Abstract
To evaluate the clinical and functional results of the surgical treatment of bifid thumb type IV in children. A retrospective study was undertaken from January 1995 to December 2006. Clinical and radiographic evaluations were made according to Wassel's classification. The patients were performed by transferring an epiphyseal segment of the proximal phalanx with insertion of the abductor pollicis brevis tendon into the radial side of the epiphyseal proximal phalanx of the ulnar thumb. All patients were operated using one of five surgical procedures for bicephalous metacarpus, cartilaginous connection between the radial and ulnar proximal phalanges, the angular deformity of the metacarpophalangeal joint (MPJ) is >20°, and zigzag deformities. The postoperative results of the patients were evaluated for both function and cosmesis according to Tien's modified Tada scoring system. One hundred and sixty-four patients (102 females, 62 males) were included in this study. The MPJ was stable in 170 thumbs, 15 thumbs had 10° of radial instability, and new collateral ligaments were augmented in 27 thumbs. The alignment was normal in 75 thumbs, with alignment of the interphalangeal joint (IPJ) in 101 thumbs and alignment of the MPJ in 75 thumbs. Postoperatively, there were zigzag deformities in four thumbs (developed zigzag in two thumbs, recurrent zigzag in two thumbs); there was no first web space in those hands. There were four of 185 thumbs with thumb stiffness. The abductor function of 185 thumbs was as follows: >70° in 158 thumbs (85.4%), 50°-70° in 21 thumbs (11.4%), and <50° in six thumbs (3.2%). At the latest follow-up evaluation, no evidence of physeal growth injury or growth arrest was observed in any patient. Overall, we attained good results in 140 thumbs (75.7%), fair results in 36 thumbs (19.4%), and poor results in nine thumbs (4.9%). We recommend the use of an epiphyseal segment of the proximal phalanx with insertion of the abductor pollicis brevis tendon into the radial side of the epiphyseal proximal phalanx of the ulnar thumb and to restore anatomical insertion of the abductor pollicis brevis muscle. The technique is simple, safe, and effective for thumb abductor function in the treatment of bifid thumb type IV in children.
Highlights
This article describes the results of a series of reconstructive operations done to correct bifid thumbs in children, using the procedure of transferring the epiphyseal segment of the proximal phalanx with insertion of the abductor pollicis brevis tendon for duplication at the metacarpophalangeal joint (MPJ) level (Wassel type IV) between 1995 and 2006
A retrospective study was undertaken to evaluate the results of a specific surgical technique: transferring the epiphyseal segment of the proximal radial phalanx with insertion of the abductor pollicis brevis tendon
If the radial thumb was to be excised, we identified the adductor pollicis; cut off and carefully preserved an epiphyseal segment, with insertion of the abduction pollicis brevis; and excised an epiphyseal segment of the radial side of the ulnar thumb (Fig. 1a, b)
Summary
There was one thumb that developed a zigzag deformity, and one thumb that developed joint stiffness Both parents and patients rated the result as having acceptable function and cosmesis in 15 thumbs, acceptable functional or cosmetic result in 12 thumbs, and unacceptable functional and cosmetic results in two thumbs. At the latest follow-up, the thumb abductor functions were [70° in 12 thumbs and 50°–70° in one thumb Both parents and patients rated the results as having acceptable function and cosmesis in six thumbs, and acceptable functional or cosmetic result in seven thumbs. There was one thumb that had developed a zigzag deformity, and one that had joint stiffness Both parents and patients rated the results as having acceptable function and cosmesis in seven thumbs, acceptable functional or cosmetic result in three thumbs, and unacceptable functional and cosmetic results in one thumb. Hyperplastic scar in 14 thumbs, zigzag deformities in four thumbs (developed zigzag deformity in two thumbs, recurrence of zigzag deformity in two thumbs), and joint stiffness in four thumbs
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