Partial translocation of flexor carpi radialis tendon for treatment of traumatic dislocation of first carpometacarpal joint_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Yaolin ¹ ,  YANG Yong ² , WANG Zhenzhong ² , WANG Yang ²

1. Department of Orthopedics, Fuwai Central China Cardiovascular Hospital, Zhengzhou Henan, 450003, P. R. China;
2. Department of Hand Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100032, P. R. China;

Corresponding author：

YANG Yong, Email: 0414yang@sina.com

Keywords：

The first carpometacarpal joint; traumatic joint dislocation; tendon transfer; ligaments reconstruction

DOI：

10.7507/1002-1892.202503094

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the effectiveness of partial translocation of flexor carpi radialis tendon in the treatment of traumatic dislocation of the first carpometacarpal joint. Methods The clinical data of 6 patients with traumatic dislocation of the first carpometacarpal joint who met the selection criteria between March 2020 and June 2024 were retrospectively analyzed. There were 3 males and 3 females with an average age of 33.5 years (range, 16-42 years). All the 6 cases were treated with plaster immobilization for 4-6 weeks, and the time from injury to operation was 6-12 weeks, with an average of 8.8 weeks. All patients underwent reconstruction of the metacarpophalangeal anterior oblique ligament and dorsal posterior oblique ligament of the first carpometacarpal joint with partial translocation of flexor carpi radialis tendon. The pain relief was evaluated by visual analogue scale (VAS) score before and after operation, and the pinch force, palmar abduction and radial abduction angles of the affected side and the healthy side were recorded before and after operation, and the ratio of the above indexes between the affected side and the healthy side was calculated to evaluate the effectiveness.Results All the incisions healed by first intention after operation, and there were no complications related to operation such as neurovascular injury. All patients were followed up 6-19 months (mean, 12.7 months). The range of motion of the thumb on the injured side was the same as that on the healthy side, the first carpometacarpal joint was stable without recurrent dislocation and pain. At last follow-up, the VAS score, the pinch force of the affected side, the abduction angle of the palmar side of the affected thumb, the abduction angle of the radial side of the affected thumb, and the pinch force ratio, the abduction angle ratio of the palmar side of the thumb, and the abduction angle ratio of the radial side of the thumb of the affected side to the healthy side significantly improved when compared with those before operation (P<0.05). Conclusion Partial translocation of the flexor carpi radialis tendon to reconstruct the metacarpophalangeal and dorsal radial ligaments for the treatment of traumatic dislocation of the first carpometacarpal joint is a reliable surgical method.

1.	Jeong C, Kim HM, Lee SU, et al. Bilateral carpometacarpal joint dislocations of the thumb. Clin Orthop Surg, 2012, 4(3): 246-248.
2.	Kronlage SC, Whitaker EA. Thumb carpometacarpal stabilization with a dorsal capsule repair augmented with an internal brace. Tech Hand Up Extrem Surg, 2023, 27(3): 157-160.
3.	Bosmans B, Verhofstad MH, Gosens T. Traumatic thumb carpometacarpal joint dislocations. J Hand Surg (Am), 2008, 33(3): 438-441.
4.	Knoedler TG, Condit KM, Zachary SV. Recurrent bilateral basilar joint subluxation in a teenage boy. J Hand Surg Glob Online, 2021, 3(6): 363-367.
5.	Rusli WMR, Mirza E, Tolerton S, et al. Ligamentous constraint of the first carpometacarpal joint. J Biomech, 2021, 128: 110789. doi: 10.1016/j.jbiomech.2021.110789.
6.	Connell DA, Pike J, Koulouris G, et al. MR imaging of thumb carpometacarpal joint ligament injuries. J Hand Surg (Br), 2004, 29(1): 46-54.
7.	Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg (Am), 1973, 55(8): 1655-1666.
8.	Stauffer A, Schwarz Y, Uranyi M, et al. Outcomes after thumb carpometacarpal joint stabilization with an abductor pollicis longus tendon strip for the treatment of chronic instability. Arch Orthop Trauma Surg, 2020, 140(2): 275-282.
9.	Mahmood B, Hammert WC. Carpometacarpal joint pathology in the thumb and hand: Evaluation and management of difficult conditions. Hand Clin, 2023, 39(3): 321-329.
10.	Jongen IC, Nieuwdorp NJ, Hundepool CA, et al. The figure-of-eight ligament reconstruction in thumb carpometacarpal instability: Surgical technique and clinical outcomes. J Hand Surg (Am), 2024. doi: 10.1016/j.jhsa.2024.05.017.
11.	何树坤, 徐龙, 赵思淳, 等. 不同术式重建第一腕掌关节稳定性的生物力学研究. 中国修复重建外科杂志, 2017, 31(2): 171-175.
12.	Eaton RG, Lane LB, Littler JW, et al. Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment. J Hand Surg (Am), 1984, 9(5): 692-699.
13.	Mazhar FN, Jafari D, Jafari SS, et al. Ligament reconstruction of traumatic pure dislocation of carpometacarpal joint of the thumb: A series of acute and chronic cases. J Hand Microsurg, 2020, 12(Suppl 1): S16-S20.
14.	Rabinovich RV, Polatsch DB, Shin SS, et al. Thumb carpometacarpal instability. J Am Acad Orthop Surg, 2021, 29(22): 943-950.
15.	Shah J, Patel M. Dislocation of the carpometacarpal joint of the thumb. A report of four cases. Clin Orthop Relat Res, 1983, (175): 166-169.
16.	Watt N, Hooper G. Dislocation of the trapezio-metacarpal joint. J Hand Surg (Br), 1987, 12(2): 242-245.
17.	Zhang X, Shao X, Huang W, et al. An alternative technique for stabilisation of the carpometacarpal joint of the thumb after dislocation or subluxation. Bone Joint J, 2015, 97-B(11): 1533-1538.
18.	Shah A, Martin G, Thomson JG. A novel use for suture button suspension: reconstruction of the dorsal ulnar ligament to treat thumb metacarpal dislocation. Case Reports Plast Surg Hand Surg, 2015, 2(1): 7-11.
19.	Yao J. Suture-button suspensionplasty for the treatment of thumb carpometacarpal joint arthritis. Hand Clin, 2012, 28(4): 579-585.
20.	Court T, Hussain K, Kim JS, et al. Systematic review of ligament reconstruction of traumatic isolated thumb carpometacarpal joint dislocation. J Am Acad Orthop Surg Glob Res Rev, 2022, 6(12): e22.00103. doi: 10.5435/JAAOSGlobal-D-22-00103.

