Thumb Arthritis: Soft-Button CMC Suspensionplasty Animation

This animated video demonstration will show a surgical treatment for carpometacarpal joint thumb arthritis. The repair will utilize soft and hard-bodied bone anchors and flat supporting suture, suspended between 2 bones like a sling. The carpometacarpal joint, or C M C joint of the thumb, lies between the trapezium and metacarpal bone at the base of the thumb. To begin, here is a left hand. The trapezium will initially be removed to alleviate pain. An instrument called an elevator will be used to help remove this bone. A metal wire is inserted all the way through the base of the index finger to breach the far layer of bone. This will mark the path of insertion for the implant that will fixate on the outside of the bone. The correct placement of the wire is confirmed with an x-ray during the surgery. Once confirmed, a guide is placed over the metal wire. This guide will serve as the trajectory of the implant's anchor. Lines at the back of the guide will help measure the depth of the tunnel. These lines correspond with the lines on both the drill and the anchor inserter to make sure the proper depth through the far side of the bone is reached. The metal wire is removed, and the drill is placed and checked on x-ray. Then, the drill is removed, and the implant is advanced. A slight tap with a mallet ensures the implant is through the far cortex or outside of the bone. Placement is confirmed on the lines. An additional x-ray will also be taken to confirm the placement. The soft-bodied anchor is set in place on the outside of the bone by pulling on the inserter. The inserter is removed along with the guide. The ends of the flat support suture are attached to the anchor and remain in place after the inserter is removed. These will eventually serve as the sling at the end of the thumb. A second metal wire is inserted at the base of the thumb metacarpal. An x-ray confirms placement. A hollow drill bit makes a tunnel for the second anchor. The second anchor is a hard-bodied anchor. This anchor secures the flat support suture ends to provide the sling underneath the thumb metacarpal for proper movement and function of the thumb. The surgery is now complete.