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PubMed2004

Osteoarthritis in the carpometacarpal joint of the thumb. Prevalence and associations with disability and mortality.

BACKGROUND: This study was designed to investigate the prevalence of osteoarthritis in the carpometacarpal joint of the thumb in adults thirty years of age or older in Finland. METHODS: Between 1978 and 1980, a representative population sample of 8000 Finns thirty years of age or older were invited to have a comprehensive health examination; 90% accepted. Hand radiographs were made of 3595 subjects. Since the examination, the subjects have been followed systematically to assess work disability and mortality by reviewing registers covering the whole population. RESULTS: The age-adjusted prevalence of thumb carpometacarpal osteoarthritis of Kellgren grade 2, 3, or 4 was 7% for men and 15% for women. After adjustment for age, sex, and other alleged risk factors, body mass index was found to be directly proportional to the prevalence of thumb carpometacarpal osteoarthritis in both sexes. The adjusted odds ratio was 1.29 (95% confidence interval, 1.15 to 1.43) per 5-kg/m(2) increment in body mass index. No significant association was found between the physical workload history and thumb carpometacarpal osteoarthritis. Restricted mobility of the thumb and local tenderness and swelling were frequently found in conjunction with radiographic evidence of thumb carpometacarpal osteoarthritis. Advanced (grade-3 or 4) thumb carpometacarpal osteoarthritis predicted the total mortality rate in men (adjusted relative risk, 1.32; 95% confidence interval, 1.03 to 1.69). Radiographic signs of thumb carpometacarpal osteoarthritis did not predict work disability. CONCLUSIONS: and CLINICAL RELEVANCE: Obesity is a strong determinant of thumb carpometacarpal osteoarthritis in both sexes. The effect of thumb carpometacarpal osteoarthritis on disability and mortality in the general population is modest. Because of the rarity of ensuing disability, carpometacarpal osteoarthritis of the thumb is likely to be underdiagnosed in clinical practice.

Adult↗
PubMed2004

The association of radial deficiency with thumb hypoplasia.

BACKGROUND: Congenital longitudinal deficiencies of the radius and thumb are known to be associated with one another; however, the details of their relationship are unknown. The purpose of this study was to determine whether increased severity of radial deficiencies is associated with increased severity of thumb deficiencies and to review the relationship between radial deficiency and reconstructibility of a hypoplastic thumb. METHODS: Radiographs and charts of 227 affected upper extremities of 139 patients with radial longitudinal deficiency were reviewed. The associated thumb deficiency was classified according to a modification of the Blauth and Schneider-Sickert scheme and the radial deficiency was classified according to a modification of the Bayne and Klug criteria for 191 extremities of 119 patients. RESULTS: The severity of the thumb deficiency was directly proportional to the severity of the radial deficiency (p < 0.0001). Half of the extremities had either a thumb deficiency or thumb and carpal deficiencies without radial deficiency. Two-thirds (sixty-three) of the ninety-five limbs with a normal radius had a thumb that could be surgically reconstructed. Seventy-one (91%) of seventy-eight extremities with a thumb amenable to surgical reconstruction had a radius that did not require surgical reconstruction. All extremities with a radial and/or carpal deficiency had a thumb deficiency. Forty-eight (94%) of fifty-one extremities with complete absence of the radius had a thumb that was not reconstructible. CONCLUSIONS: This study supports the growing body of evidence that the components of radial longitudinal deficiency represent a progressive spectrum of upper extremity abnormalities, and a distal progression of severity, with distal structures likely to be more involved than proximal structures.

Abnormalities, Multiple↗
PubMed2004

Clinical indicators of normal thumb length in adults.

