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

• Lesion of the radial artery
• Lesion/Transection of the FCR
• Lesion of the branches of the superficial radial nerve and the medial antebrachial cutaneous nerve
• Incomplete removal of the trapezium
• Fracturing of the bone during drilling

Management 

• Primary microsurgical nerve or artery suture 
• Careful exposure of the bone and its osteophytes. Control of resection by palpation of the surgical area, possibly fluoroscopic control
• If possible, reconstruction of the FCR tendon and change of procedure (trapeziectomy alone, possibly with fixation of the 1st metacarpal bone using K-wires to the 2nd and 3rd metacarpal bones)
• In case of fracturing, change of procedure with suspension through partial transfer of the APL (abductor pollicis longus tendon)

Acute Complications

• Bleeding/Hematoma
• Infection/Wound healing disorder

Management

• In case of significant hematoma, surgical revision
• In case of infection, immediate surgical revision
• In case of wound healing disorder, surgical revision depending on the severity of the condition

Late Complications

• Loss of suspension of the base of the first metacarpal
• Protracted scar pain/neuroma pain
• Restriction of movement
• CRPS (Sudeck's disease)

Management

• In case of loss of suspension and corresponding symptoms, consider suspension with wire suture (e.g., Tightrope®)
• In case of scar pain/neuroma pain/neuropathic pain, adopt a wait-and-see approach, possibly desensitization therapy
• In case of neurodesis pain with adhesions, neurolysis, microsurgical reconstruction, and neuroma resection; as a last resort: high resection of the superficial branch of the radial nerve at the level of the proximal forearm
• In case of CRPS, appropriate treatment of the condition (see specialized literature)