1. Jeong C, Kim HM, Lee SU, et al. Bilateral carpometacarpal joint dislocations of the thumb. Clin Orthop Surg, 2012, 4(3): 246-248.
2. Kronlage SC, Whitaker EA. Thumb carpometacarpal stabilization with a dorsal capsule repair augmented with an internal brace. Tech Hand Up Extrem Surg, 2023, 27(3): 157-160.
3. Bosmans B, Verhofstad MH, Gosens T. Traumatic thumb carpometacarpal joint dislocations. J Hand Surg (Am), 2008, 33(3): 438-441.
4. Knoedler TG, Condit KM, Zachary SV. Recurrent bilateral basilar joint subluxation in a teenage boy. J Hand Surg Glob Online, 2021, 3(6): 363-367.
5. Rusli WMR, Mirza E, Tolerton S, et al. Ligamentous constraint of the first carpometacarpal joint. J Biomech, 2021, 128: 110789. doi: 10.1016/j.jbiomech.2021.110789.
6. Connell DA, Pike J, Koulouris G, et al. MR imaging of thumb carpometacarpal joint ligament injuries. J Hand Surg (Br), 2004, 29(1): 46-54.
7. Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg (Am), 1973, 55(8): 1655-1666.
8. Stauffer A, Schwarz Y, Uranyi M, et al. Outcomes after thumb carpometacarpal joint stabilization with an abductor pollicis longus tendon strip for the treatment of chronic instability. Arch Orthop Trauma Surg, 2020, 140(2): 275-282.
9. Mahmood B, Hammert WC. Carpometacarpal joint pathology in the thumb and hand: Evaluation and management of difficult conditions. Hand Clin, 2023, 39(3): 321-329.
10. Jongen IC, Nieuwdorp NJ, Hundepool CA, et al. The figure-of-eight ligament reconstruction in thumb carpometacarpal instability: Surgical technique and clinical outcomes. J Hand Surg (Am), 2024. doi: 10.1016/j.jhsa.2024.05.017.
11. 何树坤, 徐龙, 赵思淳, 等. 不同术式重建第一腕掌关节稳定性的生物力学研究. 中国修复重建外科杂志, 2017, 31(2): 171-175.
12. Eaton RG, Lane LB, Littler JW, et al. Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment. J Hand Surg (Am), 1984, 9(5): 692-699.
13. Mazhar FN, Jafari D, Jafari SS, et al. Ligament reconstruction of traumatic pure dislocation of carpometacarpal joint of the thumb: A series of acute and chronic cases. J Hand Microsurg, 2020, 12(Suppl 1): S16-S20.
14. Rabinovich RV, Polatsch DB, Shin SS, et al. Thumb carpometacarpal instability. J Am Acad Orthop Surg, 2021, 29(22): 943-950.
15. Shah J, Patel M. Dislocation of the carpometacarpal joint of the thumb. A report of four cases. Clin Orthop Relat Res, 1983, (175): 166-169.
16. Watt N, Hooper G. Dislocation of the trapezio-metacarpal joint. J Hand Surg (Br), 1987, 12(2): 242-245.
17. Zhang X, Shao X, Huang W, et al. An alternative technique for stabilisation of the carpometacarpal joint of the thumb after dislocation or subluxation. Bone Joint J, 2015, 97-B(11): 1533-1538.
18. Shah A, Martin G, Thomson JG. A novel use for suture button suspension: reconstruction of the dorsal ulnar ligament to treat thumb metacarpal dislocation. Case Reports Plast Surg Hand Surg, 2015, 2(1): 7-11.
19. Yao J. Suture-button suspensionplasty for the treatment of thumb carpometacarpal joint arthritis. Hand Clin, 2012, 28(4): 579-585.
20. Court T, Hussain K, Kim JS, et al. Systematic review of ligament reconstruction of traumatic isolated thumb carpometacarpal joint dislocation. J Am Acad Orthop Surg Glob Res Rev, 2022, 6(12): e22.00103. doi: 10.5435/JAAOSGlobal-D-22-00103.

Chinese Journal of Reparative and Reconstructive Surgery

Latest ArticlesPartial translocation of flexor carpi radialis tendon for treatment of traumatic dislocation of first carpometacarpal joint

Abstract Full text Figures/Tables Video References Cited by

Format

Content