Osteoplastic thumb reconstruction. A, A 32-year-old woman presented with traumatic thumb amputation 4 years previously with amputation level just distal to metacarpophalangeal joint and thumb-index web space contracture. B, Simple two-flap Z-plasty web space release allows access to ulnar shaft of thumb metacarpal. C, Lengthening frame applied percutaneously from radial side of thumb under fluoroscopic guidance before osteotomy. Note web contracture release after Z-plasty. D and E, Palmar and dorsal view of thumb soon after frame application. Lengthening begun at 1 week after surgery at a rate of 0.5 mm twice daily. F and G, Lateral radiograph at 2 weeks and 10 weeks after surgery. H, Lateral radiograph 5 months after surgery indicating solid union. No bone graft was required, and metacarpal manual osteoclasis was done after fixator removal to simulate metacarpophalangeal joint fusion. SEE TECHNIQUE 19.16.