Metacarpal Lengthening After Traumatic Amputation of the Thumb

Abstract

In nine patients of median age 34 years who had sustained an amputation of the thumb at a median 24 (5 to 131) months previously, we lengthened the first metacarpal by 30 (17 to 36) mm. Seven amputations had been through the proximal phalanx and two through the metacarpal. The first two patients had autogenous grafting at a second stage, but the other seven had callotasis alone. In these patients the external fixators were removed at a median 189 (115 to 271) days after osteotomy. In six cases the adductor pollicis tendon was transferred proximally and the first web deepened. There was late fracture or palmar flexion of the callus in five patients, but this required further surgery in only one. Treatment was complete at 326 (140 to 489) days after osteotomy. The extended thumb retained its sensitivity; both grasp and key-pinch strength were satisfactory and only one patient felt that the result did not warrant the long course of treatment. Metacarpal lengthening by this method is a prolonged procedure, but provides a valuable alternative to more complex reconstructions.

Factors That Affect the Healing Index of Metacarpal Lengthening: A Retrospective Study

“…7,15 Similarly, bone graft is recommended in patients who need lengthening of more than 20 mm. 9,15 We achieved a mean lengthening of 16.5 mm without the use of bone graft. Lengthening of more than 20 mm may require greater HI and CT (Table 2); the associated risk of fracture at the lengthened callus is also higher.…”

“…Lengthening of more than 20 mm may require greater HI and CT (Table 2); the associated risk of fracture at the lengthened callus is also higher. 9,15 Limited corticotomy has been advocated when there is a compromised endosteal blood supply, but endosteal blood supply and bone marrow have no effect on consolidation and healing. 4 The proximal metaphysis is the site with the best blood supply, and this reduces the time needed for healing and consolidation.…”

Correction of a Deformed Thumb by Distraction of the Phalanx

“…It has also been used on the small tubular bones of the hands and ngers (1,8,14,15). For these small bones, an external xator is used as the distraction device.…”

First metacarpal lengthening following traumatic amputation of the thumb: long-term follow-up

“…Finsen and Russwurm [10] also mention volar flexion in 55% of their metacarpal elongations. If the fixator does not provide enough stability to avoid this complication, Foucher [6] recommends a longitudinal wire during the whole process.…”