[Resection of the fourth ray for annular lesions: amputations of the fourth ray of the hand].

INTRODUCTION

Several procedures have been reported for amputation of the fourth ray of the hand. Most surgeons recommend translocation of the fifth finger on the proximal end of the fourth metacarpal bone. Others prefer to perform a resection of the fourth metacarpal bone combined with intracarpal osteotomy.

MATERIAL AND METHODS

The authors' choice was to perform a resection of the fourth metacarpal bone with conservation of its proximal end. They emphased on two technical details: resection of the interosseous muscles and reconstruction of the intermetacarpal ligament. The present series includes 8 patients operated on with this technique. Results were assessed with an average follow-up of 47 months. Evaluation of the result was based on a personal rating score including 9 clinical scores and on 1 radiological measurement of the hand width.

RESULTS

Mobility of the adjacent digits was normal in all cases except one with a retractile scar. In 7 cases out of 8, the aesthetic result was satisfactory. Grip strength was 65 per cent of the contralateral side. Diminution of the hand width was of 12 per cent. Five results were excellent and three were good.

DISCUSSION

Translocation with intracarpal osteotomy can produce impairement of carpus function, especially with apparition of pain, but also some rotational malposition. Translocation of the fifth digit on the fourth metacarpal bone can also procedure an imbalance of the extrinsic muscles, but also a rotational malposition.

CONCLUSION

Transmetacarpal amputation of the fourth ray has the advantage to be an easy anatomic procedure, and is particularly reliable and reproductible regarding to the results. This procedure does not produce any specific complication comparing with other techniques.