Pollicization of the Index Finger

More documents

Recommendations

Info

$fracture dislocations of the proximal ... - Northwestern University$

1616 DIETER BUCK-GRAMCKO Su mmary - The experiences with 100 operations of pollicization of the index finger in congenital deformities of the thumb in seventy-three patients are reported on. The operation is indicated in aplasia and in hypoplasia if there is no stable metacarpopha_ langeal joint and there are adduction contracture and poor mobility due to abnormal_ ities of aluscles and tendons. The operative technique was improved by the experiences in twelve years of use. Most important are the bone fixation and the muscle stabilization. In transformation of an index finger into a thumb it is necessary to shorten the ray, to rotate it sufficiently, and to give it the right angle of abduction. The shortening takes place in the metacarpal bone with preservation of its head: the metacarpophalangeal joint becomes now the carpometacarpal joint and the metacarpal head the new trapezium. For preventing a hyperextension deformity it is necessary to rotate the metacarpal head For good muscle stabilization and good mobility the two interossei of the index finger have to be detached and to be fixed in the shortened position on both sides of the new thumb to the mobilized lateral slips of the dorsal aponeurosis. This new manner of muscle fixation gives a very good thenar eminence not only in respect to appearance but also in function with full or nearly full opposition and abduction. It requires a new skin incision with a dorsoradial skin flap for covering the gap between the wound edges of the former proximal phalanx broadened by the muscle masses. The excellent results show a surprising .... adaptation of bones and soft tissues due to function and growth--a reason for an earl), performance of the operation. :. References 1. BROOKS, DONAL: In Rehabilitation of the Hand. Ed. 2, pp. 336-348. Edited by C. B. Wynn Parry. London, Butterworths, 1966. 2. BUCK-GRAMCKO, DIETER: Operative Behandlung einer Spiegelbild-Deformit~t der Hand. Ann. Chir. Plast., 9; 180-183, 1964. 3. BUcK-GRAMCKO, DIETER: Daumenrekonstruktion bei Aplasie und Hypoplasie. Kiln. Med., 21; 325-329, 1966. 4. BUCK-GRAMCKO, DIETER: Indikation und Technik der Daumenbildung bei Aplasie und Hypoplasie. Chit. Plast. Reconstr., 5:46-51. 1968. 5. EDGERTON, M. T.: SNYDER, G. B.; and WEB~, W. L.: Surgical Treatment of Congenital Thumb Deformities (Including Psychological Impact of Correction). J. Bone and Joint Surg., 47-A-" 1453-1474, Dec. 1965. 6. GOSSET, J.: La poIIicisation de l’index (Technique chirurgicale). J. Chir., 65:403-411, 1949. 7. HARRISON, S. H.: Restoration of Muscle Balance in Pollicization. Plast. Reconstr. Surg., 34; 236-240, 1964. 8. HARRISOr~, S. H.: Pollicisation in Cases of Radial Club Hand. British J. Plast. Surg., 23~ 192-200, 1970. 9. HILGENFELDT, OTTO: Operativer Daumenersatz und Beseitigung v0n Greifst6rungen bei Fingerverlusten. Stuttgart, Ferdinand Enke Verlag, 1950. 10. LITTER, J. W.: The Neurovascular Pedicle Method of Digital Transposition for Reconstruction of the Thumb. Plast. Reconstr. Surg., 12:303-319, 1953. 11. LITTLER, J. W.: Digital Transposition. In Current Practice in Orthopaedic Surgery, Vol. 3, pp. 157-172. St. Louis, The C. V. Mosby Co., 1966. 12. RIORDhN, D. C.: Congenital Absence of the Radius. J. Bone and Joint Surg., 37-A: 1140, Dec. 1955. 13. WroTE, W. F.: Pollicisation for the Missing Thumb, Traumatic or Congenital. The Hand, 1: 23-26, 1969. 14. WHITE, W. F.: Fundamental Priorities in Pollicization. J. Bone and Joint Surg., 52-B: 438- 443, Aug. 1970. DISCUSSION .DR. J. W. LITTLER, NEW YORK, N. Y.: Through a tragic pharmacological mishap Buck-Gramcko has gathered this unprecedented series (100 cases) of thumb aplasia. His paper a splendid one and therefore a pleasure to discuss: its clarity is refreshing, the surgical approach is exact, and the functional reward for these little patients is superior. His outstanding contribution gives great authority to this particular procedure. Several points, however, deserve emphasis. First: the surgical timing. For many years I have resisted transposing the radial digit into thumb position during infancy, believing that the THE JOURNAL OF BONE AND JOINT SURGERY
