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Anatomy - Resection-suspension arthroplasty according to Epping for thumb carpometacarpal osteoarthritis

  1. Principle of resection-suspension arthroplasty

    Thumb carpometacarpal joint osteoarthritis is often associated with subluxation of the metacarpal bone and simultaneous insufficiency of the stabilizing ligament apparatus at the carpometacarpal joint. In connection with rhizarthrosis, there are numerous procedures to restore pain-free mobility of the thumb. However, the "gold standard" is trapezium removal with ligament reconstruction through tendon interposition (LRTI = Ligament Reconstruction with Tendon Interposition).

    In the group of LRTI, the Epping procedure is probably the most commonly used method in the German-speaking area. The trapezium is completely removed (resection).

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    To prevent dislocation of the base of the first metacarpal bone towards the palmar and radial sides, the bone is held in line using a distally pedicled strip from the FCR tendon (= Flexor carpi radialis tendon) (suspension).

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    The rest of the tendon graft is inserted as a spacer into the cavity of the former trapezium (interposition).

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    This procedure, in turn, has countless variations concerning the suspension of the bone and the interposition of tendon material.

    The procedure presented in this video is therefore a method preferred by the author.