Outcome After Pollicization for Congenital Thumb Deficiency: A Cohort Study of Cases in a Single Unit, 1987 to 2016

Ida Neergård Sletten,Magne Røkkum,Mona Irene Winge

doi:10.1016/j.jhsa.2021.05.023

Ida Neergård Sletten, Magne Røkkum + Show 1 more

Open Access

https://doi.org/10.1016/j.jhsa.2021.05.023

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Abstract

To investigate the functional and aesthetic outcomes in a cohort with pollicizations performed due to congenital anomalies in our hospital. From 1987 to 2016, we performed pollicizations in 32 hands of children aged 1 to 8 years (median, 2 years). We followed-up on 31 of the hands from 1 to 31 years (median, 10 years) after the procedure. The participants and their caregivers self-assessed their function and appearance with visual analogue scales and patient-reported outcome measures (Patient-Reported Outcomes Measurement Information System Pediatric Upper Extremity; the short version of the Disability of Arm, Shoulder and Hand Outcome Measure; and EQ-5D-3L). We examined the hands with regard to motion, strength, sensitivity, and function. There were 2 complications and 6 reoperations. Participants with mild anomalies (radial longitudinal deficiency Bayne type N/0 to 2) had better subjective and objective hand function than participants with severe anomalies (radial longitudinal deficiency Bayne type 3-4, ulnar dimelia, 5-finger hand). Hands with preoperatively near-normal index fingers had, in most cases, good thumb opposition and pinch, and hands in both groups benefited from the creation of a cylinder grip. Grip and pinch strength were lower than reported in cohort studies where an additional opponensplasty had been performed. Hands with severe congenital anomalies also benefited from the procedure. We recommend a simplified follow-up program to identify cases where additional surgeries to enhance strength should be considered during growth of the child. Therapeutic IV.

Highlights

From the *Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway; and the †Institute of Clinical Medicine, University of Oslo, Oslo, Norway
Through the years, proposed modifications to the Buck-Gramcko technique.3,6e13 Many hand units have performed cohort studies of pollicization outcomes since the 80s, and comparisons according to diagnosis have found the best results in cases with isolated thumb hypoplasia/ aplasia.5,14e21 Most of these studies were conducted in large tertiary referral centers, with low follow-up rates
We recorded the congenital upper limb anomalies (CULA) type (ObergManske-Tonkin classification, modified Blauth classification, and modified Bayne classification) and sorted the participants into 2 groups according to their diagnosis for stratified analyses of all outcomes (Table 1).1,25e27 Group 1 consisted of patients with radial longitudinal deficiency (RLD), modified Bayne type N/0 to 2

Summary

Introduction

From the *Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway; and the †Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Through the years, proposed modifications to the Buck-Gramcko technique.3,6e13 Many hand units have performed cohort studies of pollicization outcomes since the 80s, and comparisons according to diagnosis have found the best results in cases with isolated thumb hypoplasia/ aplasia.5,14e21 Most of these studies were conducted in large tertiary referral centers, with low follow-up rates. We have the ability to locate all former patients through their lifespan, as our hospitals’ systems are regularly updated according to our National Population Register. This registry contains social security numbers and residence information of everyone who resides or has resided in Norway. The purpose of this study was to investigate the surgical outcomes of all pollicizations performed in congenital cases, regardless of diagnosis in our unit

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