Application of double osteotomy and lengthening of proximal phalanx and metacarpal with Ilizarov technique for thumb defect_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

FANG Jun ¹ ,  WANG Bin ¹ , HAO Ruizheng ¹ , WANG Wei ¹ , JIA Song ¹ , WANG Binggang ² , GONG Zhongping ¹ , ZHANG Yi ³ , YANG Huanyou ¹

1. The First Department of Hand Surgery and Reconstructive Surgery, Tangshan Second Hospital (Affiliated Orthopaedic Hospital, North China University of Science and Technology), Tangshan Hebei, 063000, P.R.China;
2. The Fifth Department of Trauma Surgery, Tangshan Second Hospital (Affiliated Orthopaedic Hospital, North China University of Science and Technology), Tangshan Hebei, 063000, P.R.China;
3. Department of Orthopaedics, Affiliated Hospital of North China University of Science and Technology, Tangshan Hebei, 063000, P.R.China;

Corresponding author：

WANG Bin, Email: wbladyp3@163.com

Keywords：

Thumb defect; Ilizarov technique; double osteotomy and lengthening; proximal phalanx; metacarpal

DOI：

10.7507/1002-1892.202101159

Video：

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Objective To investigate the effectiveness of double osteotomy and lengthening of proximal phalanx and metacarpal with Ilizarov technique in treatment of thumb defect. Methods Between February 2017 and June 2019, 6 patients with traumatic thumb defects were treated with double osteotomy and lengthening of proximal phalanx and metacarpal by Ilizarov technique. There were 5 males and 1 female. The age ranged from 28 to 57 years, with an average of 41.5 years. There were 3 cases on the left side and 3 cases on the right side. All patients were admitted to the hospital in emergency department after injury, and the stump of the thumb was trimmed and sutured. The osteotomy plane was the distal part of the proximal phalanx in 4 cases and the interphalangeal joint in 2 cases. The interval between injury and osteotomy was 20-245 days (median, 34.5 days). After minimally invasive osteotomy and placement of a semi-circular external fixator, the lengthening began on the 5th day. The proximal phalanx and metacarpal were lengthened by 0.5 mm every day, once every 12 hours. The thumb of the affected side was distracted to the middle of the distal phalanx of the healthy thumb, and the fixator was removed after the bone healed. Results The distraction time was 14-23 days, with an average of 18.8 days. The osteotomies were healed with healing time of 91-147 days (mean, 120.2 days). The total distraction length of the proximal phalanx and metacarpal was 1.40-2.25 cm, with an average of 1.86 cm; healing index was 51.0-72.2 days/cm, with an average of 64.9 days/cm. All patients were followed up 5-12 months (mean, 8.2 months). At last follow-up, the two-point discrimination was 5.3-8.5 mm with an average of 6.98 mm. According to the evaluation standard of the upper limb part of the Chinese Medical Association, the score was 10-14, with an average of 12.5. Among them, 4 cases were excellent and 2 cases were good, with an excellent and good rate of 100%. All patients were satisfied with the function and appearance of thumb after operation. The Quick Disabilities of Arm, Shoulder, and Hand (Quick-DASH) score was 2.3-9.1, with an average of 6.1. Conclusion The double osteotomy and lengthening of proximal phalanx and metacarpal with Ilizarov technique is an effective method for the treatment of thumb defects.

Citation： FANG Jun, WANG Bin, HAO Ruizheng, WANG Wei, JIA Song, WANG Binggang, GONG Zhongping, ZHANG Yi, YANG Huanyou. Application of double osteotomy and lengthening of proximal phalanx and metacarpal with Ilizarov technique for thumb defect. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(8): 989-993. doi: 10.7507/1002-1892.202101159 Copy

1.	Graham D, Bhardwaj P, Sabapathy SR. Secondary thumb reconstruction in a mutilated hand. Hand Clin, 2016, 32(4): 533-547.
2.	Kempny T, Paroulek J, Marik V, et al. Further developments in the twisted-toe technique for isolated thumb reconstruction: our method of choice. Plast Reconstr Surg, 2013, 131(6): 871e-879e.
3.	Sabapathy SR, Venkatramani H, Bhardwaj P. Reconstruction of the thumb amputation at the carpometacarpal joint level by groin flap and second toe transfer. Injury, 2013, 44(3): 370-375.
4.	Chi Z, Song DJ, Tian L, et al. Reconstruction of combined thumb amputation at the metacarpal base level and index amputation at the metacarpal level with pollicization and bilateral double toe composite transfer. J Plast Reconstr Aesthet Surg, 2017, 70(8): 1009-1016.
5.	Woo SH, Lee GJ, Kim KC, et al. Immediate partial great toe transfer for the reconstruction of composite defects of the distal thumb. Plast Reconstr Surg, 2006, 117(6): 1906-1915.
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9.	Matev IB. Thumb reconstruction after amputation at the metacarpophalangeal joint by bone lengthening. J Bone Joint Surg, 1970, 52(5): 957-965.
10.	Saleem A, Sharma RK, Kumar P. Distraction lengthening of first metacarpal in traumatic thumb amputations. Indian J Plast Surg, 2019, 52(3): 309-313.
11.	赵玉华, 邵文年. 拇指延长术在重建手功能中的临床应用. 中华手外科杂志, 2019, 35(5): 389-390.
12.	王斌, 郝睿峥, 王辉, 等. Ilizarov 技术治疗外伤后拇指短缩或骨缺损. 中华骨科杂志, 2019, 39(1): 52-57.
13.	Mann M, Hülsemann W, Winkler F, et al. Distraction osteogenesis is an effective method to lengthen digits in congenital malformations. Handchir Mikrochir Plast Chir, 2016, 48(1): 48-52.
14.	Vekris M, Lykissas M, Pakos E, et al. Digital ray reconstruction through distraction osteogenesis: a retrospective study of 82 rays with long-term follow-up. Injury, 2015, 46(7): 1354-1358.
15.	Hosny GA, Kandel WA. Distraction lengthening by callotasis of traumatically shortened bones of the hand. J Trauma Acute Care Surg, 2012, 72(6): 1676-1680.
16.	Heo CY, Kwon S, Back GH, et al. Complications of distraction lengthening in the hand. J Hand Surg (Eur Vol), 2008, 33(5): 609-615.
17.	Matev I. Thumb metacarpal lengthening. Tech Hand Up Extrem Surg, 2003, 7(4): 157-163.
18.	潘生德, 顾玉东, 侍德. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, (3): 130-136.
19.	Beaton DE, Wright JG, Katz JN, et al. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg (Am), 2005, 87(5): 1038-1046.
20.	Fischgrund J, Paley D, Suter C. Variables affecting time to bone healing during limb lengthening. Clin Orthop Relat Res, 1994, (301): 31-37.

