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At least 19 recordsLinked to original sources
PubMed1991

Triphalangism in thumb polydactyly: an anatomic study on surgically resected thumbs.

Surgically resected thumbs in preaxial polydactyly were submitted to anatomic dissection to detect a triphalangeal thumb. Radiologically, two particular categories of thumbs with duplication at the metacarpophalangeal joint were seen. The surgically excised thumbs of either the radial or the ulnar member were preserved for dissection. Depending on the number of phalanges as well as on osteocartilaginous structures, the thumbs were classified into three groups. In the first group, the thumbs consisted of three phalanges but had absent joint formation between the phalanges and metacarpal. The second group consisted of three phalanges with two well-formed joints between them. The third group of thumbs also had three phalanges but had only one interphalangeal joint between them. In all three groups, morphologic features and clinical criteria are discussed.

Humans↗
PubMed1992

[Thumb reconstruction with cryopreserved autogenous thumb skeleton and microneurovascular flap].

This paper describes a procedure for thumb reconstruction using autogenous cryo-conserved bone from the thumb itself. In a case of severe explosion injury, the thumb and index finger were amputated at the carpometacarpal joint level and the remaining fingers at the distal interphalangeal joint level. Severe soft tissue damage and lesion of both the superficial and deep palmar arterial arches rendered customary surgical procedures for thumb reconstruction impossible. The cryo-conserved bone was replanted following soft tissue healing and then covered with a free radial forearm flap. This procedure resulted in a stable and painfree thumb and provided satisfactory grip.

Adult↗
PubMed1991

Thumb duplication and contralateral thumb hypoplasia in infant of mother with diabetes.

Uncontrolled maternal diabetes frequently results in congenital anomalies. This report describes an infant of a mother with diabetes born with thumb hypoplasia and contralateral thumb duplication without other associated anomalies. Maternal diabetes should be part of the etiologic differential diagnosis of thumb anomalies. The concomitant occurrence of thumb duplication and hypoplasia, apparently as a result of the same systemic insult, suggests a close relationship between hypoplasia and duplication.

Adult↗
PubMed1991

Thumb's rule tested: visual angle of thumb's width is about 2 deg.

Measures of the size of various hand parts and their viewing distance when held at arm's length were made on one hundred and eighteen undergraduate students. A simple rule of thumb can be confirmed: Visual angle of the width of the thumb held at arm's length is about 2 deg. The thumbnail subtends about 1.5 deg and the index fingernail about 1 deg in width, when both are held at arm's length. These figures are good approximations for males and females, although a significant, direct, linear relationship exists between hand-part size and the visual angle of the part at arm's length.

Adult↗
PubMed1979

Arthrography as a method of diagnosing tear of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb ("gamekeeper's thumb").

Arthrography of the metacarpo-phalangeal (MP) joint of the thumb was performed on 47 thumbs. The normal arthrographic appearance shows a closed joint space, whereas leakage of contrast material indicates tear of the joint capsule with or without an associated tear of a stabilizing ligament. Arthrographic demonstration of the heads of the adductor pollicis muscle was found to be specific for tear of the ulnar collateral ligament (UCL) of the MP joint, a tear which is commonly responsible for its instability. Arthrography is suggested as a safe and accurate diagnostic examination for the early detection of tears of the UCL of the MP joint.

Adolescent↗
PubMed1990

[Thumb replacement operation using metacarpal distraction osteotomy as a secondary intervention after thumb amputation].

After thumb amputation distal to the MCP-1 joint, good results can be achieved with lengthening of the first metacarpal bone by an external fixateur if a correct technique is applied. In all our patients the lengthened thumb was mechanically stable and sensitive, thus improving the patient's ability to use the hand to grasp. Another advantage of this procedure is the relative simplicity of the method. Furthermore, the original nerve and vascular supply can be preserved.

Amputation, Traumatic↗
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↗
PubMed1990

Thumb duplication: surgical treatment and analysis of sequels.

