Resection-Suspension Arthroplasty according to Epping for Rhizarthrosis

Anatomical orientation by palpation and marking of anatomical landmarks:

• 1. ECF = Extensor tendon compartment
• 1. CMC joint (thumb saddle joint) = Carpometacarpal joint
• STT joint = Scaphotrapeziotrapezoidal joint

Longitudinal skin incision dorsally over the saddle joint with arc-shaped extension proximally over the 1st ECF. Sharp transection of the subcutis under bipolar coagulation of individual veins.

Successive exposure of the trapezium bone with the adjacent joints (1st CMC joint, ST joint). The radial artery crossing over the trapezium bone is dissected free and provided with a rubber sling, so that it can be safely spared during the operation.

(CMC joint = Carpometacarpal joint, 1st CMC = Thumb saddle joint; ST joint = Scaphotrapezoidal joint)

Caution

• Cutaneous branches of the R. dorsalis N. radialis or N. cutaneus antebrachii medialis
• A. radialis

First, the joint capsule of the saddle joint is opened longitudinally, the trapezium is detached all around from its surroundings. Exposure of the STT joint. The trapezium bone is osteotomized longitudinally with a Lambotte chisel and detached from the remaining joint capsule. Removal of the bone fragments with Luer forceps. Particular attention should be paid to the removal of osteophytes, which are typically located between the base of the 1st and 2nd metacarpal.

Careful inspection of the joint surfaces (metacarpal base and scaphoid) as well as the STT joint. In case of pronounced arthrosis, consider partial resection of the trapezoid if necessary.

Caution

• FCR tendon (Flexor carpi radialis tendon)! The osteotomy of the trapezium bone using a chisel is performed in the direction of the FCR tendon, approximately 45° from proximal-radial to distal-ulnar. In this way, the chisel cannot transversely cut the palmarly located FCR tendon.

• Osteophytes at the base of metacarpal 1 and 2 and the hemihamulus of the trapezium can be very persistent.