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Osteotomy for Thumb Metacarpal Lengthening

  • Alan E. Freeland
  • Michael E. Jabaley
  • James L. Hughes

Abstract

Reconstruction of acquired traumatic amputations at the level of the middle third of the thumb may be accomplished by pollicization of an injured or partially amputated digit, the cocked-hat flap, metacarpal lengthening, or osteoplastic reconstruction techniques that involve a bone graft covered by a tubed pedicle flap and an island pedicle flap. Particularly in the absence of another injured or partially amputated digit, metacarpal lengthening followed by a second-stage bone grafting procedure and deepening of the web space with phalangization of the remaining thumb at the same time provides an excellent method of managing this devastating injury (Figs. 57-1 A Figs. 57-1 B Figs. 571-1 C Figs. 571-1 D-N). The purpose of this operation is to restore length and mobility to oppose other digits. In addition, the reconstructed thumb should have adequate sensation, stability to allow strong resistance without collapse, and freedom from pain.

Fig. 57-1 A

The middle third of the thumb is defined as that area between the supracondylar area of the metacarpal and the supracondylar area of the proximal phalanx. When first seen, the wound had healed at this level, but there was tenderness over the tip of the amputation stump. The patient had good volar sensation, and he was started on a desensitization program that was continued until his tenderness resolved.

Fig. 57-1 B

The middle third of the thumb is defined as that area between the supracondylar area of the metacarpal and the supracondylar area of the proximal phalanx. When first seen, the wound had healed at this level, but there was tenderness over the tip of the amputation stump. The patient had good volar sensation, and he was started on a desensitization program that was continued until his tenderness resolved.

Fig. 57-1 C

A surgical osteotomy was performed, and a miniHoffman external fixator was applied using threated transfixing pins in the distraction mode.

Keywords

Bone Graft Pedicle Flap Iliac Bone Graft Traumatic Amputation Amputation Stump 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag New York Inc. 1986

Authors and Affiliations

  • Alan E. Freeland
    • 1
    • 2
  • Michael E. Jabaley
    • 3
    • 4
  • James L. Hughes
    • 5
    • 6
  1. 1.Section of Hand SurgeryUniversity of Mississippi Medical CenterJacksonUSA
  2. 2.Jackson Veteran’s Administration Hospital, Mississippi Methodist Rehabilitation Center, Blake Clinic for Crippled Children and Mississippi Children’s Rehabilitation CenterJacksonUSA
  3. 3.Division of Plastic SurgeryUniversity of Mississippi Medical CenterJacksonUSA
  4. 4.St. Dominic’s-Jackson Health Services Center, Mississippi Baptist Medical Center, River Oaks Hospital, Mississippi Methodist Rehabilitation CenterJacksonUSA
  5. 5.Division of Orthopaedic SurgeryUniversity of Mississippi Medical CenterJacksonUSA
  6. 6.Jackson Veteran’s Administration Hospital, Mississippi Methodist Rehabilitation Center, Blake Clinic for Crippled Children and Mississippi Children’s Rehabilitation CenterJacksonUSA

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