Early Versus Delayed Fourth Ray Amputation With Fifth Ray Transposition for Management of Mutilating Ring Finger Injuries.

Abstract

To compare hand function after early versus delayed fourth ray amputation and transposition of the fifth ray in mutilating ring finger injuries. We prospectively compared 2 groups of patients who sustained either isolated mutilating ring finger or complex hand injuries between January 2008 and December 2013. The first group (12 patients; 10 male and 2 female) was managed by early (within 14 d) fourth ray amputation with fifth ray transposition, and the second group (13 patients; 9 male and 4 female) was managed similarly but on a delayed basis (after 20 d). The postoperative fifth metacarpophalangeal joint active range of motion was recorded and compared with the preoperative value. Function was evaluated by measuring grip and key pinch strengths, supination and pronation strengths, and hand breadth. All parameters were evaluated by comparing the injured and the noninjured hands. Group 1 patients exhibited superior results to group 2 patients regarding the postoperative grip and key pinch strength and pronation and supination strength in addition to the mean postoperative active range of motion of the transposed ray metacarpophalangeal joint. However, the results were statistically significant regarding only grip and pronation strengths. Postoperative active range of motion of the transposed ray metacarpophalangeal joint was significantly reduced in the cases having preoperative compromise of the transposed digit in group 1. The final subjective cosmetic satisfaction was better in group 1. Our results support early fourth ray amputation with fifth ray transposition for mutilating ring finger injuries. Therapeutic II.