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Başparmağın distal amputasyonlarında proksimal falanksın distraksiyon yöntemi ile uzatılması

Year 2015, , 227 - 232, 17.07.2015
https://doi.org/10.3944/AOTT.2015.14.0292

Abstract

Amaç: Başparmağın amputasyonu el fonksiyonlarında kısıtlanma yaratan önemli bir etkendir. Başparmağın distal amputasyonlarının tedavisi tartışmalıdır. Her ne kadar parmakların distraksiyon yöntemi ile uzatılması parmakların uzunluğunu ve fonksiyonunu tekrar sağlamak için uygulanan yöntemlerden biri olsa da, literatür araştırmamızda başparmak amputasyonlarının tedavisi için falanks uzatmasına yönelik bir yayın bulamadık. Başparmağın interfalangial (İF) eklem seviyesi veya civarındaki amputasyonlarında proksimal falanksın uzatılması ile tedavi edilen hastaların sonuçlarını değerlendiren bir çalışma düzenledik.Çalışma planı: Distraksiyon yöntemi ile proksimal falanksları uzatılan hastalar geriye dönük olarak değerlendirildi. Osteotomi, ya ilk ameliyat esnasında ya da ikinci aşamada yapıldı. Osteotomiden 10 gün sonra bir eksternal fiksatör üzerinden distraksiyona başlandı. Bu fiksatör oluşan boşluğun kemikleşmesine kadar yerinde bırakıldı. Kemik grefti kullanılmadı. Hastalar QuickDASH skorlaması ile değerlendirildi.Bulgular: 14 hastanın ortalama yaşı 27, ortalama takip süresi 7 yıl idi. Falankslar ortalama olarak 20 mm. uzatıldı. Tüm uzatma bölgeleri kemikleşti. Fiksatörlerin çıkarılma zamanları ortalama 85 gün, iyileşme indeksi ortalaması 42.5 gün/cm idi. 14 hastanın tümünde amaçlanan falanks uzatmasına, kaynamama, erken kaynama veya belirgin infeksiyon gibi major komplikasyonlar gelişmeden, ulaşıldı.Çıkarımlar: Başparmağın distal amputasyonlarının rekonstrüksiyonu için proksimal falanksın distraksiyon yöntemi ile uzatılması, başparmağın mutlak uzunluğunun ve web aralığının arttırılması ve daha iyi bir kavrama mesafesi yaratmak için kullanılabilir. Güvenli ve etkili olan bu yöntem, fonksiyonu ve görünüşü iyileştirirken, düşük komplikasyon riskine sahiptir.

References

  • Matev IB. Thumb reconstruction after amputation at the interphalangeal joint by gradual lengthening of the proxi- mal phalanx. A case report. Hand 1979;11:302–5.
  • Institute for Work & Health. The Quick DASH. Toronto, Ontario, Canada: The DASH Outcome Measure; 2013. Available from: http://dash.iwh.on.ca/.
  • Düger T, Yakut E, Öksüz Ç, Yörükan S, Bilgütay BS, Ayhan Ç ve ark. Kol, Omuz ve El Sorunları (Disabilities of the Arm, Shoulder and Hand - DASH) Anketi Türkçe uyarlamasının güvenirliği ve geçerliği. Fizyoter Rehabil 2006;17:99–107.
  • Azari KK, Andrew Lee WP. Thumb reconstruction. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, editors. Green’s Operative Hand Surgery. 6th ed. Vol. 2., Philadelphia, PA: Elsevier; 2011. p. 1839–82.
  • Koman LA, Poehling GG, Price JL Jr. Thumb reconstruc- tion-an algorithm. Orthopedics 1986;9:873–8.
  • Muzaffar AR, Chao JJ, Friedrich JB. Posttraumatic thumb reconstruction. Plast Reconstr Surg 2005;116:103–22.
  • Heitmann C, Levin LS. Alternatives to thumb replanta- tion. Plast Reconstr Surg 2002;110:1492–505.
  • Ratliff AH. Amputations of the distal part of the thumb. Hand 1972;4:190–3.
  • Sawaizumi T, Ito H. Lengthening of the amputation stumps of the distal phalanges using the modified Ilizarov method. J Hand Surg Am 2003;28:316–22.
  • Del Piñal F, Moraleda E, de Piero GH, Ruas JS, Galin- do C. Onycho-osteo-cutaneous defects of the thumb re- constructed by partial hallux transfer. J Hand Surg Am 2014;39:29–36.
  • Matev IB. The bone-lengthening method in hand re- construction: twenty years’ experience. J Hand Surg Am 1989;14(2 Pt 2):376–8.
  • Brooks D, Buncke GM, Buncke HJ. Distraction osteogen- esis after toe-to-thumb transplantation. Plast Reconstr Surg 2002;109:2434–8.
  • Lee JW, Chiu HY, Hsu HY. Distraction lengthening of a replanted digit. Plast Reconstr Surg 1995;96:1438–41.
  • Lesley NE, Pirela-Cruz MA. Distraction lengthening of the thumb following replantation. J Reconstr Microsurg 2005;21:161–5.
  • Seitz WH Jr, Froimson AI. Digital lengthening using the callotasis technique. Orthopedics 1995;18:129–38.
  • Ünal MB, Cansü E, Parmaksizoğlu F. Lengthening of a thumb distal phalanx replanted to its metacarpus because of loss of the proximal phalanx: case report. J Hand Surg Am 2011;36:661–4.
  • Matev I. Thumb metacarpal lengthening. Tech Hand Up Extrem Surg 2003;7:157–63.
  • Parmaksizoğlu F, Beyzadeoğlu T. Lengthening of the pha- langes by callus distraction in traumatic amputations of the fingers. [Article in Turkish] Acta Orthop Traumatol Turc 2004;38:60–6.
  • Salom M, Aroca JE, Chover V, Alonso R, Vilar R. Dis- traction-lengthening of digital rays using a small external fixator. J Hand Surg Br 1998;23:781–4.
  • Finsen V, Russwurm H. Metacarpal lengthening after traumatic amputation of the thumb. J Bone Joint Surg Br 1996;78:133–6.
  • Sommer NZ, Brown RE. The Perionychium. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, editors. Green’s Operative Hand Surgery. 6th ed. Vol. 1. ,Philadel- phia, PA: Elsevier; 2011. p. 333–54.

