Second Toe-to-thumb Transfer Using Intramedullary Screw Fixation after Traumatic Thumb Amputation

Abstract

Summary: Loss of the thumb secondary to trauma leads to significant disability due to the digit contributing 40% of overall hand function. Toe-to-thumb transfer has been a well-studied reconstructive method as a means to restore function after thumb amputation. First described in 1969 by Cobbett and colleagues, toe-to-thumb transfers have undergone several modifications in technique to better improve functional and aesthetic outcomes, including toe wrap-around flaps, trimmed great toe transfer, and second toe transfers. Although these methods have allowed patients to retain use of the thumb, traditional interosseous wire reattachment often leads to significant stiffness and need for prolonged rehabilitation to regain maximal function. Intramedullary screw fixation has been increasingly used in phalanx and metacarpal fractures, but its implementation outside of these contexts is not well reported. Here, we present a case of a patient who presented with traumatic thumb amputation and was treated with second toe-to-thumb transfer with intramedullary screw fixation, a novel mode of interosseous rigid fixation in toe-to-hand surgery. Postoperatively, our patient was able to begin mobilizing the new thumb immediately, which allowed for earlier return to work. We believe our technique can be applied to other cases of second toe, as well as great toe, transfers to improve length of recovery and rehabilitation postoperatively.