Thiphalangeal thumb is characterized by interposition of an extraphalanx between the two normal phalanges of the thumb. The extra-phalanx varies from a small triangular bone to a normal phalanx in what appears to be a thumbless five fingered hand. Triphalangeal thumbs are divided into three types and the treatment differs from associated anomalies and clinical features. We had a bilateral triphalangeal thumbs treated by closed wedge osteotomy to the extra-phalanx.
Fingers ; Hand ; Osteotomy ; Thumb

The reconstruction of a mutilated thumb is one of the most fascinating aspect of hand surgery. The hand deprived of the thumb loses approximately 40 per cent of its function. it corresponds to a total body loss of 22 per cent, which is compatible with the loss of an eye. Recently reconstructive operations were performed for the restoration of the mobility, sensibility, and length of thumb. 4-flap Z-plasty were performed for the skin contracture in the first web space. For the sensibility, we transferred the neurovascular island flap from the middle or ring fingers. And we reconstructed the loss of thumb by pollicization, microsurgical reattachment, and toe-to-thumb transfer operation. We selected 11 cases who were followed over one year after operation.
Contracture ; Fingers ; Hand ; Skin ; Thumb

To investigate the relationship of skeletal maturity among the normal occlusion group and each malocclusion groups, the author used hand and wrist X-ray of 133 Korean 13 year old boys (normal occlusion 30, Class I malocclusion 35, Class II malocclusion 35 and Class III malocclusion 33) and assessed their skeletal maturity. In this study, fourteen skeletal maturity stages were selected from; Radius, Hamate, Pisiform, Ulnar sesamoid of the metacarpophalangeal joint of the first thumb, proximal phalanges of the first, second and third finger, middle and distal phalanx of the third finger. The difference of skeletal maturity of each malocclusion groups in relative to normal occlusion group and that of each malocclusion groups were analyzed. The findings of this study can be summerized as follows: 1. Average skeletal maturity stage of each groups were MP3cap stage in normal occlusion group, H-2 stage in Class I malocclusion group, midstage between S and H-2 stage in Class II malocclusion group, MP3cap stage in Class III malocclusion group. 2. There was no significant difference in skeletal maturity of Class J malocclusion and Class III malocclusion groups in relative to normal occlusion group. 3. There was significant retardation of skeletal maturity in Class II malocclusion group in relative to normal occlusion group. 4. There was no significant difference in skeletal maturity between Class I and Class II malocclusion groups. 5. There was no significant difference in skeletal maturity between Class I and Class III malocclusion groups. 6. There was significant retardation of skeletal maturity in Class II malocclusion group in relative to Class III malocclusion group.
Adolescent ; Fingers ; Hand ; Humans ; Malocclusion* ; Metacarpophalangeal Joint ; Radius ; Thumb ; Wrist

Injury of the hand has been steadily increasing in this country in recent years, accordingly the proper surgical care for recently injured hand can not be overemphasized. The author has experienced 25 cases of wringer injuries of the hand in the years 1965 to 1971, and the results of the treatment is reported in this paper. 1. 12 cases out of 25 were in age group between 16 to 20 year. 23 cases were male and two cases were female. The incidence was remarkably higher in male. 2. Mode of the injury; All the cases were injured on the joh in factory. 17 cases were injured by a roller machine with or without gears. Four cases were injured by a belt, and three cases were injured by a pressor. 3. Extent of the injury was classified in 10 groups. Avulsion of the skin below the palmar crease were six cases, and below the wrist were in other groups. 4. Fracture and traumatic amputation in the hands were complicated in 16 cases out of 25. 5. 20 cases out of 25 were treated with primary skin repair followed by debridement of the wound. Among them three cases obtained primary healing, and 17 cases had to be treated by repeating surgeries. Five cases out of 25 were treated with delayed primary skin graft, and four cases obtained primary healing. Accordingly the delayed primary skin graft had much better result than primary skin repair in this series. 6. 19 cases out of 25, had surgical amputation in the hands, among them 16 cases had complicated with fracture and traumatic amputation. The incidence of surgical amputation was higher on the proximal phalanx in 33 fingers out of 59 surgically amputated fingers. 7. 23 cases out of 25 were treated by skin graft. The result of primary healing in primary skin graft was three out of 12, and that of secondary skin graft was five out of six, and that of third skin graft was seven out of 10, and that of fourth skin graft was five out of seven, and that of fifth skin graft was one case. Accordingly, the result of primary healing was considerably higher in the group of the secondary skin graft. 18 cases out of 23 of skin graft were split thickness graft, four were full thickness graft and one was full thickness combined with split thickness skin graft. 8. Seven cases of contracture developed in the webs and joints after the healing of the skin graft were treated by web plasty and arthrodesis. One case had had surgical amputation of four fingers at the metacarpophalangeal joints was treated by resection of the second and third metacarpus, which made the hand possibIe to pinch and grasp.
Amputation ; Amputation, Traumatic ; Arthrodesis ; Contracture ; Debridement ; Female ; Fingers ; Hand Strength ; Hand ; Humans ; Incidence ; Joints ; Male ; Metacarpophalangeal Joint ; Metacarpus ; Skin ; Transplants ; Wounds and Injuries ; Wrist

