Double ray amputation for tumors of the hand Journal Article


Authors: Puhaindran, M. E.; Athanasian, E. A.
Article Title: Double ray amputation for tumors of the hand
Abstract: Background: Partial hand amputations for malignant tumors allow tumor resection with negative resection margins, which is associated with lower local recurrence rates and improved overall survival while preserving native tissue, which improves functional outcome. Questions/purposes: We conducted this study to assess the functional outcome of double ray amputations of the hand. Methods: We retrospectively reviewed the records of five patients who underwent double ray amputations at our center over 12 years: four amputations of the fourth and fifth rays and one amputation of the second and third rays. Mean age at surgery was 34 years (range, 10-45 years), and minimum followup was 64 months (mean, 98 months; range, 64-136 months). All five patients had high-grade soft tissue sarcomas of the hand, two synovial sarcomas, two malignant peripheral nerve sheath tumors, and one undifferentiated sarcoma. No patients had detectable metastases at surgery. Results: Four of the five patients were completely disease-free at latest followup. One patient was alive with lung metastases detected 32 months after surgery. No patients developed local tumor recurrence. Functional assessment showed a mean Musculoskeletal Tumor Society score of 24 (range, 19-28) and mean grip strength 24% of the contralateral side (range, 17%-35%). Conclusions: Although double ray amputation results in worse functional outcome than single ray, good key, tip, and tripod pinch can be preserved when the deep motor branch of the ulnar nerve is preserved, and this hand can still assist in bimanual hand activities. Our observations suggest double ray amputation is an acceptable hand-preserving procedure. © 2010 The Association of Bone and Joint Surgeons®.
Keywords: adolescent; adult; child; clinical article; school child; treatment outcome; disease-free survival; middle aged; functional assessment; hand function; surgical technique; recovery of function; retrospective studies; young adult; overall survival; conference paper; nuclear magnetic resonance imaging; outcome assessment; follow up; neoplasm recurrence, local; surgical approach; retrospective study; time factors; sarcoma; amputation; soft tissue sarcoma; new york city; synovial sarcoma; nerve sheath tumor; soft tissue neoplasms; hand; grip strength; hand tumor; double ray amputation; hand strength; ulnar nerve
Journal Title: Clinical Orthopaedics and Related Research
Volume: 468
Issue: 11
ISSN: 0009-921X
Publisher: Springer  
Date Published: 2010-11-01
Start Page: 2976
End Page: 2979
Language: English
DOI: 10.1007/s11999-010-1389-2
PUBMED: 20490732
PROVIDER: scopus
PMCID: PMC2947675
DOI/URL:
Notes: --- - "Export Date: 20 April 2011" - "CODEN: CORTB" - "Source: Scopus"
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