PURPOSE: This study was undertaken to obtain clinical indicators of normal relative thumb length in adults. METHODS: Fifty two normal hands in 26 volunteers were analyzed. There were 10 women and 16 men. The average age was 34 years (range, 23-47 years). Eighteen of the volunteers (36 hands) were Chinese and 8 were Caucasian (16 hands). All the subjects were healthy with no history of trauma or disease affecting the hand. The relative distal extent of the tip of the thumb was measured against 2 parameters: the length of the proximal phalanx of the index finger and the distance between the proximal digital crease and proximal interphalangeal crease of the index finger. The obtained values were designated as the thumb-proximal phalanx (TPP) index and the thumb-digital crease (TDC) index, respectively. RESULTS: The TPP index was 0.69 (standard deviation = 0.09) and the TDC index was 0.41 (standard deviation = 0.15). There were no statistically significant differences between the right and left hands nor were there any between male and female hands. It was also noticed that when the thumb was adducted the thenar crease and thumb interphalangeal crease came into contact with one another in 90% of the hands. Consequently, an arc traced along the thenar crease could be extended smoothly into the interphalangeal crease of the thumb. This was termed the thenar arc. Positive or negative variances of the thenar arc correlated statistically with variations of the TPP and TDC indexes. CONCLUSIONS: This study provides 3 simple clinical indicators of normal thumb length: the TPP index, the TDC index, and the thenar arc. Statistical analysis of the TPP and TDC indexes showed that the values are independent of gender, race, or laterality of the hands examined. These 3 indicators may help the clinician determine normal relative thumb length when reconstructing the thumb in adults.

Adult↗
PubMed2006

The effect of the epiphyseal growth plate on the length of the first metacarpal in triphalangeal thumb.

PURPOSE: Triphalangeal thumb is characterized as a congenital difference of the thumb with an extra phalanx. Additional thumb length is attributed mostly to the extra phalanx. The influence of the epiphyseal plate positions on growth in congenital hand anomalies is unclear. The purpose of this article was to compare the length of the first metacarpal in triphalangeal thumbs with the length of the same bone in normal thumbs and to investigate the influence of the often aberrant metacarpal epiphyseal plates on the length of the triphalangeal thumb metacarpal during growth. METHODS: The positions of the epiphyseal plate and the relative length of the first metacarpal were examined retrospectively in 37 patients with triphalangeal thumb. Ratios of the measurements were calculated (metacarpal II/metacarpal I) and compared with a normal population. Subjects were divided into 3 groups based on the position of the epiphyseal plate (double, proximal, distal). RESULTS: The distally placed growth plate was the most common variety, present in 22 of patients, followed by the proximal position in 14, and double epiphyseal plates in 6. All ratios of patients with triphalangeal thumb were significantly smaller than those of a normal population, indicating a longer first metacarpal in this condition. First metacarpals in triphalangeal thumb with double epiphyses grew disproportionately more than those of a normal population, whereas those with distal epiphyses grew disproportionately less than normal. First metacarpals with proximal epiphyses grew at the same rate as normal first metacarpals. CONCLUSIONS: In this study population the most common growth plate location was distal whereas the most common location in the normal population is proximal. The different positions of the epiphyseal plates correlate with growth differences in patients with triphalangeal thumb.

Adolescent↗
PubMed2001

Thumb carpometacarpal osteoarthritis: arthrodesis compared with ligament reconstruction and tendon interposition.