PURPOSE: Pollicization typically involves surgical migration of the index finger to the position of the thumb. This procedure facilitates the conversion of a useless hand into a well-functioning one in patients who are not amenable to the toe-to-hand transfer. However, middle finger pollicization has been rarely reported. MATERIALS AND METHODS: We reconstructed a thumb by immediate pollicization of the remnants of the middle finger in two patients who sustained a tumor and a trauma, respectively. The former, after cancer ablation was performed, has not been reported literally, and the latter involved free devitalized pollicization of the middle finger using a microsurgical anastomosis. The distal third extensor communis tendon was sutured to the proximal extensor pollicis longus tendon and the distal flexor digitorum superficialis and profundus were sutured to the proximal flexor pollicis longus. The abductor pollicis brevis tendon was sutured to the distal end of the first palmar interosseous muscle. Coaptation of the third digital nerve and the superficial radial nerve branch was performed. RESULTS: Patients showed uneventful postoperative courses without complication such as infection or finger necrosis. Based on the principles of pollicization, a wide range of pinch and grasp movements was successfully restored. They were pleased with the functional and cosmetic results. CONCLUSIONS: Although the index finger has been the digit of choice for pollicization, we could also use the middle finger on specific occasions. This procedure provides an excellent option for the reconstruction of a mutilated thumb and could be performed advantageously in a single step.
Fingers* ; Hand ; Hand Strength ; Humans ; Necrosis ; Radial Nerve ; Tendons ; Thumb

Cheiro-oral syndrome is a unilateral sensory impairment that is restricted to the homolateral hand and perioral area. An unusual clinical presentation with bilateral perioral involvement has also been described. Most of the responsible lesions involved the paramedian pontine tegmentum; thalamic involvement is extremely rare. We report herein a patient who presented with purely sensory symptoms involving the bilateral perioral regions and the distal thumb and index finger of the left hand following a small infarction in the right lateral thalamus.
Fingers ; Hand ; Humans ; Infarction ; Thalamus ; Thumb

PURPOSE: Thumb hypoplasia gives rise to various derangement of hand functions, leading to various degrees of malformation. The treatment of choice for grade IV or V congenital hypoplasia of the thumb, classified by Buck-Gramcko's criteria, is the pollicization of the index finger. The purpose of this article is to review the clinical usefulness of pollicization for more than grade IV hypoplasia. MATERIALS AND METHODS: Three grade IV and 3 grade V hypoplastic thumbs in 6 patients, one with radial club hand, were reviewed retrospectively. They underwent pollicization between 1987 and 1997. The index metacarpi were osteotomized for shortening and readjusted by pronation. To evaluate postoperative function, authors used the criteria of Sundararaj and Mani. RESULTS: Except for the exclusion of one patient, four had excellent and one had good functional statuses. CONCLUSION: Pollicization was considered to be worthwhile for functional improvement of the hands in more than grade IV congenital hypoplasia of the thumb.
Fingers ; Hand ; Humans ; Pronation ; Retrospective Studies ; Thumb*

The human hand is a highly sophisticated tool of sensibility and prehension, and the reconstruction of injured hands are essential to not only reconstruct of hand function but also reconstruct of body. Seven cases of tendocutaneous flap, a case of osteocutaneous flap, nine cases of thumb reconstruction with a free neurovascular wrap-around flap from the big toe, two cases of second toe-to-index trander, and a case of left ring finger to right index finger transfer were performed at the Department of Orthopedic Surgery of Hanyang University Hospital, and satisfactory results were obtained both comsmetically and functionally.
Fingers ; Hallux ; Hand ; Humans ; Microsurgery ; Orthopedics ; Thumb

Loss of radial nerve function in the hand results in a significant disability and so cannot extend the wrist, thumb & fingers according to the injury levels. Therefore the patient has great difficulty in grasping objects, especially power grip. Tendon transfers to restore function of extension of wrist and fingers are among the the best − most predictable transfers in the upper extremity. We performed 13 cases of tendon transfers for radial nerve palsy and extensive extensor ruptures from 1987 to 1993. The results were evaluated according to Arbitrary Value Method. Among 13 cases 30% of excellent, 46% of good, 24% of fair and no poor result were obtained and the better results were obtatined in low radial nerve lesion.
Fingers ; Hand ; Hand Strength ; Humans ; Methods ; Paralysis ; Radial Nerve ; Radial Neuropathy ; Rupture ; Tendon Transfer ; Tendons ; Thumb ; Upper Extremity ; Wrist

PURPOSE: Thumb reconstruction plays most important role in hand injuries because total loss of a thumb constitutes about 40% disability in the hand. The reconstruction can be accomplished by pollicization, free toe-to-thumb transfer, wrap around procedure and lengthening extraction. However, we sometimes need consecutive or double free flaps in the reconstruction of mutilating hand injuries. METHODS: We reconstructed a mutilating hand injury in a 54-years old man. Because of severe crushing injury of right thumb and index fingers, we reconstructed a thumb with pollicization using nearly amputated middle finger. Although it survived completely, the adjacent soft tissues which had been covered by fillet flap from the space past was necrosed on 1 month. We debrided the necrotic tissues and covered it with anteromedial thigh perforator free flap consecutively because he had an anatomical variation in branches of lateral femoral circumflex artery. RESULTS: He had an uneventful postoperative course without any complication such as infection, dehiscence and flap necrosis. Three months later, he had undergone tenolysis and defatting procedure of flap site. He recovered the some amount of grip function and was happy with the result. CONCLUSIONS: In severe hand trauma including thumb amputation, thumb reconstruction using pollicization and perforator free flap could be an alternative option. It provides minimal donor site morbidity and an acceptable functional result.
Amputation ; Fingers ; Free Tissue Flaps ; Hand ; Hand Injuries ; Hand Strength ; Humans ; Necrosis ; Thigh ; Thumb ; Tissue Donors