Oberg-Manske-Tonkin Classification of Congenital Upper Extremity Anomalies

Abstract

Purpose Although the Oberg-Manske-Tonkin (OMT) classification has been recommended by the International Federation of Societies for Surgery of the Hand owing to some insufficiencies of the Swanson classification system, it has not achieved a universal adoption by hand surgeons. In this study, we hypothesize that the OMT classification can be used easily to classify congenital upper extremity anomalies. We also aim to make epidemiological analysis of congenital upper extremity anomalies with the OMT classification and to compare the applicability of the OMT and the Swanson classifications. Methods We retrospectively analyzed 711 patients and 833 extremities operated on between 2012 and 2017. Photographs, plain x-rays, and brief medical histories of the patients were evaluated by 4 plastic surgeons. Two independent evaluations were made by each surgeon in 1-month interval using these classification systems. Results Total number of upper extremity anomalies recorded was 1050. Of the 711 patients operated on, 122 had bilateral anomalies. The anomalies were identified in 833 extremities because many extremities had more than a single diagnosis. We were able to classify all of the anomalies within the OMT classification. The OMT classification gives better reliability results compared with the Swanson classification according to intrarater and interrater reliabilities. Conclusions Compared with the Swanson classification system based on phenotypic evaluation of the extremity, the OMT classification system is easier to apply and the association of the anomaly with the embryologic origin during evaluation is possible. We believe that multiple studies from different centers will boost the international acceptance of the OMT classification.

Inter- and intra-rater reliability of the Oberg–Manske–Tonkin classification of congenital upper limb anomalies

“…The overall inter-rater reliability of the OMT classification was substantial in our study, in agreement with previous studies (Bae et al., 2018; Uzun et al., 2020). However, this was apparently mainly due to the five easily distinguishable and common anomalies (Group 1) for which the mean inter- and intra-rater reliabilities were almost perfect.…”

“…INS instructed the raters to read all the relevant publications on OMT classification use (Bae et al., 2018; Ekblom et al., 2014; Ezaki et al., 2014; Goldfarb et al., 2015, 2020; Manske and Oberg, 2009; Oberg et al., 2010; Tonkin, 2006; Tonkin and Oberg, 2015; Tonkin et al., 2013; Uzun et al., 2020) and to use the codes and text from the IFSSH homepage (www.ifssh.info/scientific_committee_reports.php), because the OMT 2020 update article contains some errors (Goldfarb et al., 2020). To mirror the use of the classification in clinical practice, we purposely did not arrange a consensus meeting or give any other instructions to the raters on how to use the OMT 2020 classification.…”

“…As yet, no one has published a reliability study of the 2020 version of the OMT. One study has shown substantial inter-rater reliability and almost perfect intra-rater reliability of the previous 2015 version (Bae et al., 2018), and only one reliability study originates from outside the institutions to which the developers of the OMT classification were affiliated (Uzun et al., 2020).…”

An international survey on the adoption and practicality of the Oberg, Manske, Tonkin classification

“…Even after the 2020 OMT update, questions have been raised regarding the practicality and utility of the classification. While many support careful categorization of limb anomalies in the OMT system based on limb development (Ekblom et al., 2014; Goldfarb et al., 2015; Uzun et al., 2020), this support has not been universal with much criticism and discussion regarding the shortcomings of the classification (Lowry et al., 2017; Sletten et al., 2022). In particular, clinicians remained hesitant about its usefulness in patient care, for example in the busy outpatient setting.…”

The Intrarater and Interrater Reliability of the OMT Classification Among Physicians With a Different Background

“…Although the Oberg–Manske–Tonkin (OMT) classification is comprehensive and etiologically correct, it is an elaborate instrument, and classification can be ambiguous. A number of validation studies have been conducted to assess its reliability 1–4 . Half of these studies originated from institutions that contributed to the development of the OMT, 1,4 and all found high reliability scores indicating substantial to almost perfect agreement.…”