Abstract The present study aimed to compare the clinical outcomes of the two surgical strategies for thumb carpometacarpal arthrodesis, conventional open locking plate (LP) arthrodesis and arthroscopy (AS)-assisted arthrodesis, and explore the potential advantages of the AS-assisted technique. A total of 17 and 12 thumbs were included in the LP and AS groups, respectively. A 2.0-mm T-shaped LP was used in the LP group, and three headless compression screws were used in the AS group. First, we compared the bone union rate and the mean time to bone union between the two groups. Subsequently, we compared clinical outcomes, including grip strength, pulp and key pinch strength, range of motion of the thumb, visual analog scale score for pain, Disabilities of Arm, Shoulder, and Hand score, and Hand20 questionnaire score at the following time points: preoperatively; 3, 6, and 12 months postoperatively; and at the final postoperative follow-up. The bone union rates were 88 and 92% in the LP and AS groups, respectively, with no significant differences. Mean times to bone union were 4.5 months and 2.6 months in the LP and AS groups, respectively. Bone union in the AS group occurred significantly earlier than that in the LP group. Comparing the clinical outcomes at each time point between the two groups, the Kapandji score and metacarpophalangeal joint flexion angles were greater in the AS group than in the LP group at 12 months postoperatively and the final postoperative follow-up. Analysis of chronological changes in clinical outcomes showed that the AS group exhibited significantly earlier improvement in the Hand20 score at 6 months postoperatively. In addition, the AS group showed significant improvements in pulp and key pinch strength at 12 months postoperatively and the final postoperative follow-up. AS-assisted minimally invasive headless compression screw arthrodesis with autologous bone grafting demonstrated earlier bone union, earlier improvement in the Hand20 score, significant improvement in pinch strength, and greater thumb motion compared with conventional open LP arthrodesis.
Komura et al. (2026) studied this question.