Carpometacarpal Arthrodesis for Spasticity-Related Thumb-in-Palm Deformity

Abstract

Introduction: Patients who suffer from upper motor neuron (UMN) disease frequently develop a thumb-in-palm (TIP) deformity, wherein the thumb metacarpal is adducted, severely limiting function and potentially causing compromised hand hygiene. The role of surgical treatment in this population ranges from tendon transfers, soft tissue releases, and in severe cases, arthrodesis. In this study, we review our experience with carpometacarpal (CMC) arthrodesis with staples for the treatment of UMN related recurrent TIP deformity. Methods: This single surgeon case series included 5 patients with UMN-related TIP deformity who underwent CMC arthrodesis with nitinol staples. Data regarding union, infection, hardware failure, and recurrence of TIP deformity were recorded from the electronic medical record. Results: All patients achieved radiographic union. The average follow-up was 2.7 months. No patients had evidence of recurrence of TIP deformity, hardware loosening, infection, dehiscence or delayed healing. Conclusion: This is the first described use of thumb CMC arthrodesis using nitinol staples in patients with UMN-related recurrent TIP deformity. The use of staples for CMC arthrodesis in the UMN population is an effective method without evidence of failure or recurrence.