Arthrodesis of the Thumb Metacarpophalangeal Joint: Tension Band Wiring Versus Intramedullary Screw Fixation.

PURPOSE: Tension band wiring (TBW) and intramedullary (IM) screw fixation represent two well-established methods for thumb metacarpophalangeal (MP) joint arthrodesis. Studies comparing these methods have included small sample sizes and reported inconsistent findings. The objective of this study was to provide a descriptive comparison of the 1-year union, clinical success, and complication rates for both methods.

METHODS: This retrospective review examined all cases of TBW and IM screw thumb MP arthrodesis at a single institution between January 2012 and August 2024. Exclusion criteria included fusion of nonthumb MP joints, <90 days of follow-up, revision fusions, and incomplete medical records. Data collection occurred via chart review. The 1-year union, clinical success, and complication rates were reported for TBW and IM screw groups.

RESULTS: One hundred twenty-one patients were fused with TBW and 31 with IM screw. Of those with radiographs at final follow-up, union was observed in 80/89 (90%) TBW constructs and 20/27 (74%) IM screws. Clinical success was noted in 112/121 (93%) TBW cases and 24/31 (77%) IM screw cases. Re-arthrodesis was required in 3/121 (2%) TBW cases and 5/31 (16%) IM screw cases. Removal of hardware (ROH) was noted in 27/121 (22%) TBW cases and 2/31 (6%) IM screw cases. Overall complication rates were 48/121 (40%) with TBW and 10/31 (32%) with IM screws. Reoperation occurred in 29/121 (24%) TBW constructs and 8/31 (26%) IM screw fixations, with ROH representing 26/29 (90%) TBW reoperations and re-arthrodesis representing 5/8 (63%) IM screw reoperations.

CONCLUSIONS: In this retrospective descriptive study without inferential statistics, union occurred in 90% and 74% of TBW and IM screw arthrodesis cases, respectively. Reoperation was required in 24% of TBW cases and 26% of IM screw fixations. ROH represented the majority of TBW reoperations, whereas re-arthrodesis represented the majority of IM screw reoperations.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.