Between 1978 and 1988, 50 thumb duplications were operated upon at either the orthopedic department of Hôpital Trousseau (Paris) or at l'Institut Français de la Main (Paris). Following Wassel's classification, we observed a large incidence of types IV, II and VII (in that order). There was a 30% incidence of associated anomalies. The average age at operation was 15 months. We were able to review 30 patients (31 thumbs) with a mean follow-up of 30.9 months. We divided our series into two groups depending on the operative protocol. Group A: 19 patients (20 thumbs), operated on between 1978 and 1982 and reviewed at 33 months on average. Group B: 11 patients (11 hands) operated on between 1983 and 1988 and reviewed with a mean follow-up of 28.5 months. All of the children were evaluated following Wassel's and Tuch's criteria. In groupe A, only five thumbs could be considered normal, or near normal upon this reexamination. All the others were affected by various sequels, which were essentially esthetic. Only two thumbs had a functional deficit, due to instability of the MP joint in one case, and stiffness of the two joints of the thumb in the other. These poor objective results were, however, not shared by the children and their parents, since 16 of them declared themselves satisfied with the appearance and the function of the thumb. 6 patients required further surgery with an average of 2.5 operations per patient. These secondary operations gave imperfect results: out of 6 such patients, we obtained 3 fair results, and three remained poor. This relatively high proportion of sequels in our patients in group A led us to change our treatment protocol in 1983. Our revised attitude was to treat all deformities at once, and especially axial deviation with a corrective osteotomy if soft tissue surgery alone did not afford perfect realignment of the thumb. Thus, among the 11 reviewed patients of group B, 6 results could be considered to be good, 4 suffered from slight sequels, and one patient required a secondary surgery (tenolysis of the extensor apparatus) to correct an inadequate active extension of the IP joint. This result was functionally good on review. The optimal age for operation is between 12 and 18 months. Il seems to us that bad results are apparent early, after 6 to 12 months, because they are mainly due to inadequate treatment. Conversely, good short-term results seem to persist with growth, but there is an overall paucity of studies in this field.

Classification↗
PubMed1979

Effect of thumb anaesthesia on weight perception, muscle activity and the stretch reflex in man.

1. We have confirmed the results of Gandevia & McCloskey (1977) on the effect of thumb anaesthesia on perception of weights lifted by the thumb. Weights lifted by flexion feel heavier and weights lifted by extension feel lighter. 2. The change in size of the long-latency stretch reflex in flexor pollicis longus or extensor pollicis longus after thumb anaesthesia cannot explain the effect on weight perception by removal or augmentation of the background servo assistance to muscular contraction. 3. During smooth thumb flexion, thumb anaesthesia increases e.m.g. activity in flexor pollicis longus and extensor pollicis longus for any given opposing torque. 4. During smooth thumb extension the opposite occurs: e.m.g. activity in both extensor and flexor pollicis longus decreases. 5. Clamping the thumb at the proximal phalanx to limit movement solely to the interphalangeal joint reduces or abolishes the effect of anaesthesia on both weight perception and e.m.g. activity during both flexion or extension tasks. 6. Gandevia & McCloskey's findings on the distorting effects of thumb anaesthesia on weight perception cannot be used to support the hypothesis of an efferent monitoring system of the sense of effort. Our results emphasize the close functional relationship between cutaneous and joint afferent information and motor control.

Anesthesia, Local↗
PubMed1992

Reconstruction of traumatic absence of the thumb by microvascular free tissue transfer from the foot.

The development of microvascular surgical techniques during the last quarter century has advanced the ability of the hand surgeon to reconstruct the traumatically amputated thumb. The use of tissue from the foot has become the mainstay of therapy for this previously exceedingly difficult reconstructive problem. Although numerous minor variations of thumb reconstruction with use of the toes from the foot are available, three main techniques--the complete great toe transfer, wraparound flap, and second toe transfer--provide a predictable outcome. With multiple donor sites available, the surgeon can choose a procedure based on the needs of the patient as well as the particular preferences of the individual surgeon involved. The uniform goal in thumb reconstruction is to provide a cosmetically acceptable, stable, mobile, and sensible thumb that can be used in opposition and pinch maneuvers. Transfer of the great toe can provide excellent reconstruction in the selected patient. This transfer may be the procedure of choice in the child who requires continued epiphyseal growth of the transferred digit. The esthetic appeal of this transfer is somewhat dependent on individual patient variation and the appearance of the toe relative to that of the contralateral uninjured thumb. In patients with a narrow great toe, the transfer can provide an ideal esthetic result. Disadvantages of this transfer are that it is less esthetic when the toe is very bulbous in appearance and that the resultant defect and morbidity in the donor foot may be significant, possibly affecting activities of daily living. The wraparound flap provides the unique ability to customize the thumb reconstruction. The final esthetic outcome of the thumb can be altered in nail size, circumference, and length. Use of the wraparound flap permits a greater portion of the great toe to be left with the foot in an attempt to preserve more normal gait and function postoperatively. This type of transfer does not permit interphalangeal joint motion and may not permit metacarpophalangeal joint motion. Therefore, the requirements of a normal carpometacarpal joint with excellent thenar musculature so that the postoperative thumb can be put through a functional arc of motion are essential. Transferring a portion of the distal phalanx in the wraparound flap permits the intercalary iliac crest graft to have viable bone on both the distal and proximal aspects, thereby reducing postoperative osteopenia of the iliac crest graft itself.(ABSTRACT TRUNCATED AT 400 WORDS)

Amputation, Traumatic↗
PubMed1991

Functional splinting versus plaster cast for ruptures of the ulnar collateral ligament of the thumb. A prospective randomized study of 63 cases.

