Long term functional outcomes after early childhood pollicization

Abstract

Study Design Retrospective Cohort Introduction Pollicization creates a thumb from another finger to treat hypoplasia/aplasia. Important outcomes include strength, function, dexterity, and quality of life. Purpose of the Study To evaluate mid- to long-term outcomes and examine predictors of outcome after early childhood pollicization. Methods 8 children who underwent 10 pollicizations (age at surgery ≤ 5 years) were evaluated 3 to 15 years after surgery. Anthropometrics, range of motion, and basic medical history were obtained. Participants completed an upper extremity questionnaire (PODCI) and functional tests including grip and pinch strength, Box and Blocks, 9-hole pegboard, and strength-dexterity (S-D) tests. Results Almost all pollicized hands had poor strength and performed poorly on the traditional functional tests. Six of 10 pollicized hands had normal dexterity scores but were less stable in maintaining a steady-state force. Predictors of poorer outcomes included older age at surgery, reduced metacarpophalangeal and interphalangeal range of motion, and radial absence. Discussion Early childhood pollicization resulted in poor strength and overall function, but normal dexterity was often achieved using altered control strategies. Conclusions Most children will likely obtain adequate dexterity despite weakness after pollicization, but older children and those with the most severe involvement may have poorer outcomes.

Feasibility of Ultrasound in Infant Wrist and Thumb Imaging

“…Earlier characterization of the degree of thumb hypoplasia with the use of US may also allow for more expeditious surgical interventions and potentially better outcomes. These advantages are supported by existing data from Lightdale-Miric et al, 11 who showed better long-term thumb strength after pollicization in those who received surgery at a younger age than those who had surgery at an older age.…”

Strength, Multijoint Coordination, and Sensorimotor Processing Are Independent Contributors to Overall Balance Ability

“…More recently, LED F has shown strong correlations with single limb cross-country ski distance, which one can easily argue is a dynamic measure, but showed no correlation with a static single limb balance test [ 42 ]. Additionally, the force fluctuations (e.g., RMS) during the hold phases of the SD paradigm for the upper extremity were first introduced as a method of quantifying differences in performance (i.e., sensorimotor processing) attributed to several clinical conditions [ 18 , 22 , 23 ]. Greater RMS indicates larger dynamical dispersion and suggests weaker (or looser) corrective actions by the neuromuscular controller enforcing the sustained compression.…”

“…Therefore, we introduce the Lower Extremity Dexterity (LED) test, which has been proven to quantify sensorimotor processing to control instabilities while controlling for the confounding factors of strength and whole-body equilibrium [ 18 , 19 ]. The test is based on the principles of the upper extremity Strength-Dexterity (SD) test, which is a repeatable and informative paradigm that has successfully quantified differences in finger dexterity attributed to age, sex, and numerous clinical impairments [ 18 , 20 – 23 ]. The SD test quantifies sensorimotor processing for dynamic finger function because it is independent of strength [ 21 , 24 ] and engages distinct cortico-striatal-cerebellar networks in a context-sensitive way [ 25 , 26 ].…”

Innovative evaluation of dexterity in pediatrics

“…The FDT has been used in children to assess dexterity after pollicization 27 (surgically replace an absent thumb with a functional finger) 28-30 and performance in children with congenital conditions. We used the FDT to assess the unaffected hands of children ages 4 to 17 years of age with unilateral congenital differences and found that the unaffected hands were slower than the age-matched norms (unpublished).…”