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[Results following isolated fourth ray resection].

Michael Stephan Mayr-Riedler1, Karl-Josef Prommersberger1, Jörg van Schoonhoven1

  • 1Rhön-Klinikum, Klinik für Handchirurgie.

Handchirurgie, Mikrochirurgie, Plastische Chirurgie : Organ Der Deutschsprachigen Arbeitsgemeinschaft Fur Handchirurgie : Organ Der Deutschsprachigen Arbeitsgemeinschaft Fur Mikrochirurgie Der Peripheren Nerven Und Gefasse : Organ Der V
|August 11, 2020
PubMed
Summary

Total resection of the fourth finger ray with soft tissue adaptation effectively closes the metacarpal gap, leading to good functional and cosmetic outcomes with minimal complications. This surgical approach offers a viable alternative for hand reconstruction.

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Area of Science:

  • Hand surgery
  • Orthopedic surgery
  • Surgical techniques

Background:

  • Partial resection of the fourth finger ray often leads to transposition of the fifth ray.
  • An alternative involves total resection of the fourth ray with adaptation of the deep transverse metacarpal ligament.
  • This study evaluates outcomes of total fourth ray resection and ligament adaptation.

Purpose of the Study:

  • To examine clinical, radiological, and patient-reported results after total resection of the fourth finger ray.
  • To assess the effectiveness of deep transverse metacarpal ligament adaptation in reducing the intermetacarpal gap.
  • To evaluate functional and cosmetic outcomes and complication rates.

Main Methods:

  • Retrospective study of seven patients (mean age 50) with a mean follow-up of 43 months.
  • Assessed parameters: finger movement, hand strength, sensitivity, dexterity (nine-hole peg test), pain, and patient-reported outcomes.
  • Radiological assessment measured intermetacarpal distances before and after surgery and at follow-up.

Main Results:

  • One patient had a mild wound healing disorder; no neuromas or impaired sensitivity were noted.
  • Finger movement was slightly impaired in two patients; grip and pinch strength averaged 61% and 65% of the unaffected hand.
  • Intermetacarpal gap reduced by 67% at the bases and 50% at the heads; DASH score improved from 42.2 to 27.5.
  • Cosmetic appearance was rated as very good by patients.

Conclusions:

  • Total resection of the fourth finger ray with soft tissue adaptation achieves sufficient intermetacarpal gap closure.
  • The procedure results in good to very good functional and cosmetic outcomes.
  • This technique is associated with a low complication rate.