What is the recommended technique for relocating the base of the 5th digit?

Relocation Technique of 5th Digit Base

The recommended technique for relocating the base of the 5th digit involves a combination of mobilization, trimming/thinning, and suturing with permanent 5-0 nylon or PDS 4-0 sutures driven through periosteum or small drill holes in the bone to achieve proper alignment and stability. 1

Assessment of Deformity

Before performing relocation, a thorough assessment is essential:

• Evaluate the degree of deviation (mild, moderate, or severe)
• Assess for associated fractures using appropriate imaging
• Determine if there is soft tissue damage requiring repair
• Check for mobility/crepitus at the base of the digit

Relocation Techniques Based on Severity

For Mild Deviations

1. Mobilization technique:
   • Gently mobilize the digit base to midline position
   • Trim or thin the base as needed to reduce tension
   • Secure with permanent sutures (5-0 nylon or PDS 4-0)
   • Suture through periosteum or small drill holes in the bone for stability 1

For Moderate Deviations

1. Contralateral subluxation locking technique:
   • Reposition the digit base (at least 1 cm in width)
   • Lock to the contralateral side of the thinned bone/joint
   • Apply additional suturing to maintain position
   • Slightly bend the structure to prevent overcorrection 1

For Severe Deviations

1. Weakening and reconstruction approach:
   • Perform partial or complete incisions to weaken rigid structures
   • Consider interdigitating incisions (castellation) to maintain some integrity
   • Apply "figure 8" sutures to stabilize adjacent segments
   • Use batten type grafts to reorient and straighten the digit base 1
   • Avoid aggressive morselization as it increases absorption risk and complicates revision 1

Special Considerations

• Timing: Early intervention (within 4 weeks) is critical for optimal correction of deformities
• Bone grafting: For severely unstable or flail digits, consider calcaneal autogenous bone grafting to improve stability 2
• Transpositional techniques: In cases of multiple digit involvement, consider transpositional techniques to optimize functional outcomes 3
• Staged approach: For complex cases, a staged approach may be necessary to first stabilize the digit and then realign the digital length pattern 2

Post-Relocation Management

• Immobilization for 3-4 weeks to allow proper healing
• Gradual rehabilitation to restore range of motion
• Regular follow-up to assess stability and function
• Consider secondary procedures if needed to improve function

Potential Complications

• Inadequate fixation leading to recurrent deviation
• Overcorrection resulting in functional limitations
• Stiffness from prolonged immobilization
• Neurovascular compromise if fixation is too tight

The key to successful relocation of the 5th digit base is selecting the appropriate technique based on the severity of deviation while ensuring adequate fixation and stability without compromising blood supply or mobility.