Thumb metacarpal extension osteotomy for the hyermobile trapeziometacarpal joint

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Purpose of review

The aim of this article is to review the biomechanical basis and rationale for treatment of the hypermobile thumb carpometacarpal joint with extension osteotomy.

Recent findings

Normal ligamentous anatomy and the consequences of attenuation are well documented in the literature reviewed. Biomechanical investigations of the effects of extension osteotomy show that the procedure alters forces, shifts load away from the volar compartment, and further engages the dorsoradial ligament.


Thumb metacarpal extension osteotomy provides effective treatment for the hypermobile trapeziometacarpal joint consistent with Eaton stage 1 disease. This procedure is a useful alternative to Eaton ligament reconstruction. Clinical outcomes are favorable, and should symptoms persist, the procedure does not jeopardize satisfactory execution of trapezium excision with ligament reconstruction in the future.

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