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American Association for Hand Surgery

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Preservation of Metacarpophalangeal Joint Vascularity May Be Protective Against Physeal Arrest After Index Finger Pollicization
Katharine M Hinchcliff, MD1, Courtney Schneidau, PA2, Christopher Stutz, MD2, Marybeth Ezaki, MD3 and Scott Oishi, FACS4, (1)Department of Surgery, Division of Plastic Surgery, University of California San Diego, San Diego, CA, (2)Texas Scottish Rite Hospital for Children, Dallas, TX, (3)Hand Surgery/Orthopedics, Texas Scotish Rite, Dallas, TX, (4)Hand Surgery/Orthopedics, Texas Scottish Rite Hospital, Dallas, TX

Introduction: Proximal phalanx physeal arrest is the most common complication that occurs to the index finger metacarpophalangeal joint (MCPJ) following pollicization. We hypothesize that preservation of the blood supply to the MCPJ will decrease the rate of proximal phalanx physeal arrest when compared to historical controls.
Materials & Methods: Thirty pollicized digits in 26 patients (2008-2018) with a minimum of two-year radiographic and clinical follow up were evaluated for physeal arrest. Other complications evaluated included non-union at the pollicized digit base and clinical instability at the new carpometacarpal joint. Findings were compared to historical controls, which were performed by our group prior to routine identification and sparing of the MCPJ blood supply. No other modifications to surgical technique were made between the historic and current patient cohorts.
Results: Two patients had radiographic evidence of physeal arrest, one of which was partial and the other complete, for an arrest rate of 6.7%. This was significantly less than the arrest rate in our historical cohort of 24.7% (21 of 85 patients), p = 0.034. Three patients did not have bony union at the base of the index metacarpal, although no patients had clinical instability at the new carpometacarpal joint.
Conclusions:

  • Significantly fewer patients who underwent index finger pollicization with preservation of the MCPJ blood supply went on to develop physeal arrest when compared to patients who underwent pollicization prior to adoption of this technique.
  • This finding suggests that sparing of the physeal blood supply is preventative against proximal phalanx physeal arrest.

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