Eight most commonly performed surgical procedures are volar ligament
reconstruction, metacarpal osteotomy, CMC arthrodesis, joint replacement, trapeziectomy, trapeziectomy with tendon interposition, trapeziectomy with ligament reconstruction, and trapeziectomy with ligament reconstruction and tendon interposition.
One of the four articles on hand and elbow conditions focuses on the operative treatment of advanced basal joint arthritis, with detailed information and illustrations on the techniques of volar ligament
reconstruction and ligament reconstruction with tendon interposition (LRTI) arthroplasty.
Procedures for stage I disease include volar ligament reconstruction, thumb CMC arthroscopy, and metacarpal extension osteotomy.
Initially described by Eaton and Littler, in 1973, volar ligament reconstruction with a strip of autogenous flexor carpi radialis (FCR) tendon remains the procedure of choice by which the basal joint can be most effectively stabilized in stage I disease.
33) Combining the volar ligament reconstruction of Eaton and Littler with Froimson's space-filling concept, the LRTI arthroplasty was described by Burton and Pellegrini in 1986.
The volar approach is similar to that described for the volar ligament reconstruction technique.
For Eaton stage I disease, the most common surgical treatment performed is the volar ligament reconstruction described by Eaton and Littler.
In 2000, Freedman and coworkers reported the long-term result of volar ligament reconstruction.
Chronic pain may also occur if a volar ligament reconstruction for more advanced disease or a hemi-trapeziectomy for stage IV disease is performed.
In stage IV injuries, strong volar ligaments remain attached to the lunate.
If an attempt is made to reduce a volar lunate dislocation (stage IV), the wrist should be flexed first to relax volar ligaments, and the lunate should be manipulated back into its fossa.
11 Inoue and Kuwahata have also argued for approaching only dorsally, as it is extremely difficult to repair volar ligaments directly.