Orthopedic restoration of thumb opposition in consequences of the upper extremity trauma

S.S. Strafun, M.P. Oberemok, A.S. Lysak, S.V. Tymoshenko


Background. The vast majority of patients with consequences of the upper extremity injury require surgical restoration of thumb opposition. The purpose was to determine the effectiveness of surgical restoration of thumb opposition in consequences of the upper extremity trauma, to describe the main factors that determine the degree of opposition recovery and possible causes of poor results. Materials and methods. Thirty nine patients (neglected peripheral nerve trauma (n = 19), brachial plexus lesions (n = 11 patients) and upper extremity ischemic contracture (n = 9)) underwent: opponensplasty (n = 25) and opponodesis (n = 14). Dynamics of thumb function restoration and ability to use it in three­finger grasp were evaluated. Results. Opponensplasty effectiveness in most of the analyzed cases was lower than expected, the techniques using flexor tendons (Thompson, Bunnell) are more effective than methods involving extensors. However, due to initial conditions, they can be realized only in one third of patients, who need this recovery. Methods using extensors (Taylor, Burkhalter) provide a compelling immediate result, but in the postoperative period, their effectiveness is significantly reduced, which requires special approaches to increase their efficacy. The effectiveness of opponodesis is more predictable, but grasp restoration requires correct function of long fingers, and the choice of thumb position — a thorough agreement with patient. Conclusions. It is necessary to create a systematic approach for choosing techniques and taking into account the components of these interventions. In addition, it is important to optimize these interventions by clarifying tendon tension in the motor muscle and the means to reduce the adhesion process.


opponensplasty; opponodesis; tendon transfer


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