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Learn the Trapeziectomy and Abductor pollicis longus suspensionplasty surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Trapeziectomy and Abductor pollicis longus suspensionplasty surgical procedure.

Thumb-base arthritis, effecting one or both of the trapeziometacarpal (TMC and scapho-trapezio-trapezoid (STT) joints are very common degenerative conditions, and will trouble in the order of 1:3 people at some point. They can also arise as part of a more systemic inflammatory arthritis, or secondary to trauma to the thumb metacarpal base (such as a Bennett’s or a Rolando fracture) or damage to the intrinsic ligaments of the thumb base (the palmar oblique or beak ligament). Most patients will not need surgical treatment, but excision of the trapezium (trapeziectomy) is the gold-standard surgical treatment.

Following simple trapeziectomy, the thumb will usually shorten by a few millimetres and the absolute power of pinch grip will be reduced; for this reason, some surgeons try to combine trapeziectomy with steps to maintain thumb base stability and ray length; this includes steps to reconstruct the palmar oblique ligament and/or suspend the thumb base using strips of tendon passed across the resection left after removal of the trapezium gap to maintain thumb base position. While the long-term advantage of these additional steps is controversial, many surgeons will undertake thumb base stabilisation after trapeziectomy, particularly in younger, higher-demand patients.

There are already excellent published surgical techniques on the Orthoracle site for simple trapeziectomy ( Trapeziectomy ), trapeziectomy with capsular flap interposition ( Trapeziectomy with capsuloperiosteal flap interposition arthroplasty ) and trapeziectomy with abductor pollicis longus suspensionplasty ( Trapeziectomy with APL suspensionplasty ); in this series, I aim to add detail and technical tips to enhance the already-published techniques to allow for easy, reproducible execution of this useful procedure.

Author: Chris Little FRCS (Tr & Orth)

Institution: The Nuffield Orthopaedic centre, Oxford, UK.

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