function with full or cision with a dorso- the former proximal :s show a surprising th--a reason for an Edited by C. B. Wynn Deformit/it der Hand. ypoplasie. Klin. Med., POLLICIZATION OF THE INDEX FINGER ically unmolested child, possibly with another anomaly, would better tolerate the operation i later. Never, however, have I hesitated to encourage the removal, relatively early, of any rudie index finger in con- :eported on. The o ;table metacarpopha_ ~. i:;!~:!~;.i rnentary, functionally and hopelessly blighted first pre-axial digit. It is acknowledged that the thumbless child will endeavor to force his independent index finger as an opponent of the other digits. What we attempt with our surgery is to complete that !!~:!l(i ~ endeavor. Both Dr. Buck-Gramcko and Dr. Riordan now firmly believe that the digital transpotity due to abnormal, sition should be done during infancy. This may or may not be true for the best result. It is my ,roved by the experi_, !i!i~, opinion that a non-existing thumb has no special cortical representation; any oppositional functtiorl and the muscle tion resides in the next most independent digit, regardless of the time of any transposition. nb it is necessary to Heretofore, I have awaited the age of from two to four, but perhaps my approach is too cau- ¯ angle of abductiot tious, despite parental pressure. Certain technical aspects are most important and of these the incision is of primary con- :rvation of its head: cern, for finally the closure must have allowed the digit to be shifted into proper position, pro- 11 joint and the meta- viding an adequate cleft and a sufficient proximal phalangeal skin envelope to house the bulk of ~sion~deformity it is the intrinsic muscles advanced to encompass the recessed proximal phalanx (now acting as the ~bilization and ed and to be fixSd in metacarpal). Though it is not carefully documented in this paper, the head of the epipyseal-arrested metacarpal fails to develop, but as shown in some of the illustrations, the hypertrophic proximal .obilized lateral slips phalanx has taken on the characteristics of a thumb metacarpal. It also shows good projection n gives a very good (despite an incomplete carpal arch) and has a firm fibrous base to meet the oppositional de- :tung bei Aplasie und ,atme~it of Congenital ~). J. Bone and Joint :.. 6~: 403-411, 1949. :21 ?~ st. Reconstr. Surg., 34: ;sh J. Plast. Surg., 23: m Greifst6rungen bei nsposition for ~aedic Surgery, Vol. 3, int Surg., 37-A: 7ongenital. The Hand, ;0int Surg., 52-B: ~cological mishap Dr. ,b aplasia. His paper " . the surgical approach ; outstanding contribu- ncy believing that the 1 617 mands. In the words of Sir Charles Bell: "On the length, strength, free lateral motion and perfect mobility of the thumb, depends thepower of the human hand. The thumb is called Pollex because of its strength; and that strength is necessary to the power of the hand, being equal to that of all the fingers." It must be admitted that to bring the thumb-deprived primitive hand into a more advanced state, the pre-axial finger can be substituted through careful surgery and that ~vith time and use, though imperfect, its appearance and function will approach quite nearly that prime digit which faiied to develop. : AND JOINT SURGERY ~ ~i~,~ VOL. 53-A, NO. 8, DECEMBER 1971
Page 1 and 2: ~s recorded a it. that they have ~o
Page 3 and 4: performed mgeal joints was .re rota
Page 5 and 6: :ation of the ind, es of equal (b)
Page 7 and 8: ted lateral of the new .’ned. le
Page 9 and 10: could not cooperate ’. hand opera
Page 11: and crochet-work. xlf years was mos

Pollicization of the Index Finger

Create successful ePaper yourself

Delete template?

Save as template?