Clinical case - fx of base thumb (dominant arm) not treated, hand heavy worker

Clinical case - fx of base thumb (dominant arm) not treated, hand heavy worker


Dear colleagues,

I would like to ask for your opinion, male 40 years old, fx of base thumb (dominant arm) not treated, hand heavy worker , I have evaluated him for the first time after 3 months,  pain at thumb base with limited ROM.

Best regards

Dr Alberto Sgarbossa - Italy


Dear Alberto,

For me it is a 100% case for CMC fusion.

Best regards,

Igor Golubev - Russia


I happened to have similar cases, and always successfully treated them as I do for CMCJ osteoarthritis. I think there’s no way to restore normal joint conditions at this level

Alberto Lazzerini - Italy


Hi Alberto.

I’ve had three of these in similar aged heavy manual workers.

In all of these I have used the Arpe CMCJ prosthesis. MAIA is also essentially the same. All are back at work, usual occupation, with normal function typically by 3 months.  My followup for these heavy manual cases is only about 3 years for the longest case however.  I am not certain how long a prosthesis can last in such a high demand case but it is the only way I have found to give them a “normal” thumb again and back to work. They understand they may eventually need trapeziectomy which would impact their ability to work same occupation.

Regards

Nathan Stewart - Australia


Dear Alberto,

in these Cases I prefer open Resection of the malunited volar Bennett-Fragment and perform a Reconstruction of the volar beak ligament to the Base of the Thumb to re-center the joint. Additionally you can perform a Capsulorrhaphy on the dorsal Joint aspect, if reasonable. Good Luck.

Best,

Justin Hasenecker - Germany


I agree with Alberto

Roberto Maggi - Italy


If articulate cartilage remains in good volume (arthroscopic examination ideally), why not excise the osteophytes and do a mini-tight rope suspension arthroplasty to correct the subluxation? Doesn’t burn any bridges. 

Kind Regards,

Sharon Chu - Australia


Dear Colleague

At 3 months you can do open réduction and ligamentoplasty but if you find chondrolysis at surgery you might change your

indication to trapezectomy or prosthesis or arthrodesis which is not our preferred choice in France. I usually explain the problem to my patient and ask for "white card" during surgery. If there is chondrolysis the prosthesis is a good choice even in heavy worker in my practice

Let us know

best regards

Bernard Cadot - France


Dear colleagues

Lately I have seen a fair amount of failed Bennett fractures that were initially treated by general surgery and I have found that exploration and either an intra-articular correction osteotomy, debridement of osteophytes or in this particular case resection of the Bennett fragment and correction of the dorsal subluxation with en Eaton-Littler type procedure (or mini-tightrope) has had very satisfactory short term results, probably because the CMC1 joint appears to deal well with stiffness but not at all with incongruency. Obviously there is some degree of cartilage loss at the time of revision surgery and some patients will ultimately develop early CMC1 arthritis.

Regards

Robert de Wijn - the Netherlands


Hi Robert,

Treated by general surgeons? Hoopte dat we dit tijdperk nu een beetje achter ons hadden gelaten. Is niet goed voor samenwerking en onnodige toevoeging als je het mij vraagt.

Gr Niels - Netherland


Dear All, 

Bennett’s fractures are Often not unnoticed ni our region because  of rugby accidents(they keep playing).

I usually  performance an osteotomy through Gedda Moberg approach.

Even if the joint si worn, once the articulation is reduce and stable, we have good results.

Regards

Dr Erle Weltzer - France


Hi Alberto.

Agree with colleagues that treat this old lesion as a thumb base arthritis. The Badoino’s procedure (called “resection arthroplasty”) could be the choice, since the main step is the resection of the base of the 1st metacarpal for 2 mm. In the arthritic patients this procedure restores completely stability or the thumb base.

Stefano Tognon - Italy


Good evening.

Do you have any reference of Badoino’s procedure (called “resection arthroplasty”) please ?

Regards.

Dr Emmanuel BEAUDOUIN - France


Write to Cesare Badoino, it’s his technique.

His email is : badoino2001@yahoo.it

Dr. Lucian Lior Marcovici - Italy

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