Early vs Late Mobilization After Simple Excision of the Trapezium

Author(s): Horlock N, Belcher HGCR

Source: J Bone Joint Surg 84B: 1111-1115, 2002

Summary:

The controversy between simple trapezium excision and ligament reconstruction continues.  Thirty-nine patients (40 hands) were enrolled into this study that randomized patients into either early mobilization or delayed mobilization after simple trapezium excision.  The operative technique consisted of a dorsal approach to the trapezium with simple excision and capsular closure.  The "early mobilization group" was placed in a cast with the wrist in slight extension and the thumb in abduction and extension for one week.  Subsequently, a removable splint was used allowing light use of the hand and active exercises.  The splint was worn for heavy activities until 6 weeks after surgery when it was discontinued.  The "late mobilization group" was immobilized for a total of 4 weeks, followed by a similar regimen.  The splint was also abandoned at 6 weeks after surgery.

Patients were reassessed at a median of 6 months after surgery using multiple parameters.  Outcome measurements included range of motion, grip and pinch strength, along with stress radiographs.  Comparison of the groups showed no significant differences, except that the early mobilization group found rehabilitation to be "more convenient."  Both therapy programs lead to significant improvement in range of motion, grip and pinch strength, and overall satisfaction.  The procedure did result in significant shortening of the thumb, as indicated by the reduction of the scaphometacarpal distance.  This distance decreased approximately 8mm in both groups.

This study lends support to early mobilization following simple trapezium excision.  The authors indicate that this technique and rehabilitation is not indicated in the patient with significant instability and laxity.  Alternatives such as arthroplasty with ligament reconstruction, or fusion, should be considered in this setting.  Although the authors provide ?rationale? for early immobilization after trapezium excision, the length of follow-up is short and the effect of diminished scaphometacarpal distance after trapezium requires a further study.

 


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J Bone Joint Surg