BACKGROUND: There has been considerable controversy regarding the procedure of choice for treatment of any given stage of osteoarthritis of the thumb carpometacarpal joint. This study was designed to directly compare the clinical results of two common surgical procedures for this condition, trapeziometacarpal arthrodesis and trapezial excision with ligament reconstruction and tendon interposition, in similar patient populations. METHODS: Between 1988 and 1998, 109 patients (141 thumbs) who were less than sixty years old were treated with one of the two procedures. In a retrospective review, forty-two patients (fifty-eight thumbs) treated with arthrodesis completed an outcome questionnaire and twenty-nine patients (forty-four thumbs) treated with arthrodesis completed the questionnaire and were examined. In the group treated with trapezial excision with ligament reconstruction and tendon interposition, thirty-nine patients (forty-nine thumbs) completed the questionnaire and thirty patients (thirty-eight thumbs) completed the questionnaire and were examined. The average duration of follow-up was sixty-nine months. The groups were similar with regard to age, gender, hand dominance, and duration of follow-up. RESULTS: Subjective evaluation of pain, function, and satisfaction demonstrated no significant difference between the two groups, with >90% of patients satisfied following either procedure. Although grip strength did not differ between the groups, the arthrodesis group had significantly stronger lateral pinch (p < 0.001) and chuck pinch (p < 0.01). The group treated with ligament reconstruction and tendon interposition had a better range of motion with regard to opposition (p < 0.05) and the ability to flatten the hand (p < 0.0001). There was a higher complication rate in the arthrodesis group, with nonunion of the fusion site accounting for the majority of the complications. However, despite a persistent nonunion in six thumbs, those thumbs and the thumbs in which union was obtained did not differ with regard to pain; all of the patients with nonunion had improvement in their pain status compared with preoperatively, and all were very satisfied with the outcome. Peritrapezial arthritis developed in nine patients (fourteen thumbs). This finding was not related to age and did not affect overall pain, function, or satisfaction. CONCLUSIONS: Although traditionally arthrodesis and ligament reconstruction and tendon interposition have been indicated in two different patient populations, we compared them in a homogeneous group and found that the two procedures had similar results with regard to pain, function, and satisfaction despite minimal differences in strength and motion. Although complications were more frequent following arthrodesis, most did not affect the overall outcome.

Arthrodesis↗
PubMed1989

Thumb reconstruction--great toe transfer.

Thumb reconstruction has a long and exciting history spanning more than 100 years. Reflecting on the evolution of techniques, the problems encountered and solved, and the advancement of technologies, one is struck by the versatility of surgeons in their varied approaches to the restoration of the thumb. Philosophical differences over the relative advantages and disadvantages of each operation have fueled debate over the choice of technique, but a unifying concept in reconstruction "to replace the lost tissue with like tissue" must be sought. The ideal reconstruction is one that replaces all of the lost structures, provides restoration of all function, and has no donor site morbidity. Homotransplantation of the thumb fits each of these criteria and may well be available some day. The experimental work of Furnas and others with limb transplantation is bringing us ever closer to realizing this goal. Even now, cadaver preparations of bone, joint, and tendon together with wrap-around flaps are being used clinically for thumb reconstruction. The initial reports are favorable, and these procedures portend exciting prospects for the future when immunological barriers can be selectively overcome. Some 10 years ago Dr. Littler, in discussing thumb reconstruction, wrote "Just as the neurovascular pedicle method of composite tissue transfer unshackled the older but limited procedures and made possible more accurate planning in substituting for the structural loss, so must the new freedom, afforded the transfer of composite tissue through microvascular surgery, not fail to utilize established structural and functional principles. Nor must the urge to use the free transfer method lure the surgeon from a safer, more predictable procedure." In the decade since Dr. Littler expressed these sentiments, a great deal of progress has been made in microsurgery, and we feel that there is ample evidence in our clinical experience as well as that of the literature to allow us to state with confidence that great toe to thumb transfer is a safe, reliable, and efficient means of thumb reconstruction that offers significant advantages over other techniques and few disadvantages. Anatomically, the great toe is nearly identical to the thumb and provides a transplant with tendon, bone, joint, and innervated skin elements that, in many instances, restores the attributes of the lost thumb in a superior fashion compared with other procedures. Our series now consists of 80 great toe transplants and the results continue to be gratifying. In short, great toes make great thumbs.

Humans↗
PubMed1989

Comparison of short and long thumb-spica casts for non-displaced fractures of the carpal scaphoid.

A prospective study was undertaken of fifty-one patients who were randomly assigned to treatment with either a long or a short thumb-spica cast for a non-displaced fracture of the carpal scaphoid. The duration of follow-up was at least until union; the average follow-up was twelve months. Twenty-eight fractures were treated with a long thumb-spica cast and twenty-three, with a short thumb-spica cast. The hands that initially were treated with a long thumb-spica cast were placed in a short thumb-spica cast after six weeks. Fractures that initially were treated with a long thumb-spica cast united at an average of 9.5 weeks and those that were maintained in a short thumb-spica cast, at an average of 12.7 weeks. There were no non-unions and two delayed unions in the fractures that initially were treated with a long thumb-spica cast, compared with two non-unions and six delayed unions in those that had only a short thumb-spica cast. Fractures of the proximal or middle third of the carpal scaphoid had a significantly shorter time to union when they were treated initially in a long thumb-spica cast. Fractures of the distal third did well regardless of the type of immobilization.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1997

Train-of-four and double burst stimulation fade at the great toe and thumb.

