Thumb Reconstruction after Amputation at the lnterphalangeal Joint by gradual lengthening o f the Proximal Phalanx. A Case Report Ivan B. Mater
THUMB RECONSTRUCTION AFTER AMPUTATION AT THE I N T E R P H A L A N G E A L J O I N T BY G R A D U A L L E N G T H E N I N G OF T H E PROXIMAL PHALANX A CASE REPORT IVAN B. MATEV, Sofia SUMMARY A case of thumb amputation at the interphalangeal joint and reconstruction by gradual lengthening of the proximal phalanx is described. As a result of the treatment the amputation stump was lengthened 2cms which means a 70 per cent increase of the original length of the proximal phalanx. The quality of sensibility of the stump has been preserved. INTRODUCTION Since 1966 we have been using a method of thumb reconstruction after amputation by using gradual lengthening of the first metacarpal bone. The present article deals with a case in which a reconstruction was achieved by lengthening of the proximal phalanx. Though the indication for reconstruction after amputation at such a level is relative and open to discussion, this case shows the possibilities of phalangeal lengthening in the hand. CASE R E P O R T The left thumb of a twenty-one-year-old male patient was amputated at the interphalangeal joint after crushing of the distal phalanx (Figs. 1,2). The amputation stump was covered with good skin except for the tip where a small stellate scar could be seen. A transverse osteotomy in the middle of the proximal phalanx was done through a small incision o f the skin and a little opening of the periosteum; then a distraction device was applied. The distraction period lasted twenty-one days as the screw of the distraction device was turned one to one and a half turns daily providing 1-1,5 millimetres o f elongation. The immobilization period lasted three months during which spontaneous ossification of the gap between the fragments took place (Figs. 3,4). The proximal phalanx of the thumb was lengthened 2 cms which means a 70 per cent increase o f its original length. Both the distraction period and the immobilization period ran an uneventful course. The patient resumed his original job as a technician (Figs. 5, 6). Six months later the thinned out stellate scar on top of the elongated phalanx was replaced by a pedicle graft raised from the dorsal surface of the index finger and the prominent volar condyles on the phalanx were trimmed. At the latest examination of the patient two years after completion of the treatment, the reconstructed thumb is in good condition with a full range of movement at the metacarpophalangeal joint. The x-ray shows no osteoporosis or osteolysis at the tip of this unusually long proximal phalanx (Fig. 7). The quality of skin sensibility in the elongated phalanx does not show any change as a result of the treatment. Ivan B. Matev, M.D. The Institute of Orthopaedics and Traumatology Boul. P. Napetov 56, Gorna Banya, 1614 Sofia, Bulgaria. 302
The Hand-- Volume 11
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1979
Thumb Reconstruction after A mputation at the lnterphalangeal Joint by gradual lengthening o f the Proximal Phalanx. A Case Report Ivan B. Matev
Figs. I & 2. t"rc-operali,, c condition of the thumb.
Figs. 3 & 4. The distraction device in situ 24 days after cessation of distraction.
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Thumb Reconstruction after Amputation at the Interphalangea! Joint by gradual lengthening o f the Proximal Phalanx. A Case Report Ivan B. Matev
Fig. 5. Comparison of two thumbs, six months after completion of treatment.
Fig. 6. The Pinch of the thumb six months after completion of treatment. 304
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Thumb Reconstruction after Amputation at the Interphalangeal Joint by gradual lengthening o f the Proximal Phalanx. A Case Report Ivan B. Matev
Fig. 7. X-ray of the thumb two years post-operatively showing the lengthened proximal phalanx. REFERENCES
MATEV, 1. B. (1967) Gradual Elongation of the First Metacarpal as a Method of Thumb Reconstruction. Communication at the Anglo-Scandinavian Meeting of Hand Surgery, Lausanne. In the Second Hand Club, ed. by H. G. Stack and H. Bolton, London, The British Society for Surgery of the Hand, 1975, p. 431. MATEV, 1. B. ~1972) New Thoughts on Hand Sm'gery. In Modern Trends in Orthopaedics - 6, ed. by A. G. Apley, London: Butterworths, 95-101. MATEV, I.B. Reconstructive Surgery of the Thumb. (In Bulgarian): Sofia. Medicina i Fizkultura Publishing House, (1978) 138-162.
