PMC5458698_01
Plain X-ray images taken during the patient's first visit to our clinic (a), just after the suspension arthroplasty and ligament reconstruction operation (b), and 3 years after the operation (c).
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F1
She felt recurrence of pain in the base of the thumb 4 months after surgery, and a plain X-ray revealed that the first metacarpal had subsided and begun to touch the distal scaphoid. 8 months after the first LRTI procedure, she had the second LRTI surgery using a strip of the APL tendon. 6 months after that surgery, the thumb had moved proximally and was impinging on the scaphoid tubercle (Fig. 1a), and the patient again complained of joint pain. A 1.5 mm K-wire was temporarily placed between the first and second metacarpals and removed 3 weeks after surgery (Fig. 1b). 3 years after the final operation, the thumb subsidence was measured as 3 mm on a plain X-ray compared with that obtained immediately after surgery, but the subsidence had not progressed when assessed 6 months after surgery (Fig. 1c).
A schematic diagram of the operation performed on the patient. (1) First metacarpal, (2) second metacarpal, (3) remaining abductor pollicis longus tendon, (4) remaining flexor carpi radialis tendon, (5) extensor carpi radialis longus (ECRL) tendon, (6) transferred ECRL tendon, (7) bone tunnel at the base of the first metacarpal, (8) bone tunnel at the base of the second metacarpal, (9) interlacing suture of the transferred ECRL tendon strip with the remaining ECRL tendon.
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F3
The end of the ECRL was passed dorsally and sutured to the ECRL remnant in an interlacing fashion (Fig. 3).