Thumb radial angulation correction without phalangeal osteotomy in Apert's syndrome

A surgical technique to correct thumb metacarpophalangeal (MCP) joint radial angulation in patients with Apert's syndrome that obviates osteotomy of the proximal phalanx is described. The anomalous insertion of the abductor pollicis brevis tendon to the distal phalanx radially is released and reattached to the radial base of the proximal phalanx. A radial MCP joint capsulotomy is performed; excision of a cartilaginous prominence on the ulnar aspect of the metacarpal head is required to assist in joint alignment, which is temporarily maintained with a K-wire. Two children underwent bilateral thumb reconstructions using this technique. At 1.5 and 5.6 years after surgery the thumbs were straight and radiographs revealed no residual lateral angulation at the MCP joint. The parents were satisfied with the results. This technique of correction of Apert's thumb radial angulation is simple and reliable and produces satisfactory clinical results.