Finger Length Restoration

A finger or thumb can be short for several reasons:

• Injury and amputation: part of the finger was lost in an accident or to frostbite, and reattachment was not possible or did not succeed.
• After fingertip reconstruction: some length is lost when a damaged fingertip is closed or rebuilt.
• Differences present from birth: some children are born with short or under-developed fingers or thumbs. See congenital hand differences.
• Growth problems: an injury or infection near the growing end of a bone in childhood can slow the growth of that finger.
• Bone loss: after severe infection or a crushing injury.

The hand works by bringing the thumb and fingers together. A thumb that is too short cannot reach the fingers to pinch, and a short finger may not close around objects to grip. Small objects such as a pen, a key or a button become hard to hold. A short finger can also affect how a person feels about their hand, at work and in social life. Restoring even part of the lost length can improve both function and confidence.

The right method depends on the finger, the cause, the amount of bone and skin available, and the person's needs. Options include:

• Deepening the web space: the skin web between two fingers, or between the thumb and index finger, is moved further down. The finger then works as if it is longer, without changing the bone.
• Gradual bone lengthening (distraction lengthening): the bone is cut and the two ends are slowly moved apart, a little each day. New bone forms in the gap as it widens. Once the target length is reached, the new bone is given time to become strong.
• Bone grafting: a piece of bone is added to lengthen the finger, sometimes together with gradual lengthening.
• Moving tissue from elsewhere: in selected patients, tissue such as a toe or part of a toe can be transferred to the hand with microsurgery to rebuild a thumb or finger. When a thumb is absent from birth, an index finger can be moved into the thumb position (pollicization).

Gradual lengthening of a finger is traditionally done with an external fixator: a small frame outside the finger, attached to the bone with pins, that is adjusted each day. Dr. Jindal has long worked on fixators for the hand, including a miniature fixator for the finger and hand bones developed during his training in Mumbai.

He has also described a technique for lengthening a finger after amputation without an external fixator, which he has presented at professional meetings. It is being studied in a larger group of patients before publication. Whether it is suitable for your finger is decided after examination.

Finger length restoration may help:

• adults and children who have lost part of a finger or thumb in an injury,
• patients whose finger could not be reattached after an amputation, once the wound has healed,
• children born with short fingers or thumbs,
• people whose finger was shortened by an earlier operation or infection.

Before planning, the surgeon checks the skin, the bone, the movement of the nearby joints, the feeling in the finger, and the person's work and daily needs. Healthy skin and blood supply are needed for lengthening to succeed. It is not necessary to have the lengthening at the time of the injury: it can be planned months or years later.

• Planning: examination, X-rays and a discussion of what length and function are realistic for your hand.
• Surgery: usually under regional or general anaesthesia. Some methods need more than one stage.
• Lengthening phase: with gradual lengthening, the finger is lengthened a little each day over several weeks, with regular clinic visits and X-rays.
• Healing phase: the new bone needs time to become strong. The hand is protected during this time.
• Hand therapy: exercises keep the nearby joints moving and help the lengthened finger work well.

As with any operation, there are risks, including infection, stiffness of nearby joints, the new bone healing slowly, and the need for a further procedure. Your surgeon will explain these for your situation.

Book a consultation to find out whether the length of your finger or thumb can be restored.