Introduction and Aims:

The surgical treatment of fractures of the scaphoid with delayed presentation or with established non-union pose a formidable challenge with reported failure rates between 15% and 45%. The aim of this study is to report the results of percutaneous versus open fixation with bone grafting of these fractures.

Introduction and Aims: Many surgical techniques are available for thumb reconstruction. These include deepening of the first web, flaps, osteoplastic reconstructions, toe to thumb transfer, pollicisation and metacarpal lengthening. The aim of this study is to assess the outcome following use of distraction methods for thumb lengthening.

Method: Nineteen patients who underwent thumb metacarpal lengthening over a six-year period have been reviewed retrospectively. Lengthening was performed for terminal deficiency in 12 cases and for segmental bone loss in seven cases. The callotasis method was used in 11 patients and the Matev method in eight. The Orthofix mini-external fixator was used as the distracting device in all cases.

Results: Final gains in length achieved measured from 22mm to 41mm, with an average fixator application time of 86 days (range 58 to 125). Complications included two malunions, one overlengthening, four pin migrations through bone and six cases of pin track sepsis. There were no skin or neurovascular complications. Narrowing of the first web space has been found to be a significant problem associated with thumb metacarpal lengthening in this study. This necessitated subsequent deepening of the web space in 14 patients with adductor release in seven patients.

Conclusion: Distraction methods for thumb reconstruction are relatively easy, safe and do not require special facilities or prolonged theatre time. Where indicated, these techniques provide a useful alternative to other methods of thumb reconstruction.