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THUMB RECONSTRUCTION AFTER AMPUTATION AT THE I N T E R P H A L A N G E A L J O I N T BY G R A D U A L L E N G T H E N I N G OF T H E PROXIMAL PHALANX A CASE REPORT IVAN B. MATEV, Sofia SUMMARY A case of thumb amputation at the interphalangeal joint and reconstruction by gradual lengthening of the proximal phalanx is described. As a result of the treatment the amputation stump was lengthened 2cms which means a 70 per cent increase of the original length of the proximal phalanx. The quality of sensibility of the stump has been preserved. INTRODUCTION Since 1966 we have been using a method of thumb reconstruction after amputation by using gradual lengthening of the first metacarpal bone. The present article deals with a case in which a reconstruction was achieved by lengthening of the proximal phalanx. Though the indication for reconstruction after amputation at such a level is relative and open to discussion, this case shows the possibilities of phalangeal lengthening in the hand. CASE R E P O R T The left thumb of a twenty-one-year-old male patient was amputated at the interphalangeal joint after crushing of the distal phalanx (Figs. 1,2). The amputation stump was covered with good skin except for the tip where a small stellate scar could be seen. A transverse osteotomy in the middle of the proximal phalanx was done through a small incision o f the skin and a little opening of the periosteum; then a distraction device was applied. The distraction period lasted twenty-one days as the screw of the distraction device was turned one to one and a half turns daily providing 1-1,5 millimetres o f elongation. The immobilization period lasted three months during which spontaneous ossification of the gap between the fragments took place (Figs. 3,4). The proximal phalanx of the thumb was lengthened 2 cms which means a 70 per cent increase o f its original length. Both the distraction period and the immobilization period ran an uneventful course. The patient resumed his original job as a technician (Figs. 5, 6). Six months later the thinned out stellate scar on top of the elongated phalanx was replaced by a pedicle graft raised from the dorsal surface of the index finger and the prominent volar condyles on the phalanx were trimmed. At the latest examination of the patient two years after completion of the treatment, the reconstructed thumb is in good condition with a full range of movement at the metacarpophalangeal joint. The x-ray shows no osteoporosis or osteolysis at the tip of this unusually long proximal phalanx (Fig. 7). The quality of skin sensibility in the elongated phalanx does not show any change as a result of the treatment. Ivan B. Matev, M.D. The Institute of Orthopaedics and Traumatology Boul. P. Napetov 56, Gorna Banya, 1614 Sofia, Bulgaria. 302
The Hand-- Volume 11
No. 3
1979
Thumb Reconstruction after A mputation at the lnterphalangeal Joint by gradual lengthening o f the Proximal Phalanx. A Case Report Ivan B. Matev
Figs. I & 2. t"rc-operali,, c condition of the thumb.
Figs. 3 & 4. The distraction device in situ 24 days after cessation of distraction.
The Hand-- Volume l l
No. 3
1979
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Thumb Reconstruction after Amputation at the Interphalangea! Joint by gradual lengthening o f the Proximal Phalanx. A Case Report Ivan B. Matev
Fig. 5. Comparison of two thumbs, six months after completion of treatment.
Fig. 6. The Pinch of the thumb six months after completion of treatment. 304
The Hand-- Volume l 1
No. 3
1979
Thumb Reconstruction after Amputation at the Interphalangeal Joint by gradual lengthening o f the Proximal Phalanx. A Case Report Ivan B. Matev
Fig. 7. X-ray of the thumb two years post-operatively showing the lengthened proximal phalanx. REFERENCES
MATEV, 1. B. (1967) Gradual Elongation of the First Metacarpal as a Method of Thumb Reconstruction. Communication at the Anglo-Scandinavian Meeting of Hand Surgery, Lausanne. In the Second Hand Club, ed. by H. G. Stack and H. Bolton, London, The British Society for Surgery of the Hand, 1975, p. 431. MATEV, 1. B. ~1972) New Thoughts on Hand Sm'gery. In Modern Trends in Orthopaedics - 6, ed. by A. G. Apley, London: Butterworths, 95-101. MATEV, I.B. Reconstructive Surgery of the Thumb. (In Bulgarian): Sofia. Medicina i Fizkultura Publishing House, (1978) 138-162.
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