Transfert de l'abducteur du cinquième doigt palliatif de la paralysie des thénariens externes

Abstract

Described by Huber in 1921, the transfer of the abductor digiti quinti constitutes an elegant solution to paralysis of thumb opposition. Interest in this operation was renewed and defended by Littler and more recently by Manske and McCarroll. The technique is simple and we do not believe that it is necessary to detach the muscle from its proximal insertion, thus preserving the force of the transfer. The advantages are as follows: elective reconstitution of antepulsion of the thumb column, which supposes that the adductors and the flexors are intact. A small operative field with limited routes of approach reducing scarring to a minimum. The cosmetic advantage is evident with reconstitution of the thenar contour. The functional loss is minor and in our opinion the abductor digiti quinti appears to be less inexpendable than the flexor digitorum sublimis or the extensor pollicis. The limitations of the operation are the absence of functional deep thenar muscles and adductors as well as, of course, the absence of a healthy abductor digiti quinti as in associated ulnar palsy. The results in 8 operations lead us to think that, when possible, the transfer of the abductor digiti quinti is a particularly interesting solution to paralysis in women and children, but probably insufficient in manual hard labor workers, at least in those who need strong abduction of their thumb.