Distraction lengthening of the proximal phalanx in distal thumb amputations

Year 2015, , 227 - 232, 17.07.2015
https://doi.org/10.3944/AOTT.2015.14.0292

Abstract

Objective: Thumb amputation is a major cause of hand dysfunction, and the treatment for distal thumb amputations remains controversial. Although finger reconstruction methods using distraction lengthening are known to restore finger length and function, we found no reports in the literature regarding phalangeal lengthening in thumb amputations. We aimed to evaluate proximal phalangeal lengthening in thumb amputations at or near the interphalangeal (IP) joint.
Methods: We retrospectively evaluated patients who had undergone distraction lengthening of the proximal phalanx of the thumb. All patients underwent osteotomy, either during the initial procedure or as a second-stage procedure. Distraction began 10 days after osteotomy with the use of an external fixator that remained in place until ossification of the gap occurred without bone grafting. Patients were evaluated using the QuickDASH score.
Results: Fourteen patients with a mean age of 27 years and a mean follow-up period of 7 years were enrolled. The mean phalangeal lengthening achieved was 20 mm. Ossification occurred at all distraction sites, and the fixators were maintained for a mean of 85 days. The mean healing index was 42.5 days/cm. All 14 patients achieved the desired amount of phalangeal lengthening without major complications such as nonunion, premature union, or gross infection.
Conclusion: For reconstruction in cases of distal thumb amputations, distraction lengthening of the proximal phalanx can be used to improve absolute length, web space, and grip distance. The technique is safe and effective, improves functionality/cosmesis, and offers a low complication risk.