In a prospective randomized study that included 63 consecutive thumbs with injuries of the ulnar collateral ligament of the metacarpophalangeal (MCP) joint of the thumb, plaster cast immobilization was compared with functional treatment with a splint. The splint allowed flexion and extension of the MCP joint, but prevented ulnar and radial deviation of the thumb. The study included both operated on and nonoperated on cases where surgery was performed only when the torn ligament was regarded as displaced. Of 40 thumbs treated nonsurgically, 21 were treated with a cast and 19 with a splint. Of 23 thumbs treated surgically, 10 were immobilized postoperatively in a plaster cast and 13 were treated with the splint. At the follow-up examination after 15 (11-41) months, there was no difference between the treatment groups as regards stability, range of motion, strength of the injured thumb, and length of sick leave. However, the patients considered the splint more comfortable than plaster cast immobilization. We conclude that immobilization of the thumb after a ligamentous injury with a movable splint is strongly preferred by the patients and that the functional results of this technique are equal to plaster cast immobilization after both surgical and nonsurgical treatment.

Adolescent↗
PubMed1991

Per Primam thumb replantation for all patients with traumatic amputations.

Forty-two complete thumb replantations performed between 1980 and 1984 were reviewed. The mean follow-up time was 14 months. Replantation was attempted for all thumb amputations regardless of mechanism or severity of injury. Sixteen (38%) failed intraoperatively or postoperatively. Thumbs with narrow zones of injury showed a significantly higher survival rate than those with wide zones of injury. Eighty percent of those with poor arterial flow intraoperatively ultimately failed, despite pharmacologic treatment and multiple vein-graft anastomoses. Two thumbs with no vein repairs ultimately survived. Reexploration for loss of perfusion succeeded in 60% of cases. Total metacarpophalangeal and proximal interphalangeal active motion postoperatively averaged 68 degrees. Median static two-point discrimination returned to 11 mm. Avulsed thumbs survived in 46% of cases. Replantation should be attempted in all cases of thumb amputation, as success cannot be predicted by mechanism or severity of injury. Thumbs with poor intraoperative flow (20%) or no venous return (50%) can survive and should not be primarily amputated. Vein grafting is not mandatory if shortening allows anastomoses to be tension free. Prompt reexploration of acute vascular occlusions is worthwhile.

Adult↗
PubMed1992

Perception of forces exerted by jaw and thumb.

By comparing the results of force matching between the jaw and the thumbs, whether subjects have any knowledge about the magnitude of exerted forces irrespective of the motor system was studied. Subjects were asked to match isometric forces of their own choice exerted by flexion of one of the thumbs with the jaw, and the other way around. The results were compared with control experiments in which subjects matched forces exerted by flexion of one of the thumbs with the other thumb and vice versa. None of the subjects was able to match correctly in all experimental conditions. All subjects displayed inconsistent matching behaviour, showing a mixture of correct matching and mismatching. This holds both for absolute matches (in N), and for matches relative to the maximal forces. The results show that knowledge about the magnitude of exerted forces is different for the jaw and the thumbs. Sensations about isometric forces exerted by the jaw or the thumbs are different within each subject and from subject to subject.

Bite Force↗
PubMed1991

[Irreducible palmar dislocation of the metacarpophalangeal thumb joint by a skiing accident].

Amongst the large number of severe sprains of the lateral ulnar ligament of the metacarpophalangeal joint of the thumb by skiing accidents which we treat each year as a result of our geographical situation, we have encountered an original lesion on two occasions. The patients were referred with unstable palmar dislocation of the metacarpophalangeal joint of the thumb despite an attempt of reduction under local anaesthesia performed at the ski resort by practitioners particularly well trained in this form of traumatology. On examination, the thumb was globally painful and presented a defect of active extension of the MP joint suggestive of a complex lesion of the extensor apparatus. X-rays showed palmar dislocation of the MP joint of the thumb. Surgical exploration in both cases revealed identical lesions: complete rupture of the two bundles of the lateral ulnar ligament of the MP joint of the thumb, whose distal extremities could be seen as soon as the skin was opened with incarceration of the extensor apparatus between the palmar surface of the neck of the first metacarpal and the dorsal surface of the first phalanx. Perfectly classical treatment consisted of a dorso-lateral incision to reduce the extensor apparatus and to suture the two bundles of the lateral ulnar ligament; immediately restoring the stability which is usually observed in "classical" severe sprains. The current result is good, entirely comparable to that of severe sprains of the MP joint of the thumb.(ABSTRACT TRUNCATED AT 250 WORDS)

Follow-Up Studies↗