Central ray deficiency of the hand. Operative treatment and results

Fifty nine hands were studied in 42 patients with central ray deficiency. Thirty one of the hands were treated surgically and this enabled analysis of the soft tissue abnormalities that were not constant throughout the group, requiring a sub-division of the usual classification. Four major surgical procedures and two minor procedures are described and the importance of creating a substitute for the deficient transverse intermetacarpal ligament and correction of any intrinsic muscle imbalance is emphasized. Of the 31 hands treated all but three gained useful grip and all but two gained useful pinch grip and a satisfactory range of motion. From the cosmetic standpoint all were satisfactory except for one case with a hypertrophic scar and six cases with overlapping of the fingers when grasping.