[Primary ray resection as an alternative to microsurgical replantation in the management of ring finger avulsion].

OBJECTIVES

Ray resection of the metacarpal with conservation of the proximal end is a technique of management of complete ring avulsion injuries in the emergency situation. This study is a functional evaluation of the technique in comparison to replantation.

METHODS

The present series includes 11 patients, average age of 35 years, predominantly manual workers, operated between October 2005 and July 2007. It consisted of two grades IVA, six grades IVB, and three grades IVC (classification of Merle-Michon). Cases were assessed according to grip and pinch strength, quantitative 400 points score and a work evaluation.

RESULTS

Ten patients were evaluated with an average follow-up of nine months (range: three to 19 months). There were no complications apart from four patients with phantom pain. The time to return to work was three months (range: 10-219 days). All patients were satisfied with the cosmetic appearance, however eight of them suffered from psychological problems, finding it difficult to accept a four-fingered hand. Secondary surgery was unnecessary in the majority of the patients (80%). The grip strength was measured as 30% of grip strength of the unaffected side (range: 3-70%). The result of the 400 point score was 75,94% (range: 55-99%).

CONCLUSION

Ray resection of the metacarpal with conservation of the proximal end is a reliable procedure. Strength is decreased but this does not stand in the way of a rapid return to previous work. However, the choice of strategy (ray resection versus microsurgical replantation) should be discussed in detail with the patient prior to selecting the appropriate option.