DOS 2020

DOS Kongressen 2020 · 199 Thumb Amputations Treated With Osseointegrated Percutaneous Prostheses Peter Holmberg Jørgensen, Henrik Tingleff, Rikke Dyhre Bloch, Dorthe Hamilton, Klaus Kjær Petersen Orthopedic surgery, Aarhus University Hospital; Bandagistcentret, Aarhus; Physio- and occupational therapy, Aarhus University Hospital Background: Amputation of the thumb around the MP-joint, leaves the patient without a pinch-grip which is a severe handicap. Reconstructions have been performed with a free toe graft, elongation of the 1. metacarpal bone or an external prosthesis fixed to the hand with belts. Implantation of an osseointe- grated (OI) prosthesis is another alternative which restores the pinch-grip and gives the patient an osseoperception. The OI-prosthesis, consists of a fixture implanted in the 1. metacarpal bone and an abutment protruding through the skin which is connected to a custom made external prosthesis Purpose / Aim of Study: To present our experience with reconstruction of the amputated thumb with an OI-prosthesis. Materials and Methods: 8 patients (3 female), median age 54 yrs (27-65) were operated from november 2012 to july 2017. Time since amputation was 9.3 yrs (2-27). After 3 weeks the patients were equipped with an external in- dividually fit costum made prosthesis (prosthetist). The patients went through a 3 months rehabilitation program with gradually increased mechanical loading of the prosthesis (occupational therapist). Findings / Results: The patients restored the abduction/adduction and op- ponens movement of the thump and got a pinch grip enabling them to perform even heavy physical activities. Transferral of the load from the prosthesis to the bone gives the patients an osseoperception allowing them to graduate the strength of their regained grip force. The prosthesis can be worn permanently and the patients describe it as an integrated part of their body. 2 patients have been operated after 7 resp. one year with removal of granulation tissue at the interface between skin and prosthesis. In 3 patients a Z-plasty of the interstitial tissue was performed to increase the range of abduction. In one patient the abutment was removed four years after primary surgery due to permanent pain. No patients had infection of the prosthesis. Conclusions: OI-prosthesis results in a firm and functional reconstruction, with a restored pinch grip in thumb amputees. The patients regain several daily ac- tivities including return to work and report an increased quality of life. The pre- operative planning, surgery and rehabilitation needs a multimodal team setup. 178.