Surgical Management of Congenital Fourth and Fifth Metacarpal Synostosis

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Journal of the Korean Society for Surgery of the Hand 1999;4(1):94-101.
Published online January 1, 1999.

Duke Whan Chung,Ki Tack Kim

제 4-5 중수골의 선천성 골결합의 치료

정덕환,김기택

Abstract

Congenital Metacarpal synostosis is one of the rare congenital anomalies in hand. The condition frequently associate with anomalies of other part of the body. This deformity itself usually present gross abnormality in hand without significant functional deficit because of the most of the synostosis presented between 4th and 5th metacarpal bones. Because of the not so significant functional disabilities, the management of the condition were just observation without surgical correction. However the patients with this anomaly cannot make fist perfectly, the significant abduction deformity of the little finger makes the hand grotesque looking especially in bilateral involvement. Most of the patients and parents wish correcting the deformity and improvement of the hand function. We underwent surgical management in 11 cases of 6 children from 1984 to 1998. Five of six patients had bilateral synostosis of 4th and 5th metacarpal bones. The surgical procedures are separation osteotomy followed by interpositional graft. The materials which used in interposition were silicone sheet in four cases, rib cartilage in four cases, fascio-adipose tissue of hand dorsum in four cases including one case of additional operation in recurred case. Among eleven surgical cases, one case with silicone interposed case was recurred synostosis during follow-up period. Average abduction angle of the fifth finger was 47 degree before surgical treatment, all of the cases with surgical cases corrected the angle less than 15 degree after surgical intervention including recurred case which had two times operation.

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