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Reconstruction of hypoplastic thumb with unstable carpometacarpal joint using hemi-metatarsal transfer: Report of minimal 9 years outcomes in 8 patients
Wing Lim Tse, MD
Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China

Introduction:
Whether reconstruction of the best functional thumb or preservation of the normal number of digits on the hand is preferable is a matter beyond medical judgment alone. The parents of our patients with hypoplastic thumb even with unstable CMCJ prefer augmentation of thumb rather than pollicization. We developed a novel technique to reconstruct the unstable thumb by transferring a longitudinally spitted hemi-2nd metatarsal bone with physeal plate, together with extensor transfer and Huberís opponenplasty to reconstruct a functional augmented thumb.

Objective:
A retrospective review of the outcome of our surgical technique for thumb reconstruction of Manske type 3B (unstable CMCJ) and type 4 (floating) hypoplastic thumbs.

Materials and method:
Between January 1997 to February 2009, 8 patients received free hemi-metatarsal transfer and tendon transfers for reconstruction of hypoplastic thumb function. There were 7 boys and 1 girl received operation at mean age of 18.9months (11-29 months). 4 thumbs were type 3B and 5 thumbs were type 4.

Results:
The mean period of follow up was 103 months (21 to 158 months). There was no neurovascular complication or infection. No patient complaint of problem with walking and there was no significant shortening or deformity over the donar toes. There were 1 case of graft Fracture, 2 cases of retarded growth and 1 case of unstable 1st CMCJ. Radiologically the graft grown with a rate of average 1.4 mm per year. The final graft length to 2nd metacarpal ratio was 71% (35% to 88%) while the normal hand reference was around 75-80%

Conclusion:
Free hemi-metatarsal transfer is an option for reconstruction of stage 3B and 4 hypoplastic thumb at young age to restore a functional 5 digits hand which shown bone growth and minimal donar site morbidity.


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