References

  • Matev IB. Thumb reconstruction after amputation at the interphalangeal joint by gradual lengthening of the proxi- mal phalanx. A case report. Hand 1979;11:302–5.
  • Institute for Work & Health. The Quick DASH. Toronto, Ontario, Canada: The DASH Outcome Measure; 2013. Available from: http://dash.iwh.on.ca/.
  • Düger T, Yakut E, Öksüz Ç, Yörükan S, Bilgütay BS, Ayhan Ç ve ark. Kol, Omuz ve El Sorunları (Disabilities of the Arm, Shoulder and Hand - DASH) Anketi Türkçe uyarlamasının güvenirliği ve geçerliği. Fizyoter Rehabil 2006;17:99–107.
  • Azari KK, Andrew Lee WP. Thumb reconstruction. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, editors. Green’s Operative Hand Surgery. 6th ed. Vol. 2., Philadelphia, PA: Elsevier; 2011. p. 1839–82.
  • Koman LA, Poehling GG, Price JL Jr. Thumb reconstruc- tion-an algorithm. Orthopedics 1986;9:873–8.
  • Muzaffar AR, Chao JJ, Friedrich JB. Posttraumatic thumb reconstruction. Plast Reconstr Surg 2005;116:103–22.
  • Heitmann C, Levin LS. Alternatives to thumb replanta- tion. Plast Reconstr Surg 2002;110:1492–505.
  • Ratliff AH. Amputations of the distal part of the thumb. Hand 1972;4:190–3.
  • Sawaizumi T, Ito H. Lengthening of the amputation stumps of the distal phalanges using the modified Ilizarov method. J Hand Surg Am 2003;28:316–22.
  • Del Piñal F, Moraleda E, de Piero GH, Ruas JS, Galin- do C. Onycho-osteo-cutaneous defects of the thumb re- constructed by partial hallux transfer. J Hand Surg Am 2014;39:29–36.
  • Matev IB. The bone-lengthening method in hand re- construction: twenty years’ experience. J Hand Surg Am 1989;14(2 Pt 2):376–8.
  • Brooks D, Buncke GM, Buncke HJ. Distraction osteogen- esis after toe-to-thumb transplantation. Plast Reconstr Surg 2002;109:2434–8.
  • Lee JW, Chiu HY, Hsu HY. Distraction lengthening of a replanted digit. Plast Reconstr Surg 1995;96:1438–41.
  • Lesley NE, Pirela-Cruz MA. Distraction lengthening of the thumb following replantation. J Reconstr Microsurg 2005;21:161–5.
  • Seitz WH Jr, Froimson AI. Digital lengthening using the callotasis technique. Orthopedics 1995;18:129–38.
  • Ünal MB, Cansü E, Parmaksizoğlu F. Lengthening of a thumb distal phalanx replanted to its metacarpus because of loss of the proximal phalanx: case report. J Hand Surg Am 2011;36:661–4.
  • Matev I. Thumb metacarpal lengthening. Tech Hand Up Extrem Surg 2003;7:157–63.
  • Parmaksizoğlu F, Beyzadeoğlu T. Lengthening of the pha- langes by callus distraction in traumatic amputations of the fingers. [Article in Turkish] Acta Orthop Traumatol Turc 2004;38:60–6.
  • Salom M, Aroca JE, Chover V, Alonso R, Vilar R. Dis- traction-lengthening of digital rays using a small external fixator. J Hand Surg Br 1998;23:781–4.
  • Finsen V, Russwurm H. Metacarpal lengthening after traumatic amputation of the thumb. J Bone Joint Surg Br 1996;78:133–6.
  • Sommer NZ, Brown RE. The Perionychium. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, editors. Green’s Operative Hand Surgery. 6th ed. Vol. 1. ,Philadel- phia, PA: Elsevier; 2011. p. 333–54.
There are 21 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Eren Cansu This is me

Mehmet Unal This is me

Fatih Parmaksizoglu This is me

Serkan Gurcan This is me

Publication Date July 17, 2015
Published in Issue Year 2015

Cite

APA Cansu, E., Unal, M., Parmaksizoglu, F., Gurcan, S. (2015). Distraction lengthening of the proximal phalanx in distal thumb amputations. Acta Orthopaedica Et Traumatologica Turcica, 49(3), 227-232. https://doi.org/10.3944/AOTT.2015.14.0292
AMA Cansu E, Unal M, Parmaksizoglu F, Gurcan S. Distraction lengthening of the proximal phalanx in distal thumb amputations. Acta Orthopaedica et Traumatologica Turcica. July 2015;49(3):227-232. doi:10.3944/AOTT.2015.14.0292
Chicago Cansu, Eren, Mehmet Unal, Fatih Parmaksizoglu, and Serkan Gurcan. “Distraction Lengthening of the Proximal Phalanx in Distal Thumb Amputations”. Acta Orthopaedica Et Traumatologica Turcica 49, no. 3 (July 2015): 227-32. https://doi.org/10.3944/AOTT.2015.14.0292.
EndNote Cansu E, Unal M, Parmaksizoglu F, Gurcan S (July 1, 2015) Distraction lengthening of the proximal phalanx in distal thumb amputations. Acta Orthopaedica et Traumatologica Turcica 49 3 227–232.
IEEE E. Cansu, M. Unal, F. Parmaksizoglu, and S. Gurcan, “Distraction lengthening of the proximal phalanx in distal thumb amputations”, Acta Orthopaedica et Traumatologica Turcica, vol. 49, no. 3, pp. 227–232, 2015, doi: 10.3944/AOTT.2015.14.0292.
ISNAD Cansu, Eren et al. “Distraction Lengthening of the Proximal Phalanx in Distal Thumb Amputations”. Acta Orthopaedica et Traumatologica Turcica 49/3 (July 2015), 227-232. https://doi.org/10.3944/AOTT.2015.14.0292.
JAMA Cansu E, Unal M, Parmaksizoglu F, Gurcan S. Distraction lengthening of the proximal phalanx in distal thumb amputations. Acta Orthopaedica et Traumatologica Turcica. 2015;49:227–232.
MLA Cansu, Eren et al. “Distraction Lengthening of the Proximal Phalanx in Distal Thumb Amputations”. Acta Orthopaedica Et Traumatologica Turcica, vol. 49, no. 3, 2015, pp. 227-32, doi:10.3944/AOTT.2015.14.0292.
Vancouver Cansu E, Unal M, Parmaksizoglu F, Gurcan S. Distraction lengthening of the proximal phalanx in distal thumb amputations. Acta Orthopaedica et Traumatologica Turcica. 2015;49(3):227-32.