Name of the Procedure:

Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation; with autograft (includes obtaining graft)

Summary

Arthrodesis of the carpometacarpal (CMC) joint of the thumb is a surgical procedure aimed at fusing the bones of the thumb joint. This can be done with or without the use of internal fixation devices such as screws or plates. The procedure involves using a bone graft taken from the patient’s own body (autograft).

Purpose

This surgery is typically performed to alleviate pain and improve stability and function in the thumb, often due to arthritis or injury. The goal is to create a stable, pain-free joint by fusing the bones together, reducing or eliminating movement at the joint.

Indications

• Severe osteoarthritis of the CMC joint of the thumb
• Chronic pain and instability of the thumb
• Failure of conservative treatments such as medication, splints, or injections
• Post-traumatic arthritis or deformity
• Loss of thumb function impacting daily activities

Preparation

• Follow fasting instructions if general anesthesia is to be used.
• Adjust medications as directed by the surgeon, particularly those affecting blood clotting.
• Pre-surgical imaging tests like X-rays or MRI to assess the joint and plan the procedure.

Procedure Description

1. The patient is administered anesthesia (local, regional, or general).
2. An incision is made at the base of the thumb.
3. The surfaces of the CMC joint are prepared by removing the damaged cartilage.
4. A bone graft is harvested from another part of the patient’s body, typically from the wrist or pelvis.
5. The graft is placed between the bones of the CMC joint.
6. Internal fixation devices, such as screws or plates, may be used to hold the bones and graft in place.
7. The incision is closed with sutures, and the thumb is immobilized with a bandage or splint.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

This surgery is performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic surgeon specialized in hand procedures
• Surgical nurse
• Anesthesiologist
• Surgical technologist

Risks and Complications

• Infection at the surgical site
• Nonunion or delayed union of the fused joint
• Nerve damage
• Reduced thumb mobility and dexterity
• Pain at the graft donor site
• Risks associated with anesthesia
• Possible need for additional surgery if fusion does not occur properly

Benefits

• Significant pain relief
• Improved stability and function of the thumb
• Better quality of life and ability to perform daily activities

Recovery

• Keep the hand elevated to reduce swelling.
• Follow instructions for wound care and dressing changes.
• Use prescribed pain medication as needed.
• Physiotherapy may be recommended to optimize function and strength.
• Restrictions on heavy lifting or using the hand forcefully.
• Initial healing period is about 6 to 12 weeks, with full recovery taking several months.

Alternatives

• Conservative treatments including medications, splinting, and corticosteroid injections.
• Joint replacement (arthroplasty) of the thumb CMC joint.
• Osteotomy or other joint-preserving surgeries.
• Pros: Non-surgical options have fewer immediate risks; joint replacement can maintain joint movement.
• Cons: Non-surgical options may not provide long-term relief; joint replacement might wear out over time requiring additional surgery.

Patient Experience

• During the procedure: Patients will be under anesthesia and should not feel pain.
• After the procedure: Expect some pain and swelling at the surgical and graft site; managed with medications.
• Immobility of the thumb in a cast or splint initially.
• Gradual return to normal activities as healing progresses and following the guidance of the healthcare team.