PMC4623541_01
PMC4623541_02
Lateral preoperative x-rays. The patient demonstrates Z deformity and dislocation of first metacarpal. No arthritic changes are evident over the joint surfaces
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F0001
X-rays demonstrated no evidence of osteophytes or arthritic changes (See Figure 1).
Intraoperative photograph demonstrating pattern of dislocation.
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F0002
Ligamentous instability and dislocation is demonstrated (See Figures 2 and 3).
Intraoperative photograph demonstrating pattern of dislocation.
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F0003
Ligamentous instability and dislocation is demonstrated (See Figures 2 and 3).
Intraoperative photograph demonstrating 0.045 K-wire driven across the trapezium into the base of the thumb metacarpal from the dorsal and ulnar side of the metacarpal into the volar and radial side of the trapezium.
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F0004
Once the trajectory was planned, a 0.045 K-wire was then driven across the trapezium into the base of the thumb metacarpal (See Figure 4).
Intraoperative photograph demonstrating tightening of the Mini TightRope
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F0005
TightRope was tightened (See Figure 5). There was excellent stability of the CMC joint with no dorsal or ulnar dislocation. The Mini TightRope was tightened and tied (See Figure 6), and mini C-arm images were used to confirm proper alignment with lack of dislocation. The knot was buried dorsally and then the skin incisions were closed.
Intraoperative photograph demonstrating the final placement of fully deployed Mini TightRope.
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F0006
TightRope was tightened (See Figure 5). There was excellent stability of the CMC joint with no dorsal or ulnar dislocation. The Mini TightRope was tightened and tied (See Figure 6), and mini C-arm images were used to confirm proper alignment with lack of dislocation. The knot was buried dorsally and then the skin incisions were closed.
Fluoroscopic images confirming adequacy of reduction and appropriate placement of suture buttons.
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F0007
TightRope (See Figure 7). The patient was placed in a thumb spica splint, and discharged home.
Demonstration of appropriate functionality of hand and thumb-CMC interface. Patient demonstrates no residual dislocation or dorsal ulnar ligament laxity. Patient has appropriate movements associated with thumb-CMC joint, and has appropriate pinch and grip strength.
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F0008
At 6 weeks follow-up, the patient demonstrated continued stability of the thumb CMC joint without dorsal or radial dislocation, and demonstrated strong pinch and grip functionality (see Figures 8 and 9).
Demonstration of appropriate functionality of hand and thumb-CMC interface. Patient demonstrates no residual dislocation or dorsal ulnar ligament laxity. Patient has appropriate movements associated with thumb-CMC joint, and has appropriate pinch and grip strength.
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F0009
At 6 weeks follow-up, the patient demonstrated continued stability of the thumb CMC joint without dorsal or radial dislocation, and demonstrated strong pinch and grip functionality (see Figures 8 and 9).