Thumb Hypoplasia Research Articles

Single-stage Radialization and Pollicization for Radial Longitudinal Deficiency With Thumb Hypoplasia.

Typically, multistage surgeries are usually required for reconstruction of radial longitudinal deficiency with thumb hypoplasia. In this study, we propose single-stage radialization and pollicization for the radial longitudinal deficiency with thumb hypoplasia. The advantages of this technique are to reduce the number of surgical operations, the amount of anesthesia required, and to reduce the cost of multiple follow-ups for patients and family. This technique is noteworthy for the following reasons: (1) use of dorsal vertical midline incision benefit radialization proximal extension for ulnar osteotomy and has less interference with pollicization incision; (2) ulnar shortening osteotomy should be done in case of difficulty in reposition carpus over distal ulnar, overlapping bone, or wrist flexion deformity after complete soft tissue released; (3) recommended fixation technique including predrill and retrograde Kirchner insertion makes for easy osteotomy fixation; (4) exit point of Kirchner wire at the palmar site of the base index metacarpal bone was less interfered with pollicization procedure; and (5) preserved dorso-radial skin bridge between pollicization incision and radialization incision allows for adequate venous draining and prevents postoperative swelling. This technique was carried out on 2 children (4-year-old girl and 2-year-old boy) who presented with type IV radial longitudinal deficiency with unreconstructable hypoplastic thumb. This procedure was successful without any postoperative complications. At 1-year follow-up, the appearance of the wrist was corrected from 90-degree radial angulation to neutral position and from 95-degree to 15-degree radial angulation respectively. For both pollicized thumbs, adequate first web space with proper opposition thumb position was achieved. Thumb tendons started to function at 3 months after surgery. Both patients were able to use their hands to grip light objects with stable carpometacarpal joint and without any pain.

1388-P: Maternal and Neonatal Outcomes in Pregnancies with Preexisting Type 1 Diabetes and Controls

Background: There are limited contemporaneous data about outcomes in pregnancies with pre-existing type 1 diabetes (T1D) in the U.S. Objective: To determine maternal and neonatal outcomes in pregnancies with preexisting T1D and pregnancies in age, parity and BMI matched healthy subjects. Methods: We retrospectively studied 32 pregnancies in patients with preexisting T1D matched for age (mean 25.83 years), gravidity/parity {G1P1 (66), G2P1 (19), G3P1 (9) and G4P1 (6) % respectively} and BMI with controls (n=32) during a 5 year period from 01/01/2015 at Mayo Clinic, Rochester. Results: In 32 T1D pregnancies, 4 (12.5%) congenital defects (CD) were observed in neonates, 1-dysplastic ribs with thumb hypoplasia and 3-congentinal heart defects leading to death in one in comparison to no congenital defect or death in controls. CD pregnancies were complicated by severe pre-eclampsia in all 4 and poor glycemic control (HbA1c >8) in 3. There was a significant difference in Apgar score at 1 min between T1D pregnancies and controls (p=<0.001). Significant respiratory distress was observed in neonates with T1D pregnancies (p=0.011) compared to control group. Significant difference was observed in gestational age b/w two groups (35.9 ± 3.1 vs. 39.4 ± 1.4, p=<0.001). More severe eclampsia was observed in T1D subjects (11 vs. 2, p=0.005) along with pre-term deliveries (12 vs. 1, p=<0.001) compared to controls. Frequency of C-sections was increased in T1D subjects (19 vs.3, p=<0.001) compared to controls. Smoking had a significant effect on Apgar score at 5 min (p=0.014) when compared with current smokers or former smokers. Hypothyroidism (being on T4) during pregnancy had an effect on Apgar score both at 1 min (p=0.003) as well as at 5 min (p=0.004). Conclusion: Pregnancies in T1D continue to be high risk pregnancies and need tight glycemic control with a more advanced system such as closed loop insulin delivery during pregnancy to improve maternal and neonatal outcomes. Disclosure R. Kaur: None. S. Rizvi: None. M. Trinidad: None. B.H. Smith: None. S. Batthula: None. S.K. McCrady-Spitzer: None. C. Reid: None. D. Desjardins: None. G. O’Malley: Research Support; Self; Abbott, Dexcom, Inc. K.N. Castorino: Research Support; Self; Abbott, Dexcom, Inc., Medtronic, Mylan, Novo Nordisk Inc. J.E. Pinsker: Advisory Panel; Self; Medtronic. Consultant; Self; Eli Lilly and Company, Tandem Diabetes Care. Research Support; Self; Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Tandem Diabetes Care. Speaker’s Bureau; Self; Tandem Diabetes Care. W.K. Kremers: Research Support; Self; AstraZeneca. E. Dassau: Consultant; Self; Eli Lilly and Company. Research Support; Self; Dexcom, Inc., DreaMed Diabetes, Tandem Diabetes Care, Xeris Pharmaceuticals, Inc. Speaker’s Bureau; Self; Roche Diabetes Care. Other Relationship; Self; Dexcom, Inc., Insulet Corporation, Roche Diabetes Care. C.J. Levy: Consultant; Self; Dexcom, Inc. Employee; Spouse/Partner; Allergan plc. Research Support; Self; Abbott, Dexcom, Inc., Insulet Corporation. Y.C. Kudva: Research Support; Self; Dexcom, Inc., Roche Diabetes Care. Other Relationship; Self; Abbott.

