Artikel
Reconstruction of Severely Hypoplastic Thumb by Non-vascularized Metatarsal Graft with Abductor Digiti Minimi Opponensplasty
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Autoren
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Takehiko Takagi
- Department of Orthopaedic Surgery, National Center for Child Health and Development, Tokyo, Japan
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Ruriko Iigaya
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Atsuhito Seki
- Department of Orthopaedic Surgery, National Center for Child Health and Development, Tokyo, Japan
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Shinichiro Takayama
- Department of Orthopaedic Surgery, National Center for Child Health and Development, Tokyo, Japan
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: Pollicization of index finger has been usually recommended for Blauth IIIb and IV hypoplastic thumb. Although functional result of the pollicization is satisfied, majority of the family desires to keep the number of the digits. We developed two-stage reconstruction procedure, distal two-thirds of the fourth metatarsal bone graft (non-vascularized) with widening of the first web followed by abductor digiti minimi (ADM) opponensplasty.
Methods: From 1980-2018, 76 patients (41 boys and 35 girls) were reconstructed. In the first stage, the distal two-thirds of the fourth metatarsal is transplanted in the reverse manner to form the first carpometacarpal joint without microvascular anastomosis. Widening of the first web is performed using a dorsal sliding flap. More than six months later, ADM opponensplasty is carried out. Extensor index proprius (EIP) and flexor superficialis of ring finger (FDS-R) transfer was respectively added in the second stage. 41 patients were classified to III b and 35 were IV. Average ages at the surgery was 3.2 years old. In type IV, metatarsal bone graft was indicated under the condition that the thumb is larger than small finger. Fourth metatarsal head was used in 64 cases and fourth metatarsophalangeal joint including proximal phalanx was used in 12 cases. Follow-up periods were from 5.2 months to 277 months, average 77.2 months.
Results and Conclusions: Except one case, bony union between grafted metatarsal and distal part of first metacarpal was acquired without significant bony absorption. Fracture of the grafted bone was seen in two cases and additional bone grafts were performed. In the majority of the cases, epiphysis of the grafted bone was remained open more than five years and the functional results are acceptable with high degree of family's satisfaction. Carpometacarpal joint mobility and metacarpophalangeal joint stability were important for good functional results. Metatarsal bone graft with epiphysial plate could be an alternative procedure to pollicization of index finger.
