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Purpose: To explore the results of using the mini-ring Ilizarov external fixator for thumb metacarpal lengthening and its compatibility with a simultaneous groin flap.
Methods: From May 2016 to June 2019, 17 adult patients with thumb loss were treated with metacarpal lengthening using a mini-ring Ilizarov device. The device was composed of 2 rings, threaded rods, nuts, and K-wires (diameter, 1.5 mm). Of these patients, 6 also underwent simultaneous groin flap transfer. Lengthening was started 3 days after surgery at a rate of 0.66 mm/d. The pedicle of the groin flap was divided 1 month after the surgery. The healing index (days per cm), which denotes the number of days the external fixator is attached to the bone per centimeter of length gained, was used to evaluate the lengthening efficiency.
Results: The patients were observed for 21.9 ± 9.0 months. The lengthening continued for 29.1 ± 4.5 days, resulting in an additional length of 1.9 ± 0.3 cm.
Conclusions: The mini-ring Ilizarov external fixator is a simple device for primary metacarpal lengthening. This device can be used with a groin flap for single-stage lengthening of injured thumbs with bone exposure.
Type Of Study/level Of Evidence: Therapeutic IV.
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http://dx.doi.org/10.1016/j.jhsa.2022.09.008 | DOI Listing |
JBJS Essent Surg Tech
September 2025
Division of Hand and Reconstructive Microsurgery, Department of Orthopedics, Olympia Hospital & Research Centre, Trichy, Tamilnadu, India.
Background: Extensor indicis proprius (EIP) transfer augmented with proximal extensor pollicis longus (EPL) stump lengthening restores thumb extension and optimizes function in cases of chronic EPL tendon ruptures, which impair hand dexterity and fine motor skills. Traditional EIP-to-EPL transfers often disrupt the natural oblique course of the EPL around the Lister tubercle, leading to functional deficits. This dual-tendon transfer preserves anatomical alignment and improves thumb biomechanics, enhancing extension strength and the adduction moment arm at the carpometacarpal (CMC) joint.
View Article and Find Full Text PDFEplasty
November 2024
Florida Orthopaedic Institute, Hand and Upper Extremity Department, Temple Terrace, Florida.
A novel technique that requires a single-stage operation utilizing an intramedullary device is presented for metacarpal lengthening in setting of traumatic malunions. The patient desired surgical correction due to malrotation with full fist formation and a 25-degree extensor lag. Following single-stage lengthening with osteotomy, bone graft, and intramedullary screw, length was restored and the patient had full passive range of motion.
View Article and Find Full Text PDFBackground: Thumb trapeziometacarpal joint (TMj) contact area, pressures, and stability were quantified during metacarpal osteotomy and distraction lengthening with and without TMj-spanning fixation in a cadaver model. Spanning fixation was hypothesized to decrease TMj contact pressure, contact area, joint space narrowing, and subluxation compared with metacarpal fixation alone.
Methods: Twenty matched-paired cadaver specimens underwent ligament-sparing thumb TMj dissection.
J Orthop Case Rep
April 2025
Department of Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, OR, 97239, USA.
Introduction: In the critically ill patient with severe sepsis and persistent hypotension, mitigating ischemia to the distal extremities is often not the priority. However, when vasopressor-induced ischemia leads to partial distal extremity loss, this can present a complex reconstructive challenge.
Case Report: We present a case of reconstructive surgical management of multiple distal extremity loss induced by prolonged vasopressor use for treatment of septic shock, with thumb reconstruction through pollicization of a partially amputated index finger and foot salvage using a free neurotized anterolateral thigh (ALT) flap for sensate reconstruction.
J Plast Reconstr Aesthet Surg
December 2024
Department of Orthopedic Surgery, Kansai Medical University Hospital, Osaka, Japan.
Distraction lengthening of digits enhances hand function in patients with congenital phalangeal defects or traumatic hand amputations. Although callotasis is a useful distraction lengthening method, it is challenging and often results in various complications and prolonged fixation. Based on our experiences, we attempted to develop innovations to reduce the fixation period.
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