Pollicization of the Index Finger

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

1608 DIETER BUCK-GRAMCKO FIG. 4 Photographs showing a long (left) and a short thumb (right) after pollicization of the index finger. Operative Technique For the pollicization operation there are four basic principles of equal importance, relating to the following: (a) the neurovascular pedicle; (b) the skeletal readjustment with preservation of the metacarpophalangeal joint; (c) the muscular stabilization; (d) the skin incision. The first, the technique of fashioning the neurovascular pedicle, is now well known. The freeing-up of the neurovascular bundle between the index and the long finger is obtained by ligating the artery to the radial side of the long finger. The common digital nerve is then carefully separated into its component parts for the two adjacent fingers. This ensures that no tension will be present after the index finger is rotated. Sometimes an anomalous neural ring is fot]nd around the artery 5. This ring Fro. 5 Roentgenogram of a hyperextension deformity with dorsal subluxation of-the former metacarpophalangeal joint. (Fig. 4). The metacarpal head is fixed is split very carefully so that angulation of the artery after transposition of the finger will not occur. The radial digital artery to the index finger is occasionally absent. In such cases it is possible to perform the tion on a vascular pedicle of only one On the dorsal side at least one of the great veins must be preserved. ~. For skeletal fixation after bone readjustment, the length of the index finger is of considerable importance. If the phalanges are relatively short, the base of the metacarpal must be retained in order to obtain the right length of the new thumb. The metacarpal head is fixed to its base by means of one or two Kirschner wires. If the phalanges are normal length, the whole metacarpal is resected with the exception of its head. A short thumb is desirable , as it is functionally and esthetically better than a long one, which bears too close a resemblance to a finger by sutures to the joint capsule and the carpal THE JOURNAL OF BONE AND JOINT SURGERY Diagram of reduc the metacarpal head be,~es, which in ,. not essential. Fit: good function. The physiol~ especially in the my earlier cases / deformity is now so that its palma phalanx is broug head. The norma Sl~0n is possible. creased the stabil observed. For muscle trinsic mechanis~ intrinsic muscles for the mobility, than mobility fo~ necessary to sho~ months to the sh: degree. One of t:. is severed at thc metacarpal resec first metacarpal) proprius tendon The ~ intero. of the thumb, q lateral bands of partially strippc necessity. VOL. 53-A, NO. 8, D1
:ation of the ind, es of equal (b) the skeletal c) the muscular, :.le, is now well iex and the long( inger. The comz arts for the two e index finger tery 5. This rin mgulatic ¯ the finger wil artery to the in’ ~bsent. In such ,’n the only one ,ne of the ljus finger is of phalanges the metacarpal obtain the ri 7he ~eans of one halanges are ~tacarpal is re- )f its he~id. :is functionally ong one, which Ice to a : and the carpal) POLLICIZATION OF THE INDEX FINGER 1609 Fta. 6 Diagram of reduction, rotation, and angulation of the index finger: in the circle the turning of the metacarpal head for prevention of the hyperextension deformity is shown. bones, which in young children can be pierced with a sharp needle. Bone union is not essential. Fibrous fixation of the head to its new surroundings is sufficient for good function. The physiologically wide range of movement of the metacarpophalangeal joint, ~ecially in the child, was the reason that hyperextension deformity developed in my earlier cases (Fig. 5). It was more disturbing esthetically than functionally. This deformity is now prevented by turning the metacarpal head about 70 to 80 degrees so that its palmar side becomes proximal (Fig. 6)."In other words, the proximal ~halanx is brought into a position of hyperextension in relation to the metacarpal head. The normal joint looseness is markedly reduced and hardly any further extenis possible. This procedure, combined with the new muscle attachments has inicreased the stability of the thumb. No further tendency to hyperexten~ion has been :i bbserved. For muscle stabilization, the adjustment of the extensor tendons and the inmechanism is one of the most important steps of the operation (Fig. 7). The muscles and the long extensor and flexor tendons are responsible not only for the mobility, but also for the stability of the digit. Stability is more important than mobility for good function of the thumb. Experience has shown that it is not to shorten the flexor tendons. They adapt themselves in the course of a few months to the shortening of the ray and will then flex the new thumb to the required ’ee. One of the two extensor tendons, that of the extensor digitorum communis, is severed at the metacarpophalangeal level; its proximal end is sutured, after the metacarpal resection, to the base of the former proximal phalanx (now acting as first metacarpal), to become the new abductor pollicis longus. The extensor indicis proprius tendon is shortened and then resutured by end-to-end anastomosis. The interosseus muscles of the inde, x finger are also important for stabilization of the thumb. They should first be detached from the proximal phalanx and the lateral bands of the dorsal apone-urosis. Their origins from the metacarpal bone are partially stripped subperiosteally. Careful preservation of nerves and vessels is a necessity. VOL. 53-A, NO. 8, DECEMBER 1971
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Pollicization of the Index Finger

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