Characteristics of patients with congenital clasped thumb: A prospective study of 40 patients with the results of treatment

Abstract

Purpose Congenital clasped thumb is a deformity that is associated with heterogeneous congenital anomalies and it has been addressed in many congenital syndromes. The aim of this study was to diagnose and evaluate cases of clasped thumb as regards the associated congenital anomalies and syndromes, and evaluation of the results of treatment of such cases. Methods A prospective study on 40 patients with 73 clasped thumbs was done. All the patients' data regarding their personal, family, pregnancy and developmental histories were recorded. All the patients were exposed to thorough clinical and radiological examination and genetic assessment. The cases were classified using the Tsuyuguchi et al. (J Hand Surg [Am] 10:613-618, 1985) classification into three types. Conservative treatment was adopted in ten hands, and surgical treatment was performed for 28 hands in 17 patients, with an average follow-up of 26 months. Results Positive consanguinity was recorded in 57.5% of cases. Associated anomalies were recorded in 77.5% of cases. Type I was the most common one, followed by type III and then type II. Conservative treatment is effective in type I cases when presented early, and all patients were satisfied with the results of surgical treatment. ConclusionsWe reported associated anomalies which are to our knowledge have not mentioned before in the literature which include; congenital blindness, radial deviation of the index finger and ventricular septal defect. We found that 68% of the patients had associated syndromes, and this has not been mentioned before. In this study, we found that there were no difference between type II and type III clasped thumb as regards the pathological findings, severity, the operative procedures, the treatment protocol and the operative results. Properly planned treatment gives satisfactory results.

Congenital Clasped Thumb That Is Forgetten a Syndrome in Clinical Practice

“…Treatment of congenitally clasped thumb depends on disease stage, age at presentation, and comorbid pathologies. 10 , 12 Tsuyuguchi et al 12 reported that good results were achieved with type I and type II cases with conservative methods. In type II and type III, cases in whom conservative treatment is ineffective surgical treatment produces good results.…”

“…Nonsurgical methods are not recommended for patients who have agenesis or severe hypoplasia of EPB. 14 , 15 Ghani et al 10 reported that conservative treatment was effective for patients under 1 year of age but then, and in type II and type III patients who do not respond to conservative treatment surgery gives better results. Lin et al 9 suggested that application of a splint will give successful results in patients under 1 year of age, who have neither skin contracture at first evaluation nor absence or severe weakness of EPB.…”

“…Therefore, splint should be applied for 6 months in order to keep thumb at extension and then, after active thumb extension is achieved night splints should be used for another 6 months. 10 , 12 The aim of surgical treatment is to achieve near full thumb function by correcting accompanying deformities in patients who did not respond to conservative treatment. For this purpose tendon transfer in cases with absent or insufficient tendons, appropriate reconstruction in cases with tendon subluxations, several z-plasty reconstructions for first web space contraction, and thenar and adductor muscle release procedures may be performed.…”

“…For this purpose tendon transfer in cases with absent or insufficient tendons, appropriate reconstruction in cases with tendon subluxations, several z-plasty reconstructions for first web space contraction, and thenar and adductor muscle release procedures may be performed. 10 …”

“…According to Gilbert classification abduction was 40° to 45°, rotation was 110° to 120°, and opposition of thumb with all other fingers was full. 10 We informed both the patient and patient's parents about this study and obtained written informed consent.…”