gms | German Medical Science

Objectives/Interrogation: Standard practise during pollicization is to detach and re-attach intrinsic musculature from the MCP region into the PIP region. Most surgeons are reluctant to change their technique once they feel safe with their chosen approach. We have adapted our technique from detachment and re-insertion of intrinsic musculature (Kozin, 2012), to leaving dorsal interossei and extrinsic muscles attached as described by Ulrich Mennen (personal communication).

The aim was to demonstrate that the modified technique leads to a decrease in operating time, shorter rehabilitation and good postoperative results.

Methods: In 2017/8, 11 patients with Blauth 3b to 5, including one patient with an underlying Bayne 4 radial hemimelia, underwent surgery according to the Mennen modification. The rest of the technique was as described by Kozin in 2012, except two sutures were used to stabilize the new CMC joint at the base instead of K-wire. All patients were immobilized for 4 weeks in a bulky dressing and then started to move freely.

Results and Conclusions: No intra or postoperative problems were encountered in any of the patients. Despite leaving the intrinsic muscles in place good access to the metacarpal 1 was achieved. Operating time was decreased. Patient used the newly pollicised thumb sooner than with our previous method.

Interfering with the intricate anatomy of the MCP capsule including the insertion of the dorsal interossei appears to be unnecessary.

Short-term results with regards to speed of recovery and early functionality are promising. Long-term results obviously need to be awaited regarding CMC movement.