Article
Single-stage radialization and pollicization for radial longitudinal deficiency with thumb hypoplasia
Search Medline for
Authors
-
Pobe Luangjarmekorn
- Department of Orthopaedics, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
-
Pravit Kitidumrongsook
- Department of Orthopaedics, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| Published: | February 6, 2020 |
|---|
Outline
Text
Objectives/Interrogation: For children who had radial longitudinal deficiency with thumb hypoplasia, problems of unable to afford cost of multiple follow-up, transportation, and multiple operations, lack of distraction device or small-size external fixator and poor patient's compliance for taking care these devices made us develop surgical procedure that combine multi-stage reconstruction into single-stage radialization and pollicization. The advantages of this technique was to reduce number of surgical operations and anesthesia, shortening time for wound recovery, reduced frequency of follow-up, and decrease cost of transportation for patients.
Methods: Surgical technique for single-stage radialization and pollicization was explained steps-by-steps. Medical record in 2 patients who treated by this technique were reviewed.
Results and Conclusions: Two children with radial longitudinal deficiency and unreconstructable thumb hypoplasia were operated by single-stage radialization and pollicization without postoperative complication. At 1-year follow-up, wrist positions were improve from 95° to neutral and 90° to 15° radial-angulation. Both pollicized thumbs stayed in proper opposition and started function. Special considerations for this technique were
- 1.
- Dorsal vertical midline incision was used for radialization because benefit in proximal extension for ulnar osteotomy and less interfered with pollicization incision,
- 2.
- Ulnar shortening osteotomy should be done in case of difficulty in reposition carpus over distal ulnar, overlapping bone, or wrist flexion deformity after complete soft tissue released,
- 3.
- Recommended K-wire technique including pre-drill and retrograde insertion should be followed for easy osteotomy fixation,
- 4.
- Exit point of K-wire at the palmar site of base index metacarpal bone was less interfered with pollicization procedure, and
- 5.
- Preserved dorso-radial skin bridge between pollicization incision and radialization incision for adequate venous draining and prevent postoperative swelling.
In conclusion, single-stage radialization and pollicization can be done in severe radial longitudinal deficiency (Bayne and Klug type III and IV) with unreconstructable hypoplastic or absent thumb (Blauth and Schneider-Sickert type IIIB,IV,V) to reduce number of surgical operation and risk of multiple anesthesia.
