Abstract
Two case reports illustrate a relatively simple procedure to preserve thumb function in trauma and locally invasive tumours.
The first case report is of a man who presented with a slowly growing chondrosarcoma involving his left thumb metacarpal. Radiological investigations and incision biopsy confirmed the diagnosis of a low-grade chondrosarcoma. Thumb function sparing wide local excision of the metacarpal, including the thenar muscles was carried out. The floating thumb was stabilised with a temporary silicone block interposed between trapezium and the proximal phalanx. After four weeks the silicone block was replaced with a tri cortical bone graft from the opposite iliac crest and fixed distally to the proximal phalanx and proximally to the trapezium.
The second case report is of a soldier who sustained multiple injuries including open fracture of left thumb metacarpal with associated soft tissue and bone loss. This was from a mortar shell explosion in a commando operation in the jungle. After immediate debridement locally he was transferred to the UK. On arrival ARDS and sepsis requiring ITU treatment further compromised his clinical status. One week later he underwent debridement and stabilisation of his thumb injury with an external fixature. This got infected and went on to develop a non-union. Some seven months post trauma he went on to have the metacarpal reconstructed using iliac crest bone graft.
These two very different cases underwent a similar reconstructive procedure to try and preserve the thumb and regain some function. After rehabilitation both patients are pleased to have their thumb preserved.
These abstracts were prepared by Squadron Leader G. Pathak FRCS (Trauma & Orth). Correspondence should be addressed to him at Royal Hospital Haslar, Gosport, Hampshire PO12 2AA.
