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Journal of the Korean Society for Surgery of the Hand 2006;11(4):238-245.
Published online December 1, 2006.
Treatment of Painful Unstable Basal Joint of Thumb
Yong-Hoon Kim, Seung-Koo Rhee, Man-Kue Bae, Hyo-Jin Lee, Seok-Whan Song
Department of Orthopedic Surgery, College of Medicine, the Catholic University of Korea, Seoul, Korea
무지의 동통성 불안정 수근중수관절의 치료
김용훈, 이승구, 배민규, 이효진, 송석환
가톨릭대학교 의과대학 정형외과학교실
Correspondence:  Seok-Whan Song, Tel: 02-3779-1192, Fax: 02-783-0252, 
Email: sw.song@catholic.ac.kr
Abstract
Purpose
Many different operative techniques have been introduced for the treatment of painful unstable basal joint of thumb in accordance with Eaton-Littler’s stages. We report the clinical results of 22 cases, consist of ligament reconstruction using flexor carpi radialis (FCR) or extensor carpi radialis longus (ECRL) tendons for stages I and II, and trapeziometacarpal fusion, ligament reconstruction of 1-2 intermetacarpal ligament with ECRL after trapezium excision or trapezium excision with tendon interposition for stages III and IV.
Materials and Methods: Twenty-two cases operated from 1980 to 2006 were selected. Mean age was 48 years old (from 18 to 69 yrs old). There were 10 men and 11 women, 13 right and 9 left hands. Mean followup period was 19 months (from 4 to 135 months). In early stages (11 cases), ligament reconstruction with FCR (8 cases) was done, and another 3 cases with ECRL. One of the above 11 cases was underwent the opening wedge osteotomy of trapezium. In late stages, fusion (7 cases), trapezium excision with tendon interposition (2 cases), or trapezium excision combined with ligament reconstruction with ECRL (2 cases) were done.

Results
For early stage, ligament reconstruction with FCR or ECRL did not show any differences in the clinical results. For late stage, the range of motion of thumb basal joint was greater in groups of ligament reconstruction combined with trapezium excision and trapezium excision with tendon interposition than in fusion group. However, grip and pinch power were bigger, and pain was more improved in fusion group.

Conclusion
Although problematic basal joint instability of thumb can be treated by ligament reconstruction only, in late arthritic stages, fusion or ligament reconstruction after trapeziectomy are recommended. Reconstruction of 1-2 intermetacarpal ligament using ECRL was regarded as much easier than using FCR.
Key Words: Thumb, Carpometacarpal joint, Instability, Ligament reconstruction, ECRL
 


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