left thumb and 5 cases of right thumb. According to the imaging Eaton-Glickel stage before operation, there were 3 cases of stage II and 4 cases of stage III. All cases were consistent with the clinical manifestations of first carpometacarpal arthritis, including pain in the base of the thumb ( VAS pain score averaged 7 points ), tenderness of the first carpometacarpal joint, positive grinding test, and limited thumb mobility. All patients underwent at least 3 months of conservative treatment before surgery, including brace fixation, oral non-steroidal drugs and local closure. During the operation, we used a 1.9mm arthroscopy to evaluate the articular cartilage through two basic channels. Synovectomy, free body removal, articular surface grinding, etc.were performed. After adjusting the fusion force line, the Kirschner wire guide needle was temporarily fixed, and then two hollow screws were used for cross fixation.After operation, X-ray films were reviewed regularly to observe the healing of wrist-metacarpal joint fusion, complications and arthritis around most of the horns. The grip strength, interphalangeal pinch strength, range of motion ( radial abduction and volar abduction of thumb ), Kapandji score, DASH score and VAS score were measured respectively, and the above results were statistically analyzed.

Seven patients were followed up for an average of 18 months. There were no complications related to wound and internal fixation. The fusion rate of the first carpometacarpal joint reached 100 %. The grip strength and interphalangeal pinch strength increased compared with those before operation, and the VAS score decreased compared with that before operation. The differences were statistically significant. The Kapandji score and DASH score of thumb activity were also improved compared with those before operation. There was no manifestation of peripheral arthritis of most horn bones.

Arthroscopic-assisted arthrodesis screw fixation is an effective method for the treatment of Eaton-Glickel stage II and III first carpometacarpal joint osteoarthritis. It is more minimally invasive and beautiful than traditional incision and debridement of articular surface with plate fixation.

Keywords: Thumb,Carpometacarpaljoints,Osteoarthritis,Arthrodesis