1. Graham D, Bhardwaj P, Sabapathy SR. Secondary thumb reconstruction in a mutilated hand. Hand Clin, 2016, 32(4): 533-547.
2. Kempny T, Paroulek J, Marik V, et al. Further developments in the twisted-toe technique for isolated thumb reconstruction: our method of choice. Plast Reconstr Surg, 2013, 131(6): 871e-879e.
3. Sabapathy SR, Venkatramani H, Bhardwaj P. Reconstruction of the thumb amputation at the carpometacarpal joint level by groin flap and second toe transfer. Injury, 2013, 44(3): 370-375.
4. Chi Z, Song DJ, Tian L, et al. Reconstruction of combined thumb amputation at the metacarpal base level and index amputation at the metacarpal level with pollicization and bilateral double toe composite transfer. J Plast Reconstr Aesthet Surg, 2017, 70(8): 1009-1016.
5. Woo SH, Lee GJ, Kim KC, et al. Immediate partial great toe transfer for the reconstruction of composite defects of the distal thumb. Plast Reconstr Surg, 2006, 117(6): 1906-1915.
6. 王西迅, 陶丹玉, 陈旭辉, 等. 前踝上皮瓣串联第 2 足趾移植再造拇指并修复虎口软组织缺损. 中华显微外科杂志, 2019, 42(2): 120-124.
7. Segu SS, Athavale SN, Manjunath P. Osteoplastic reconstruction for post traumatic thumb amputations around metacarpophalangeal joint. J Clin Diagn Res, 2015, 9(8): 11-13.
8. Canizares MF, Feldman L, Miller PE, et al. Pollicization of the index finger in the United States: early readmission and complications. J Hand Surg (Am), 2019, 44(9): 795.e1-795.e8.
9. Matev IB. Thumb reconstruction after amputation at the metacarpophalangeal joint by bone lengthening. J Bone Joint Surg, 1970, 52(5): 957-965.
10. Saleem A, Sharma RK, Kumar P. Distraction lengthening of first metacarpal in traumatic thumb amputations. Indian J Plast Surg, 2019, 52(3): 309-313.
11. 赵玉华, 邵文年. 拇指延长术在重建手功能中的临床应用. 中华手外科杂志, 2019, 35(5): 389-390.
12. 王斌, 郝睿峥, 王辉, 等. Ilizarov 技术治疗外伤后拇指短缩或骨缺损. 中华骨科杂志, 2019, 39(1): 52-57.
13. Mann M, Hülsemann W, Winkler F, et al. Distraction osteogenesis is an effective method to lengthen digits in congenital malformations. Handchir Mikrochir Plast Chir, 2016, 48(1): 48-52.
14. Vekris M, Lykissas M, Pakos E, et al. Digital ray reconstruction through distraction osteogenesis: a retrospective study of 82 rays with long-term follow-up. Injury, 2015, 46(7): 1354-1358.
15. Hosny GA, Kandel WA. Distraction lengthening by callotasis of traumatically shortened bones of the hand. J Trauma Acute Care Surg, 2012, 72(6): 1676-1680.
16. Heo CY, Kwon S, Back GH, et al. Complications of distraction lengthening in the hand. J Hand Surg (Eur Vol), 2008, 33(5): 609-615.
17. Matev I. Thumb metacarpal lengthening. Tech Hand Up Extrem Surg, 2003, 7(4): 157-163.
18. 潘生德, 顾玉东, 侍德. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, (3): 130-136.
19. Beaton DE, Wright JG, Katz JN, et al. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg (Am), 2005, 87(5): 1038-1046.
20. Fischgrund J, Paley D, Suter C. Variables affecting time to bone healing during limb lengthening. Clin Orthop Relat Res, 1994, (301): 31-37.

Chinese Journal of Reparative and Reconstructive Surgery

Application of double osteotomy and lengthening of proximal phalanx and metacarpal with Ilizarov technique for thumb defect

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