Carpometacarpal Arthrodesis for Traumatic Carpal Boss Among Combative Athletes

Among professional combat athletes, excessive and repetitive trauma to the carpometacarpal (CMC) joints may cause instability, arthritis, and the development of traumatic carpal boss. If nonoperative management is unsuccessful, CMC joint arthrodesis with iliac crest bone graft and supplemental Kirschner wire fixation is a reliable surgical option that results in pain-free return to full competition. From 2002 to 2015, 15 professional athletes with 17 symptomatic carpal bosses were treated with CMC joint arthrodesis after unsuccessful nonoperative management. The operative technique included decortication of the articular surface of the CMC joints, insertion of iliac cancellous and corticocancellous slot grafts, and secure Kirschner wire fixation. Patient charts and postoperative imaging were retrospectively reviewed. Outcome measures included grip strength, pain relief, fusion rate, return to competition, and complications. Mean age at the time of surgery was 28.2 years (range, 21-39 years). The radiographic fusion rate was 100% and occurred at a mean of 7.5 weeks. Mean return to competition occurred at 6 months. Grip strength at final follow-up increased 32% from preoperative level and was 90% of the grip strength of the contralateral hand. Postoperatively, 2 patients had sagittal band ruptures, and 1 patient had a fifth metacarpal fracture. No revision procedures were performed. All patients undergoing CMC arthrodesis had successful fusion, without the need for revision surgery and with return to full competition. For professional fighters, CMC arthrodesis with iliac crest autograft is a safe and effective surgical method for treating symptomatic traumatic carpal boss.