Thumb Arthritis: Metal-Button CMC Suspensionplasty Animation

Thumb Arthritis: Metal-Button CMC Suspensionplasty Animation

This animated video demonstration will show a surgical treatment for carpometacarpal joint thumb arthritis. The repair will utilize suture and 2 metal suture buttons, suspended between 2 bones for support.

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 right hand. Two incisions will be made: 1 overlying the trapezium bone at the inner base of the thumb near the wrist, and 1 on the top of the hand towards the outside of the base of the metacarpal bone of the index finger. This bone is called the second metacarpal.

An instrument called a rongeur will be used to remove the trapezium bone. A temporary wire will be passed at the base of the thumb and all the way through the second metacarpal. This wire will form a tunnel for the passage of the suture. The drill is removed, moved to the wire's other end, and pulled through.

The base of the wire has a tapered end with a metal loop at the end. Two strands of strong blue suture are passed through this loop. The remaining wire, with the attached suture, is pulled through the tunnel. The end of this suture is fixed with a steel metal button that will rest across the inner base of the thumb’s metacarpal.

The other end of the suture will be cut, and another button will be threaded into the 2 blue suture strands. This button will sit firmly against the outer side of the second metacarpal. Once the button is flush with the bone, the suture will be cut and secured with a knot. The maintained and now supported motion of the thumb is shown. The incisions will be closed, and the surgery is now complete.