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Comparative Study
. 2018 Jul;13(4):435-440.
doi: 10.1177/1558944717715104. Epub 2017 Jun 30.

Suture-Button Device Stabilization Following Ring Finger Ray Amputation: A Comparative Cadaver Study

Emily N Morgan  1   2 , Kenneth R Means Jr  2 , Adrian G Paez  2 , Brent G Parks  2 , Peter C Innis  2
Affiliations
Comparative Study

Suture-Button Device Stabilization Following Ring Finger Ray Amputation: A Comparative Cadaver Study

Emily N Morgan et al. Hand (N Y). 2018 Jul.

Abstract

Background: The purpose of this study was to determine whether placing the suture-button device between the long and small finger metacarpals following ring finger ray amputation may better close the intermetacarpal gap and allow early range of motion without increasing the risk of malrotation than soft tissue repair alone.

Methods: We performed ray amputation of the ring finger of 14 cadaver specimens by performing an osteotomy of the base of the ring finger metacarpal and then excising the remainder of the digit. We first performed a soft tissue repair of the transverse metacarpal ligaments and then cycled the fingers in simulated active flexion and extension on a custom computer-controlled device to re-create 6 weeks of range of motion. We then placed a suture-button device across the long and small finger metacarpals and tested the specimens again, thereby using each hand as an internal control.

Results: The distance between the ring and small finger metacarpals was reduced following suture-button device placement compared with the initial control; this spacing was maintained following complete cycling of the fingers. The angle between the metacarpals was divergent following soft tissue repair, and then became slightly convergent after insertion of the suture-button device. None of the hands developed clinically relevant scissoring of the digits before or after application of the suture-button device.

Conclusions: The suture-button device provides stable fixation to withstand early range of motion following ring finger ray amputation and significantly closes the gap and angle between the adjacent metacarpals without causing scissoring.

Keywords: TightRope; amputation; ray amputation; suture-button device.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The views expressed in this article are those of the author(s) and do not reflect the official policy of the Department of Army, Department of Defense, or U.S. Government.

Figures

Figure 1.
Figure 1.
Each fluoroscopic image was used to measure the angle between the metacarpals (red lines) and distance between the metacarpal heads (black line).
Figure 2.
Figure 2.
(a) Guide wire device passed from ulnar to radial across the distal small and long finger metacarpals followed by (b) suture-button device. No overdrilling is required. (c) Final placement of the suture-button device on fluoroscopy.
Figure 3.
Figure 3.
Average distance in millimeters between the long and small finger metacarpals in (a) flexion and (b) extension following soft tissue–alone repair and suture-button device fixation at each cycle point for all specimens. Error bars illustrate 95% confidence intervals for all specimens.
Figure 4.
Figure 4.
Average angle between long and small finger metacarpals at each cycle point in (a) flexion and (b) extension for soft tissue repair and suture-button device fixation. Note. Positive values denote divergence; negative values denote convergence. Error bars illustrate 95% confidence intervals for all specimens.
Figure 5.
Figure 5.
Image of hand following ring finger ray amputation with slight digital overlap between the long and small fingers.
Figure 6.
Figure 6.
(a) Example of specimen with fingers in flexion following soft tissue repair and (b) specimen with fingers in flexion following suture-button device placement.
See this image and copyright information in PMC

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