[Combined dorsal injuries of the thumb. A review of treatment possibilities].

In complex dorsal injuries of the thumb with an intact CM-joint, the reconstruction of a stable post for grip is of greater importance than restoring mobility to the MP- or IP-joint. The basis of reconstruction is primary stable internal fixation of the fractured bones, in some cases necessitating an arthrodesis or interposition of cortico-cancellous bone grafts. Extensor tendons are repaired or reconstructed if distal joint function is to be expected. In order to prevent neuroma formation, direct nerve repair is favoured, but nerve-grafting is not recommended. In exclusively dorsal lesions, there is usually no need for vascular reconstruction. The main donor areas for coverage of dorsal skin defects by pedicled island flaps are the dorsal forearm and the dorsal aspect of the index finger. Reconstruction of a mobile CM-joint and its motors should always be attempted. A CM-joint fusion is only indicated as a salvage procedure.