Modified metacarpal shortening osteotomy of the midcarpal bone for preserving metacarpophalangeal joints in patients with rheumatoid arthritis

Abstract

Recent advances in medication choices have strikingly improved the management of rheumatoid arthritis. However, medication alone cannot place back already deformed joints. Thus, to prevent metacarpophalangeal (MP) joint destruction, joint deformity correction should be considered since mechanical stress induced by finger motions will eventually destruct the undestructed joint, with a possibility of recurrence and future implant arthroplasty in mind since RA still remains as a progressive disease. We report a modified metacarpal shortening osteotomy for correcting MP joint deformity. The advantage of our technique over previous osteotomies is that it easily allows for subsequent implant arthroplasty even after the recurrence of joint deformity/destruction. Major modifications include that the metacarpal is shortened at its mid-shaft and the osteotomy is performed vertical to the shaft and fixed with surgical wiring. We believe that combination therapy consisting of medication and surgery is preferable to prevent joint destruction, even in this age of biological agents.

Keywords:

• Metacarpophalangeal joints
• Midcarpal
• Osteotomy
• Rheumatoid arthritis
• Shaft
• Shortening osteotomy

Acknowledgements

We would like to thank to all the members in the Institute of Rheumatology, Tokyo Women’s Medical University and the Department of Orthopaedic Surgery, Keio University School of Medicine.

Conflict of interest

This work was supported in part by the Japan Orthopaedics and Traumatology Foundation, Inc. No. 277 to KO, and by grants-in-aid for scientific research from the Japan Society for the Promotion of Science to KO.