PURPOSE: We compared probabilities of tactile detection of fade in response to train-of-four (TOF), double burst stimulation3.3 (DBS3.3), and DBS3.2 at the great toe with those at the thumb. METHODS: One hundred and thirty adult patients anaesthetized with nitrous oxide, oxygen, isoflurane, and fentanyl were studied. At varying degrees of neuromuscular block caused by vecuronium, an observer determined the presence or absence of fade in response to TOF DBS3.3, or DBS3.2 at the great toe and that at the thumb. The relationship between T1/T0 or TOF ratio (T4/T1) measured at the great toe and that at the thumb was also examined. RESULTS: When TOF ratios were 0-0.10, 0.11-0.20, 0.21-0.30, 0.31-0.40, 0.41-0.50, 0.51-0.60, 0.61-0.70, and 0.71-1.00, the probabilities of detection of fade in response to TOF at the great toe (thumb) were 77 (100), 66 (100), 58 (96), 52 (77), 39 (38), 26 (23), 2(4), and 0(0)%, respectively (P < 0.05 at TOF ratio 0-0.40). Similarly, the probabilities of detection of fade in response to DBS3.3 at the great toe were lower than at the thumb when TOF ratios were 0.21-0.80, and those in response to DBS3.2 at the great toe were lower than at the thumb when TOF ratios were 0.61-0.80. A dose relationship was observed between T1/T0 or TOF ratio at the great toe and that at the thumb. CONCLUSION: This study suggests that the probability of tactile detection of fade in response to TOF, DBS3.3, or DBS3.2 at the great toe is less than that at the thumb. The present results may be because the flexor hallucis brevis muscle is more resistant to non-depolarizing neuromuscular relaxant than the adductor pollicis muscle and that the ratio of fade in response to neurostimulation at the great toe is higher than at the thumb.

Adult↗
PubMed2006

Melanoma of thumb: retrospective study for amputation levels, surgical margin and reconstruction.

For the treatment of melanoma of thumb, the evidence about amputation level (IP joint or MP joint) and cutaneous excision margin has not been fully presented. And reconstructions for lost thumbs need to be balanced against functional and aesthetic requirements of individual patients and overall prognosis. We report 15 patients, who underwent primary excision and reconstruction for thumb melanoma between 1986 and 2004 at Department of Plastic and Reconstructive Surgery, University of Hokkaido at Sapporo, Graduate School of Medicine. The patients were reviewed to evaluate the prognostic significance of variables including age and sex of the patient, tumour thickness, staging, level of amputation, and cutaneous excision margin. Our 15 cases were divided into two groups according to amputation level (MP or IP) and cutaneous excision margin (<40 mm or >or =40 mm) and prognosis was analysed statistically. The stage and thickness were identified as prognostic factors for disease-free survival; however, IP amputation and 10-30 mm margin did not compromise disease-free survival. Amputated thumb was reconstructed by pollicization, free toe to thumb transfer, reverse forearm flap, local flap, and skin graft. No major complication of reconstructed thumb occurred. Seven of eight cases of MP amputation were reconstructed by pollicization. On the other hand, five cases of IP amputation were reconstructed by volar skin flap in two cases, reverse forearm flap in two cases, and trimmed first toe transfer in one case. Although a small number of cases, our study is the first attempt focussing on melanoma of thumb, and evaluating amputation level and cutaneous margin separately. The reconstructive algorithm for the amputated thumb is proposed and has various tools including free toe to thumb transfer.

Adult↗
PubMed2004

The effect of percutaneous pin fixation of the interphalangeal joint on the thumb-tip force produced by the flexor pollicis longus: a cadaver study.

