Associations
Radial club hand
VECTRAL
Holt Oram
Blauth Classification
Grade I
Minor hypoplasia, all element presents
Management
- may need opposition tendon transfer if APB and opponens deficient
Grade II
Thenar muscles hypoplasia / aplasia
MCPJ ligament instability
Normal skeleton
Wed space adduction contracture
Management
1. Release web space
2. Oppensplasty
- FDS RF
- stabilise MCPJ
- provide opposition
Grade III
Skeletal hypoplasia
Variable absence MC
Aplasia of CMC
Variable absence of radial carpal bones
Thenar muscle hypoplasia
Management
- pollicisation
Grade IV
Absent metacarpal / rudimentary phalanges
Pouce flottant / floating thumb
Management
- LA & tie off at birth
- pollicisation
Grade V
Total absence
Management
- pollicisation
Pollicisation
Concept
Use index finger as thumb
Best Results / Aims
30% normal strength
Good opposition
- should get pulp to pulp pinch
Timing
Between one and two years
Technique
1. Skin incision for new web space
2. Isolating on radial and ulna NV bundles
- splitting common digital nerve
- division of radial digital artery to middle finger
3. Shorten finger
- remove metacarpal
4. Stabilise MCPJ
5. Balance MT units
- dorsal interossei becomes thumb abductor
- palmar interossei becomes thumb adductor
6. Reattach extensor tendons, leave flexors