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TUCSON, ARIZ. — Gelfoam interposition is an effective, tendon-sparing alternative to the anchovy procedure for the treatment of trapeziometacarpal osteoarthritis, Dr. Ronald E. Palmer said at the annual meeting of the American Association for Hand Surgery.
The classic treatment for osteoarthritis of the trapezial metacarpal includes excision of the arthritic trapezium bone, with a ligament reconstruction using a forearm tendon, typically the flexor carpi radialis tendon. The remainder of the tendon is then rolled up like an anchovy filet when packaged in a can for sale and interposed in place of the trapezium, where it serves as a biological cushion and minimizes collapse.
Gelfoam interposition “is an effective procedure that is much easier to do” than the anchovy procedure, said Dr. Palmer of the Orthopedic Institute of Illinois in Peoria.
“It has few of the complications that the other procedures have—certainly no synovitis or osteolysis—and it spares the use of other tendons that may cause problems.” Dr. Palmer began using Gelfoam in 1996 and has now performed interpositions in 139 patients with symptomatic osteoarthritis of the trapezial metacarpal, Eaton classification stages II-IV.
All patients were evaluated with a clinical examination and questionnaire an average of 2 months after the procedure, said Dr. Palmer.
Pain relief was achieved in all cases, and all patients were satisfied with their postoperative results, he said, citing improved function and strength as measured by thumb carpal-metacarpal extension and abduction, thumb opposition, grip strength, pinch tip, palmar pinch, and lateral pinch.
The first web space did not atrophy after the procedure. There were no complications or morbidity.
Dr. Palmer said the anchovy procedure provides excellent pain relief.
But in his experience, there frequently wasn't enough tendon left with the anchovy procedure to adequately fill the space left by the excised trapezium.
TUCSON, ARIZ. — Gelfoam interposition is an effective, tendon-sparing alternative to the anchovy procedure for the treatment of trapeziometacarpal osteoarthritis, Dr. Ronald E. Palmer said at the annual meeting of the American Association for Hand Surgery.
The classic treatment for osteoarthritis of the trapezial metacarpal includes excision of the arthritic trapezium bone, with a ligament reconstruction using a forearm tendon, typically the flexor carpi radialis tendon. The remainder of the tendon is then rolled up like an anchovy filet when packaged in a can for sale and interposed in place of the trapezium, where it serves as a biological cushion and minimizes collapse.
Gelfoam interposition “is an effective procedure that is much easier to do” than the anchovy procedure, said Dr. Palmer of the Orthopedic Institute of Illinois in Peoria.
“It has few of the complications that the other procedures have—certainly no synovitis or osteolysis—and it spares the use of other tendons that may cause problems.” Dr. Palmer began using Gelfoam in 1996 and has now performed interpositions in 139 patients with symptomatic osteoarthritis of the trapezial metacarpal, Eaton classification stages II-IV.
All patients were evaluated with a clinical examination and questionnaire an average of 2 months after the procedure, said Dr. Palmer.
Pain relief was achieved in all cases, and all patients were satisfied with their postoperative results, he said, citing improved function and strength as measured by thumb carpal-metacarpal extension and abduction, thumb opposition, grip strength, pinch tip, palmar pinch, and lateral pinch.
The first web space did not atrophy after the procedure. There were no complications or morbidity.
Dr. Palmer said the anchovy procedure provides excellent pain relief.
But in his experience, there frequently wasn't enough tendon left with the anchovy procedure to adequately fill the space left by the excised trapezium.
TUCSON, ARIZ. — Gelfoam interposition is an effective, tendon-sparing alternative to the anchovy procedure for the treatment of trapeziometacarpal osteoarthritis, Dr. Ronald E. Palmer said at the annual meeting of the American Association for Hand Surgery.
The classic treatment for osteoarthritis of the trapezial metacarpal includes excision of the arthritic trapezium bone, with a ligament reconstruction using a forearm tendon, typically the flexor carpi radialis tendon. The remainder of the tendon is then rolled up like an anchovy filet when packaged in a can for sale and interposed in place of the trapezium, where it serves as a biological cushion and minimizes collapse.
Gelfoam interposition “is an effective procedure that is much easier to do” than the anchovy procedure, said Dr. Palmer of the Orthopedic Institute of Illinois in Peoria.
“It has few of the complications that the other procedures have—certainly no synovitis or osteolysis—and it spares the use of other tendons that may cause problems.” Dr. Palmer began using Gelfoam in 1996 and has now performed interpositions in 139 patients with symptomatic osteoarthritis of the trapezial metacarpal, Eaton classification stages II-IV.
All patients were evaluated with a clinical examination and questionnaire an average of 2 months after the procedure, said Dr. Palmer.
Pain relief was achieved in all cases, and all patients were satisfied with their postoperative results, he said, citing improved function and strength as measured by thumb carpal-metacarpal extension and abduction, thumb opposition, grip strength, pinch tip, palmar pinch, and lateral pinch.
The first web space did not atrophy after the procedure. There were no complications or morbidity.
Dr. Palmer said the anchovy procedure provides excellent pain relief.
But in his experience, there frequently wasn't enough tendon left with the anchovy procedure to adequately fill the space left by the excised trapezium.