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Bilateral ulnar “thumbs”
Bilateral Ulnar "'Thumbs'" Francis J. Harvey, F.R.A. C. S.
BILATERAL ULNAR' 'THUMBS" F R A N C I S J. H A R V E Y , Sydney, Australia SUMMARY Congenital fusion of the carpal bones is fairly c o m m o n and may be associated with other congenital deformities in the hand. This report deals with an unusual congenital anomaly of the little fingers associated with fusion of the triquetrum and lunate. Both little fingers were adducted and rotated giving crude resemblance to thumbs on the ulnar borders of the hands. The deformity was easily corrected by osteotomy through the base o f the fifth metacarpals. INTRODUCTION Boyes (1970) has stated that carpal fusions are c o m m o n and that the lunate and triquetrum are most frequently involved. Minnaar (1952) found that fusion between the lunate and triquetrum was often seen in the African Bantu. It has also been reported as occurring in 8.01% of adult Yorubas in Nigeria (Cockshott 1959). None of these authors however has commented on any association of the carpal fusion with little finger deformity. CASE REPORT A twelve year old girl presented with bilateral deformities of the little finger (Fig. 1). X-rays of the hand (Fig. 2) showed adduction o f the fifth metacarpals and also fusion of the lunate and triquetrum bilaterally. It was noted that as well as the adduction of each metacarpal, there was rotation so that the pulp of the little finger faced towards the palm. The function in both hands was good but the deformity wag corrected for cosmetic reasons. It was a simple matter to perform an osteotomy at the base of the fifth metacarpal and then rotate and move it towards the adjoining one. It was necessary however to remove some excessive bone (fom the base of the fifth metacarpal to allow a close approximation to its neighbour. The osteotomy was held temporarily by a transfixing Kirschner wire. No surgery was required for the skin. The final appearance of the hand was quite satisfactory (Fig. 4) although the fifth metacarpal was shorter than normal. The patient had regained good function a few weeks after surgery but then returned to her h o m e in a remote area and was lost to follow-up. CONCLUSION As indicated above, fusion of the lunate and triquetrum is fairly c o m m o n , especially in certain races. However previous authors have not commented on any associated deformity of the little finger. REFERENCES BOYES, J. H. (1970). Bunnell's Surgery Of The Hand, 5th Edition. Philadelphia and Montreal, J. B. Lippincott Company. COCKSHOTT, W. P. (1959) Carpal Anomalies Amongst Yorubas The West African Medical Journal 8, 185-190. MINNAAR, A. B. de V. (1952) Congenital Fusion of the Lunate and Triquetral Bones in the South African Bantu. The Journal Of Bone And Joint Surgery 34B: 45-48. F. J. Harvey, M.Ch.Orth., F.R.A.C.S., F.R.C.S. 200 Pacific Highway, Crows Nest 2065, Australia The Hand--Vol, 11
No. 1
1979
95
Bilateral Ulnar " T h u m b s " Francis J. Harvey, F.R.A.C.S.
Fig. 1. Hands before operation showing deformity of 5th metacarpal.
Fig. 2. X-ray Hands showing deformity. 96
T h e H a n d - - V o l . 11
No. 1
1979
Bilateral Ulnar "'Thumbs'" Francis J. Harvey, F.R.A.C.S.
Fig. 3. Hands after operation.
Fig. 4. X-ray after opero,tion. The H a n d - - Vol. 11
No. 1
1979
97
BILATERAL ULNAR' 'THUMBS" F R A N C I S J. H A R V E Y , Sydney, Australia SUMMARY Congenital fusion of the carpal bones is fairly c o m m o n and may be associated with other congenital deformities in the hand. This report deals with an unusual congenital anomaly of the little fingers associated with fusion of the triquetrum and lunate. Both little fingers were adducted and rotated giving crude resemblance to thumbs on the ulnar borders of the hands. The deformity was easily corrected by osteotomy through the base o f the fifth metacarpals. INTRODUCTION Boyes (1970) has stated that carpal fusions are c o m m o n and that the lunate and triquetrum are most frequently involved. Minnaar (1952) found that fusion between the lunate and triquetrum was often seen in the African Bantu. It has also been reported as occurring in 8.01% of adult Yorubas in Nigeria (Cockshott 1959). None of these authors however has commented on any association of the carpal fusion with little finger deformity. CASE REPORT A twelve year old girl presented with bilateral deformities of the little finger (Fig. 1). X-rays of the hand (Fig. 2) showed adduction o f the fifth metacarpals and also fusion of the lunate and triquetrum bilaterally. It was noted that as well as the adduction of each metacarpal, there was rotation so that the pulp of the little finger faced towards the palm. The function in both hands was good but the deformity wag corrected for cosmetic reasons. It was a simple matter to perform an osteotomy at the base of the fifth metacarpal and then rotate and move it towards the adjoining one. It was necessary however to remove some excessive bone (fom the base of the fifth metacarpal to allow a close approximation to its neighbour. The osteotomy was held temporarily by a transfixing Kirschner wire. No surgery was required for the skin. The final appearance of the hand was quite satisfactory (Fig. 4) although the fifth metacarpal was shorter than normal. The patient had regained good function a few weeks after surgery but then returned to her h o m e in a remote area and was lost to follow-up. CONCLUSION As indicated above, fusion of the lunate and triquetrum is fairly c o m m o n , especially in certain races. However previous authors have not commented on any associated deformity of the little finger. REFERENCES BOYES, J. H. (1970). Bunnell's Surgery Of The Hand, 5th Edition. Philadelphia and Montreal, J. B. Lippincott Company. COCKSHOTT, W. P. (1959) Carpal Anomalies Amongst Yorubas The West African Medical Journal 8, 185-190. MINNAAR, A. B. de V. (1952) Congenital Fusion of the Lunate and Triquetral Bones in the South African Bantu. The Journal Of Bone And Joint Surgery 34B: 45-48. F. J. Harvey, M.Ch.Orth., F.R.A.C.S., F.R.C.S. 200 Pacific Highway, Crows Nest 2065, Australia The Hand--Vol, 11
No. 1
1979
95
Bilateral Ulnar " T h u m b s " Francis J. Harvey, F.R.A.C.S.
Fig. 1. Hands before operation showing deformity of 5th metacarpal.
Fig. 2. X-ray Hands showing deformity. 96
T h e H a n d - - V o l . 11
No. 1
1979
Bilateral Ulnar "'Thumbs'" Francis J. Harvey, F.R.A.C.S.
Fig. 3. Hands after operation.
Fig. 4. X-ray after opero,tion. The H a n d - - Vol. 11
No. 1
1979
97