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The SWANSON Trapezium Implant is a flexible, one-piece intramedullarystemmed implant developed to help restore function to thumbs disabled by degenerative arthritis or post-traumatic arthritis (e.g., following an old Bennett’s fracture). The SWANSON Trapezium Implant is fabricated from silicone elastomer and is available in 5 sizes. The stem of the implant fits into the intramedullary canal of the first metacarpal and has a triangular cross section to prevent rotation of the stem in the intramedullary canal. The head of the implant has a slightly concave surface to provide better seating on the articular surface of the scaphoid. An autoclavable sizing set, supplied nonsterile, and not suitable for implantation, is available for proper size determination during surgery.
- Degenerative or post-traumatic (e.g. following an old Bennett fracture)
- Disabilities of the thumb basal joint and localized bony changes
- Localized pain and palpable crepitation during circumduction movement with axial compression of involved thumb (“grind test”)
- Decreased motion, pinch, and grip strength » X-ray evidence of arthritic changes of the trapeziometacarpal, trapezioscaphoid, trapeziotrapezoid, and trapezium-second metacarpal joints, singly or in combination. » Associated unstable, stiff, or painful distal joints of thumb or swan neck deformity
Recommendation for Basal Thumb Implant Arthroplasty
1. Implant Selection There are definite separate indications for the use of the SWANSON Trapezium implants. The CSE trapezium implant is preferred for cases of pantrapezial involvement due to degenerative or post traumatic arthritis, providing there is integrity of the contiguous carpal bones and possibility of good seating of the scaphoid facet.
2. Implant Positioning Proper medialization of the trapezium implant is essential. The scaphoid facet should be large enough to accept the base of the implant. A partial trapezoidectomy and resection of exostoses at the base of the first metacarpal are important to assure a stable position of the implant over the contiguous bone.
3. Surgical Technique The importance of a firm capsuloligamentous reconstruction must be stressed. A slip of flexor carpi radialis tendon is used in all cases of trapezium implant arthroplasty. Branches of the superficial radial nerve and the radial artery must be carefully identified, protected and preserved during surgery.
4. Correction of Associated Deformities Associated imbalances of the thumb ray, especially hyperextension of the metacarpophalangeal joint and adduction contracture of the first metacarpal, must be corrected at the same time as the basal joint reconstruction. Palmar capsulodesis or fusion of the metacarpophalangeal joint is indicated where the joint hyperextends to more than 20°. Adduction contracture of the first metacarpal must be released.