Modified method for reconstruction of thumb abduction function in children undergoing surgical treatment of thumb duplication

Abstract

Purpose This study was performed to evaluate a modified method of reconstructing the thumb abduction function in children undergoing surgical treatment of thumb duplication. Methods This retrospective study included 33 children (38 thumbs) with Wassel type III to VII thumb duplication who underwent excision of the polydactylism and osteotomy of the preserved thumb. Among them, 16 children (19 thumbs) underwent reconstruction of the attachment of the articular capsule and collateral ligament of the metacarpophalangeal joint, abductor pollicis brevis and flexor pollicis brevis by the anchor technique (Group A), while 17 children (19 thumbs) underwent suturing the attachment of the above-mentioned soft tissues to the periosteum (Group B). All children were followed up for six years after surgery. The appearance, function and joint stability of the preserved thumb were compared between the two groups; the bone alignment and development were observed. Results The deformity rate of preserved thumbs and the positive rate of lateral stress test were significantly lower in Group A than B (p < 0.05). The modified Tada score and the distance of first web were significantly higher in Group A than B (p < 0.05). Flexion, extension, adduction, abduction and palmar movement of the thumbs were good; bone alignment and development were good and no osteophyte or anchor shadow was left in the preserved thumbs in Group A. Conclusion Reconstruction of the abduction function using the anchor technique is effective in children undergoing surgical treatment for Wassel type III to VII thumb duplication and it may be superior to the conventional technique. Level of evidence III

Radiographic features of congenital thumb duplication type C2 of Wu et al. classification: new subtypes and surgical strategies

“…In addition, the Kim et al subtype system is based solely on the interval between the main and duplicate thumbs and not on the morphological features of the main thumb (2). For example, in the divergent or convergent type, the alignment of the IP of the main thumb may be without deviation, with ulnar deviation, or with radial deviation; this aspect was not considered by Kim et al Some surgeons do not rely on a subtype system to determine treatment but may instead use a combination of skin, tendon, and skeletal features to guide surgical decisions (13)(14)(15)(16)(17).…”

Epidemiological characteristics and distribution of congenital thumb duplication in south China: An analysis of 2,300 thumbs in 2,108 children

“…For example, in C type, the extra thumb can be connected to the main thumb by bifurcated phalanx at the level of the distal phalanx, proximal phalanx or bifurcated metacarpus. Flap design, muscle tendon and bone reconstruction are different depending on the duplication level ( 27 , 28 ). Therefore, it is necessary to explore a simple and comprehensive classification system useful for selecting the best treatment option ( 29 ).…”

Recent Advancements in the Diagnosis and Treatment of Congenital Hand Differences

“…11 Depending on the level of duplication, another area of postoperative concern for the preserved thumb is poor joint stability, abduction function, and bony alignment. 12,13 For Wassel-Flatt types III and VII, Zhou et al 12 introduced an absorbable anchor technique, consisting of a tiny implant fixed in bone, to allow the soft tissues (articular capsule, collateral ligament, abductor pollicis brevis, flexor pollicis brevis) to be anchored to the implant instead of the periosteum. They found postoperative deformity rates and positive lateral stress test to be markedly lower in the implant versus periosteum group.…”

“…They found postoperative deformity rates and positive lateral stress test to be markedly lower in the implant versus periosteum group. 12 In addition, bony alignment is typically achieved by metacarpal osteotomies with the use of Kirschner wires. 12,13 In Wassel-Flatt types IV and VIII, Chew et al 13 introduced a suture-only technique of metacarpal osteosynthesis and found that the internalized construct reduced the rate of Kirschner wire complications with the same overall outcome.…”