PMC6409146_01
Volar (A) and dorsal (B) preoperative photographic views of a 5-year-old girl with a non-usable right thumb since birth.
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F1
On physical exam, the patient had a small and thin right thumb when compared to the left (Figure 1A and B).
AP intra-operative x-rays demonstrate aplasia of the radial portion of the carpus with a hypoplastic first metacarpal
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F2
Intra-operative x-rays demonstrate aplasia of the radial portion of the carpus with a hypoplastic first metacarpal (Figure 2).
A W-plasty was performed to deepen the web space between the thumb and index finger to enhance thumb abduction, pinching, and grasping
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F3
At the initial procedure, a longitudinally placed W-plasty was performed to deepen the web space between the thumb and index finger (Figure 3).
Harvest of abductor digiti minimi by transection of its distal insertion at the base of the fifth proximal phalanx for use in Huber Transfer Oppopensplasty
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F4
The muscle was then inverted in the same manner as turning the page of a book (Figure 4).
After the first stage of the reconstruction, the patient is able to oppose her thumb of her right hand to the middle finger without difficulty
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F5
The previous surgical procedures enabled the child to tip pinch from the thumb to the index and long fingers (Figure 5).
A mini Stryker distraction lengthener for digits was attached to the thumb metacarpal bicortically. The device was turned 1 mm/day for three months to achieve a length of 4 cm
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F6
First, the mini Stryker (Kalamazoo, MI) distraction lengthener for digits was placed into its most compressed position (Figure 6).