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Journal of the Korean Society for Surgery of the Hand 2000;5(2):177-181.
Published online June 1, 2000.
RECONSTRUCTION OF CONGENITAL FLOATING THUMB
Duke Whan Chung, Chae Ik Chung
선천성 부유 무지의 재건
정덕환, 정재익
Abstract
Authors underwent 9 cases of hypoplastic thumb reconstruction from 1985-1999 among the 13 cases of Mueller type III thumb(clinically floating thumb). The surgical procedures were composed by autogenous bone graft and internal fixation followed by secondary callotasis. The average age at first operation was 2 years 7 months old. The harvested site of bone graft were three iliac crest, four rib and two cases of the second metacarpal splited bone graft. One case was fractured at graft bone after removal of plate, the another eight cases achived the solid bone union derung the follow up period. The seven patients were able to the tip to tip pinch but, in two patients were able to the side to side pinch only. All patients were satisfied with preserving the thumb, but dissatisfied the cosmetic appearance and decreased grip and pinch power compared with normal side. The motion of interphalangeal joint and stronger grip power were presented in six patients who had flexor and extensor pollicis longus tendon. One patient complained the pain during hand motion. Normal digital sensation was presented in all patients. The conventional principle of hypoplastic thumb with the first metacarpal hypoplasia with or without carpometacarpal joint stability were ablation and another finger pollicization. But, in Korea, we considered the parent didn't agree the ablation and young patient will feel the sense of alienation if he or she will treat by pollicization. With these reasons, we performed interposional bone graft at the bone defect site of the first metacarpal base and positioned the thumb in opposition that convert the hypoplastic floating thumb to stable oppositional thumb which can preserve the functioning thumb.
 
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