The fate of the index metacarpophalangeal joint following pollicization.

[holt-oram syndrome]

To characterize the complications that occur at the index metacarpophalangeal (MCP ) joint following pollicization and to identify the blood supply of the index MCP joint .Eighty -five pollicized digits in 74 patients (1974 -2007 ) were followed after surgery and had documented clinical examinations and radiographs to evaluate physeal arrest , nonunion at the pollicized digit base , and instability of the new carpometacarpal joint at a minimum of 2 years following surgery .Proximal phalanx physeal arrest was the most common complication . Radiographic nonunion at the juncture of the index metacarpal head and base occurred with and without instability . Twenty -one of 85 pollicized digits showed radiographic evidence of physeal arrest , 12 of which were complete and 9 partial . No clinical factor was found to significantly correlate with a physeal arrest , although the 9 patients with the diagnosis of Holt-Oram syndrome trended toward a higher percentage , with 6 digits in 5 patients with Holt-Oram syndrome showing this complication . Twenty pollicized MCP joints did not have bony union to the base of the index metacarpal , but only 3 were clinically unstable and required surgical stabilization . Ten pollicized digits developed some degree of instability and subluxation at the new carpometacarpal joint , but only one required surgical intervention . In recent cases , a search for the blood supply to the MCP joint has demonstrated a consistent vessel deep to the interosseous muscles that arborizes on the volar metacarpal neck . Our surgical technique has evolved to preserve this vessel whenever possible .Our complications are most likely due to technical factors . Careful dissection of the index MCP joint during pollicization should help reduce physeal growth arrest . Patients with Holt-Oram syndrome might have an increased risk of growth arrest . However , the majority of patients did not require secondary surgery and have good function .Therapeutic IV .