Excision of the Greater Multangular Bone as an Adjunct to Mobilization of the Thumb

¹ Department of Surgery, Division of Orthopaedics, Duke Medical Center, Durham

Excision of the greater multangular together with portions of the base of either the first, second, or both first and second, metacarpals has been used as an adjunct procedure in the mobilization of the thumb when it is limited by degenerative arthritis, arthrosis as a result of trauma, severe contracture at the base of the thumb as a result of direct injury, or contracture secondary to adjacent injury. Excision of the the greater multangular and release of the soft tissues may sufficient in some instances to correct all contracture, while in others a split-thickness skin graft or abdominal pedicle flap may be necessary to maintain full motion of the thumb web. Improvement in range of motion at the base of the thumb may usually be expected, although occasionally only limited motion may persist, even though there is improvement in the position of the thumb. In effect, the procedure is an arthroplasty, either increasing the range of motion at the base of the thumb or improving position of the thumb with or without increased range of motion.

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