PURPOSE: Interphalangeal joint stabilization often is performed concomitantly with tendon transfers that restore key pinch (lateral pinch) to the paralyzed thumb. The goal of this study was to measure the effect of interphalangeal joint stabilization via percutaneous pin fixation on the thumb-tip force produced by the flexor pollicis longus (FPL). METHODS: We applied 10 N of force to the tendon of the FPL in 7 cadaveric specimens and measured the resulting thumb-tip force in the intact thumb and after stabilization of the interphalangeal joint. RESULTS: The nominal thumb-tip force was approximately 6 times less than the applied force and was directed primarily in the thumb's plane of flexion-extension at an oblique angle of 44 degrees relative to the palmar direction (the direction that is perpendicular to the thumb tip in the plane). Joint stabilization increased significantly the nominal force and oriented the force more toward the palmar direction (ie, decreased the obliqueness of the force). CONCLUSIONS: After paralysis and a tendon transfer to the paralyzed FPL the FPL is often the only muscle actuating the thumb. We conclude that the oblique nominal force direction is prone to cause the thumb to slip during pinch. Joint stabilization, however, has the capacity to reduce the tendency for slippage because it rotates the force toward the palmar direction.

Biomechanical Phenomena↗
PubMed2006

Suspensionplasty with the abductor pollicis longus tendon for osteoarthritis in the carpometacarpal joint of the thumb.

PURPOSE: Many surgical procedures have been described for treating painful osteoarthritis at the carpometacarpal joint of the thumb. This article reports our clinical and radiographic results in performing suspensionplasty using the abductor pollicis longus (APL) tendon without tendon interposition after a complete trapeziectomy for patients with painful osteoarthritis in the carpometacarpal joint of the thumb. METHODS: Eighteen patients (2 men, 16 women), including 21 thumbs with advanced arthritis of the first carpometacarpal joint, who were treated by suspensionplasty using the APL tendon after a complete trapeziectomy were evaluated both clinically and radiographically. Ten thumbs were classified as stage III and 11 were classified as stage IV (Eaton's classification). The average follow-up period was 33.3 months. RESULTS: All patients (18 patients, 21 thumbs) reported pain with daily use before surgery; after surgery 13 of the 21 thumbs had no pain, 5 thumbs had mild pain with strenuous activity, and the remaining 3 thumbs had mild pain with light work. At the final follow-up evaluation the radial and palmar abductions each were 56 degrees +/- 9 degrees and 56 degrees +/- 6 degrees. The grip and key-pinch strengths were 16 +/- 6 kg and 4 +/- 1 kg, respectively. The first metacarpal subsidence at rest was 15% and the additional subsidence when performing a 2-kg key pinch was 6% in the final follow-up radiographic findings. CONCLUSIONS: This study showed that the APL suspensionplasty has a favorable outcome for painful osteoarthritis in the carpometacarpal joint of the thumb and that the APL tendon can be removed as a deforming force without any abduction weakness. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Aged↗
PubMed1999

In-vivo function of the thumb muscles.

OBJECTIVE: The purpose of this study is to quantify the electrical activity of the thumb muscles responsible for the production of force in different directions of thumb movement. DESIGN: The isometric forces and electromyographic activity generated by seven thumb muscles were measured on five normal healthy test subjects. BACKGROUND: The thumb is very important for proper hand function. Presently available electromyographic studies of the thumb muscles provide only limited information. Most thumb muscles have more than one function. Additional studies are required to carefully examine and confirm the in-vivo relationship between the thumb muscle electromyogram and mechanical output. METHODS: The direction and magnitude of the force vector generated at the interphalangeal joint and the relative electrical activity were obtained for eight directions of thumb action. The regions of function were defined for the abductor pollicis brevis, opponens pollicis, flexor pollicis brevis, adductor pollicis, flexor pollicis longus, extensor pollicis longus, and the abductor pollicis longus. Data was collected during voluntary isometric contraction, both before and after blocking the median nerve at the wrist. RESULTS: The highest force production was obtained during flexion. The region of maximal muscle electrical activity varied for each muscle studied. The areas of maximal in-vivo muscle activity agreed with the moment arm data reported in the literature. The median nerve block eliminated the ability to produce force in abduction. CONCLUSIONS: This study has demonstrated that by combining electromyographic measurement and biomechanical analysis it is possible to confirm the relationship between in-vivo thumb muscle function and muscle mechanics in a novel manner. The findings of this study indicate the importance of the local anatomy in controlling the direction of force production.

