A retrospective comparison of total versus partial cross-bone resection in surgical management of congenital cleft hand

Abstract

This study aimed to compare clinical and radiographical results of total or partial resection of the cross-bone in the management of children with cleft hand. Nine children with 10 cleft hands who underwent resection of the cross-bone were retrospectively identified and divided into two groups based on type of resection: Group T (total resection) including 5 children (5 affected hands; 3 boys; mean age = 3.5 (range, 2–5) years), and Group P (partial resection) including 4 children (5 affected hands; 3 boys; mean age = 3.2 (range, 2–5) years). Mean follow-up was 68 (range, 60–85) months in group T and 47 (range, 40–60) months in group P. To assess clinical status, postoperative cosmetic satisfaction was evaluated by asking the parents, and cosmetic appearance was rated using a visual analogue scale (VAS) at the follow-up. In the radiographical evaluation, change in cleft divergence following reconstruction was assessed as the metacarpal divergence angle between the index and the ring finger metacarpals. Overall, cosmetic satisfaction was rated “very satisfied” or “satisfied” in 7 of the 10 hands, and functional satisfaction as “very satisfied” or “satisfied” in all. Mean postoperative cosmetic aspect on VAS was 6.4 (range, 5–8) in group T, and 6.2 (range, 4–8) in group P (p = 0.99). Mean metacarpal divergence angle significantly decreased from 42.2° (range, 35–52°) and 40.2° (range, 36–46°) preoperatively to 21.2° (range, 15–35°) and 19.8° (range = 12–31°) at 3-year follow-up in groups T and P, respectively (p < 0.001 for each group). Both total and partial cross-bone resection provided satisfactory clinical and radiographical medium-term results for of children with cleft hand.