Congenital Malformations Of Thumb Surgery

Objective: This study was designed by different surgical treatment of thumb polydactyly and three phalanx thumb deformity comparative study and treatment of scoliosis in modified joint cross stellate incision investigate the clinical efficacy of the treatment of multi-finger thumb deformity and three phalanx thumb deformity.Methods: From January 2003 to December 2014 in our hospital 32 cases of children with congenital malformations 40 thumb finger.Wherein WasselIV type thumb polydactyly 26 refers to 22 cases,10 cases of thumb phalanx three 14 fingers.WasselIV type of thumb polydactyly children were using the traditional surgical Bilhaut-Cloquet(A group,14 fingers)and improved surgical Bilhaut-Cloquet(group B,12 refers).Three phalanx of thumb malformation were used by traditional means lateral longitudinal incision(group C,6 refers)and improved cross-stellate incision(D group,8 refers).Group A: do the thumb metacarpal dorsal wedge-shaped notch dorsal incision through the nail and nail bed,the incision extends proximally to thumb crotch.Regroup and nail bed separation of subcutaneous tissue,and exposed phalanx articular surface on both sides of the thumb,the articular surface of both longitudinal wedge cut thumb phalanx,tendon and joint capsule of interphalangeal removed,etc,etc,carefully docking distal phalanges epiphyseal articular surface and the remaining portion of the Kirschner wire fixation rampant.Nail repair,suturing the skin.Group B: the thumb metacarpal dorsal tend to do well developed thumb wedge-shaped notch dorsal incision through dysplasia thumb nail and nail bed,the incision can extend proximally until the thumb crotch.Retention of well-developed thumb interphalangeal joint surface,careful dissection of the joint capsule and lateral collateral ligament in the joint capsule and ligaments of the distal cut at Fu Li,exposed joints,removal of abnormal fingers.Release the other side of the joint capsule and the lateral collateral ligament,reset joints,longitudinal Kirschner wire fixation.Good position for the joints,the joint capsule and ligament reconstruction distal dead point sutured to refer metacarpal nail nail bed unequal suture to maintain joint stability,suturing the skin.Group C: surgery on the thumb side of the maximum degree of scoliosis do longitudinal incision,separating the subcutaneous tissue,to protect the neurovascular bundle separation refers to the palm side of the longitudinal incision of the joint capsule,a ? bone removal,protection distal phalanx epiphysis,loosen the other side of the capsular contracture,the thumb is completely correct scoliosis,longitudinal Kirschner wire fixation interphalangeal joint,such as the interphalangeal joints do not match,instability,the need to correct phalangeal osteotomy wedge,cross Kirschner fixed,tight suture joint capsule and skin.Group D: According to the preoperative assessment of the convex side of the thumb interphalangeal joints marker pen to draw lines cross stellate incision line.Cut along the marked line,transverse incision the tip of the thumb pointing,no more than the dorsal midline longitudinal incision phalanx distance of not more than 1/2,the removal of excess skin in the doji,a large degree of scoliosis patients,transverse incision may be appropriate Some multi-cut.Note that protection refers artery and nerve.Completely cut the convex side,the need to cut off the distal end of the lateral collateral ligament,it is best to retain their Fuli point distal to cut triangle intermediary phalanx repair after suture.Revealed superfluous phalanx,interphalangeal joint.WoodI type removal triangle phalanx reset interphalangeal joint,as there are still scoliosis,row proximal phalanx osteotomy to correct the skew interphalangeal joint,cross Kirschner wire fixation.Suture collateral ligament and joint capsule.As Fuli point can not be sewn can rebuild only point stitches.Wood ?type row proximal interphalangeal joint resection osteotomy to correct scoliosis and long phalanges,so the thumb is no longer than the index finger proximal interphalangeal joint,0.8mm or 1-0mm pinning.Cross star tight suture the incision,such as excessive skin can be trimmed again,so that the convex side of the thumb does not produce bloated skin.Results: The group of 32 cases obtained after 12 to 48 months of follow-up,an average of 24 months.It does not appear wound infection,skin necrosis,Kirschner loss,osteotomy nonunion,interphalangeal joint instability,ulnar deformity recurrence and so on.A group compared with group B,group C and group D,group B,group D joint activity increased(P<0.05),joint stability improvement(P<0.05),skeletal lines of force improvement(P<0.05),subjective evaluation to improve the appearance of the family(P<0.05).A group of 5 means excellent,good in 6 refers to the difference between the 3 fingers,good rate of 78.5%.Group B 5 means excellent,good in 5 refers to the difference between the two means,good rate of 83.3%,A,B two groups showed no significant difference(P>0.05).Group C 2 refers to the excellent,good 3 refers to the difference between a finger,good rate of 83.3%.Group D 4 refers to the excellent,good 3 refers to the difference between a finger,good rate of 87.5%,C,D difference was not statistically significant(P> 0.05).Conclusion: Through this group of patients were followed up recently,we can see the surgery thumb polydactyly and three phalanx thumb deformity can not only improve the function of the thumb,and can significantly change the appearance of the thumb.Especially the application of improved cross stellate incision,avoid three phalanx thumb deformity Scoliosis refers to the convex side of the longitudinal and transverse directions skin bloated in interphalangeal joint,thumb affect the function and appearance.The patients need long-term follow-up,to further clarify the long-term efficacy.