Adult↗
PubMed2001

Activation patterns of the thumb muscles during stable and unstable pinch tasks.

The ability to direct forces between the thumb and fingers is important to secure objects in the hand. We compared the coordination of thumb musculature in key and opposition pinch postures between stable and unstable tasks. The unstable task (producing thumb-tip force wearing a beaded thimble) required well-directed forces; the stable task (producing thumb-tip force against a pinch meter) did not. Fine-wire electromyography of thumb muscles and thumb-tip force magnitudes were recorded. We found no statistical differences in thumb-tip force between postures or stable versus unstable tasks, indicating that the highest magnitudes of force can be accurately directed. Abductor pollicis brevis and extensor pollicis longus were significantly more activated in the unstable tasks, suggesting their importance in directing thumb-tip force. Understanding how pinch forces are directed might influence the choice of muscle-tendon transfers performed to restore function to the severely paralyzed thumb. We introduce a device to quantify the ability to control pinch force magnitude and direction simultaneously.

Adult↗
PubMedDate not supplied

The "Bilhaut-Cloquet" technique for treatment of thumb duplication.

The presentation of thumb duplication is variable depending on the level of bifurcation, the relative sizes of the two thumbs and their possible symmetry along a longitudinal axis. Resection of the supernumerary thumb often leads to disappointing results when both thumbs are hypoplastic. The principle of the "Bilhaut-Cloquet" procedure involves central resection of the duplication followed by fusion of the remaining lateral portions, in order to obtain a thumb of satisfactory volume. Thirteen children with unilateral thumb duplication were treated using the "Bilhaut-Cloquet" procedure. Nine cases involved duplication of the distal phalanx (Wassel type II). Five of these duplications were symmetrical and four were asymmetrical with an associated proximal delta phalanx. In these cases, a corrective osteotomy of the delta phalanx was performed at the same time. Four cases involved symmetrical duplications of both proximal and distal phalanges (Wassel type IV). The mean age at time of surgery was 11.5 months. Patients were reviewed with a mean follow-up of four years. The aesthetic aspect of the nail was judged as good in 12 cases. In one case, the aesthetic aspect of the nail was judged as fair due to a prominent longitudinal ridge. Bony fusion was obtained in all cases but one. The alignment was corrected in all cases but four, involving asymmetrical duplications. Joint mobility was limited in all patients. The "Bilhaut-Cloquet" technique leads to a satisfactory volume of the thumb in selected cases. Good correction of preoperative angular deformity is obtained in symmetrical cases. A precise technique of bone and nail approximation yields good functional and aesthetic results. The "Bilhaut-Cloquet" technique is indicated in balanced and symmetrical duplications, when the two thumbs are severely hypoplastic. It can be used either in the distal or proximal phalangeal types of thumb duplication.

Child↗
PubMed2002

Alternatives to thumb replantation.

LEARNING OBJECTIVES: After studying this article, the participant should: 1. Have a variety of options for thumb reconstruction. 2. Know the advantages and disadvantages of the nonmicrosurgical and microsurgical techniques for thumb reconstruction. 3. Understand the decision making from the variety of thumb reconstruction techniques based on patient needs. 4. Have a basic understanding of the various thumb reconstruction techniques discussed. The traumatic amputation of the thumb is an absolute indication for attempted replantation. The profound disability of the hand resulting from absence of the thumb, with loss of pinch and grasp, obliges the surgeon to make every attempt to replant the amputated thumb and preserve hand function. However, not all attempts at replantation result in survival of the amputated portion, and unreconstructable damage to or complete loss of the amputated part may preclude attempted replantation. In such situations, the surgeon must have alternative methods of dealing with the sequelae of thumb loss. This article will discuss nonmicrosurgical and microsurgical techniques for thumb reconstruction.

