Methods for Congenital Thumb Hypoplasia Reconstruction. A Review of the Outcomes for Ten Years of Surgical Treatment

Abstract

Background and objectives: Congenital thumb hypoplasia is a rare deformity of upper extremity. The incidence for thumb hypoplasia grade II–V is 1:10,000 newborns per year in Latvia. A technique for extensor indicis proprius (EIP) tendon transfer with subperiosteal fixation was developed and used for thumb hypoplasia grades II and IIIa. Pollicization or second-toe-to-hand transplantation with metatarsophalangeal (MTP) joint arthrodesis was used for the reconstruction of hypoplasia grade IIIb–V. The aim of this retrospective cohort study is to evaluate the outcomes for reconstruction techniques used in one surgical center during a ten-year period by one surgeon to evaluate functional and aesthetical outcomes for new techniques. Materials and Methods: In total, 21 patients were operated on during 2007–2017, and 18 of these patients were involved in this study. Long-term follow-up was completed to evaluate the functions and aesthetics of the hands. Results: disabilities of the arm, shoulder and hand (DASH) was 9.35 (8–10.7) for the second-toe-to-hand with MTP joint arthrodesis transplantation method for pollicization method 19.8 (6–26.7), and for the EIP tendon transposition, 14.54 (0.9–56.3). Conclusions: The postoperative functional parameters of congenital hand hypoplasia patients, regardless of the surgical method, are worse than the functional results of healthy patients. The use of the second-toe-to-hand with MTP joint arthrodesis transplantation method provides patients with congenital hand IIIb–V hypoplasia a stable and functional first finger formation. The functional results are comparable to the clinical results of the pollicization method while ensuring the creation of a five-digit hand.

Restoration of Five Digit Hand in Type III B & C Thumb Hypoplasia–A Game Changer in Surgical Management

“…But, in the modern world, with decreasing need of manual labor and lesser usage of power tools and heavier instruments, providing a less powerful but aesthetically more pleasing thumb is not at all a bad reconstructive option. 15 With the increasing usage of touch screens and automation mechanisms in various tools and gadgets in day-to-day activities of modern life, the need for reconstruction of a powerful thumb to restore stronger grip and grasp is becoming lesser. Parents prefer their children to have five fingered hands even though the reconstructed thumb is less powerful than pollicized index finger.…”

“…But, in the modern world, with decreasing need of manual labor and lesser usage of power tools and heavier instruments, providing a less powerful but aesthetically more pleasing thumb is not at all a bad reconstructive option. 15 …”

Natural History of Poland Syndrome: A Long-term Study of Functional and Psychosocial Outcomes

“…Similarly, most of our patients were white which prohibited us from accounting for cultural differences such as the Asian emphasis on body integrity. 27 In addition, in an attempt to increase sample size and include those recruited through social media, we were unable to independently verify the diagnosis of PS or the degree of hand anomaly. Instead, we relied on survey answers and the participant's description of their condition which introduces the risk of including inaccurate data.…”

Evaluación funcional posterior a la pulgarización en hipoplasia de pulgar mediante uso de T-GAP score

“…Se cree que estos pulgares se tratan mejor con ablación y pulgarización. Las displasias www.medigraphic.org.mx del pulgar tipo V son pulgares ausentes y requieren pulgarización 8 (Tabla 1).…”

“…1 Se requiere tratamiento quirúrgico para las deformidades de grado II-V. Para el tratamiento de la hipoplasia del pulgar de grado II-IIIa se recomienda que el primer dedo sea rescatado estabilizando la articulación metacarpofalángica (MCP) y reconstruyendo la musculatura del hipoplásico. 8 La base de este tratamiento quirúrgico es ampliar el primer espacio interdigital y estabilizar la articulación MCP. El método preferido es la transposición del flexor superficial del tercer o cuarto dedo.…”