Amputation, Traumatic↗
PubMed2004

Manipulabilities of the index finger and thumb in three tip-pinch postures.

Tip-pinch, in which the tips of the index finger and thumb pick up and hold a very fine object, plays an important role in the function of the hand. The objective of this study was to investigate how human subjects affect manipulabilities of the tips of the index finger and thumb within the flexion/extension plane of the finger in three different tip-pinch postures. The index finger and thumb of twenty male subjects, were modeled as linkages, based on measurement results obtained using two three-dimensional position measurement devices. The manipulabilities of the index finger and thumb were investigated in three tip-pinch postures, using three criteria indicating the form and posture of the manipulability ellipse of the linkage model. There were no significant differences (p > 0.05, ANOVA) in each criterion of each digit across the subjects, except for two criteria of the thumb. The manipulabilities of the index finger and thumb were separately similar across all subjects in tip-pinch postures. It was found that the manipulability for the cooperation of the index finger and thumb of all the subjects in tip-pinch depended on the posture of the index finger, but not on the posture of the thumb. In two-dimensional tip-pinch, it was possible that the index finger worked actively while the thumb worked passively to support the manipulation of the index finger.

Adult↗
PubMedDate not supplied

Thumb amputations from team roping.

BACKGROUND: Thumb injuries during team roping have elements of both avulsion and crush, resulting in a poor prognosis for replantation success. PURPOSE: To review 19 cases of thumb amputation from team roping at our institution since 1983. STUDY DESIGN: Retrospective cohort study. METHODS: Cases were included in the study only if a microvascular repair of artery and vein was needed for the thumb to survive. Vein grafts were used to span the damaged vessel segment. Of the 19 thumb amputation cases, 15 attempts were made to replant the thumb. In the remaining four cases, patients had bone shortening and primary closure. The force of injury was calculated based on mechanism. RESULTS: Of the 15 attempts at replantation, only 5 (33%) were successful, despite meticulous technique. One patient subsequently had an emergency toe-to-thumb transfer after an unsuccessful replant, and the remaining nine underwent amputation. Nine of the 10 patients with failed replants had poor flow intraoperatively. In the group of patients younger than 15, the success was 3 of 5 (60%) and in the group 15 years or older the success was 2 of 10 attempts (20%.) Follow-up was available in 13 of the 15 cases of replanted thumbs. CONCLUSIONS: All patients were subjectively satisfied with their results, and all patients with successful replants and seven patients with no thumb returned to rodeo. Biomechanical analysis showed a huge amount of force and pressure, several times larger than that of ring avulsion injury, results when a steer pulls on the thumb.

Adolescent↗
PubMed1992

Reconstruction of traumatic absence of the thumb in the adult by pollicization.

Amputation of the thumb is a severe handicap. In an emergency situation, thumb amputation must be treated by means of reimplantation when possible. If reimplantation cannot be performed or fails, several methods of thumb reconstruction can be used according to various factors. These include the number of surviving fingers and the level of the thumb amputation. Pollicization is the first choice for amputations proximal to the metacarpophalangeal joint when four and even three fingers are present. It is the easiest and safest operation that supplies the best results both from the motor and sensory points of view. Pollicization can be done even in an emergency situation in selected patients. The index finger is preferred because it can be pollicized without palmar scar or tendons, vessels, or nerves crossing over. If a damaged finger is present, it is preferred to the index finger to leave one more sound finger; a damaged finger can frequently be used, because the thumb is shorter than the other fingers, and although its mobility is very important at the trapeziometacarpal joint, it is less important at the metacarpophalangeal and interphalangeal joint levels. It is preferable to take as much second metacarpal bone as necessary to place the transferred second metacarpophalangeal joint at the position of the thumb metacarpophalangeal joint so that the tendons of the index interosseous muscles can be sutured to the intrinsic muscles of the thumb. According to this concept, the distal phalanx of the transferred finger should be amputated. In this manner, the new thumb will have a normal size, only two phalanges, only one extrinsic flexor, and normal insertion of the muscles of the thumb.

Adult↗