Holt–Oram Syndrome Associated with Complex Congenital Heart Disease: A Rare Case Presentation and Literature Review

BACKGROUND: First described by Holt and Oram in 1960 in a four-generation family with atrial septal defects and thumb abnormalities, is an inherited disorder characterized by abnormalities of the upper limbs and heart. This syndrome is characterized by upper extremity malformations involving radial, thenar, or carpal bones. An abnormal carpal bone is present in all affected individuals and may be the only evidence of disease. About 75% of individuals with Holt–Oram syndrome (HOS) have a congenital heart malformation which may include an atrial or ventricular septal defect or heart block. In rare cases, the syndrome can affect other organs and systems which can be life threatening.
 CASE REPORT: Here, we present a newborn with clinical and radiologic features of HOS consisting of bilateral asymmetric hypoplastic thumbs, generalized brachydactyly, limited bilateral supination due to radioulnar synostosis, and associated with complex heart disease and hypoplastic tricuspid valve.
 CONCLUSION: In our case HOS is associated with complex congenital heart defects including atrial septal defect, ventricular septal defect with hypoplastic tricuspid valve. Based on the listed literature we didn’t find any other case where tricuspid valve was affected.

The Second Toe-to-Hand Transfer for Full-length Thumb Reconstruction in Congenital Thumb's Grade IIIb to V Hypoplasia: MTPJ Arthrodesis Instead of Tendon Rebalansing.

Congenital thumb hypoplasia is a rare deformity of the upper extremity. The classification of thumb hypoplasia was created by Blauth in 1967 (types I to V). The base of the first metacarpal bone is absent for hypoplasia types IIIb to V, therefore, toe-to-hand transplantation is not recommended. A stable first carpometacarpal joint has been considered a mandatory factor for a successful toe-to-hand transplantation. The aim of this study is to describe a new technique for thumb reconstruction with the second toe transfer and metatarsophalangeal joint (MTPJ) arthrodesis, which can provide a five-digit hand and restore thumb functionality for thumb hypoplasia IIIb to V. We performed second toe-to-hand transplantation with MTPJ arthrodesis for 3 pediatric patients (mean age, 69 mo) with congenital thumb hypoplasia IIIb (n=2), grade V (n=1). Long-term follow-up evaluated the functions and esthetics of the hands for grade IIIb patients (n=2). We believe the second toe transfer with MTPJ arthrodesis transplantation is a promising method for reconstructing a full-length congenital or traumatic thumb absence for the pediatric population.

Assessment of hand function using the functional dexterity test after opponensplasty in young children with Blauth type 2 hypoplastic thumb.

The functional dexterity test (FDT) is a timed pegboard test based on the manipulation of each peg and suitable for young children as it is both simple and quick to perform. We assessed the postoperative FDT values for children with Blauth type 2 hypoplastic thumbs after opponensplasty. We evaluated hand function using FDT for 12 hands of 11 patients with Blauth type 2 hypoplastic thumbs. Opponensplasty was performed in all hands following by Huber's procedure. All patients were evaluated from 6 to 12 months after surgery for hand function using three types of FDT scores: time in seconds to complete the test (FDT time), combined total time with penalty seconds added to the initial time (FDT total), and the number of pegs per second to complete the task as a percentage against normative values (FDT speed). We compared the postoperative FDT scores with those for Blauth type 1 or 2 hypoplastic thumb patients without surgical treatment. FDT time and FDT total for the patients postoperatively were both significantly shorter than those in the type 2 patients without surgical treatment. FDT speed was significantly higher than that for the patients without surgical treatment. There were no significant differences in the three FDT scores between the postoperative patients and the type 1 patients. There were several limitations including small sample size, large ranges of the data, and high number of variables. FDT reflected postopponensplasty improvement in hand dexterity in young children with Blauth type 2 hypoplastic thumb.

Radial Longitudinal Deficiency: Severity Differences Between U.S. and Japanese Cohorts

Radial longitudinal deficiency (RLD) presents on a spectrum of severity and associated diagnoses. The literature is limited in describing patient presentation without comparative data between countries. In a study comparing 2 cohorts of patients, 1 in the United States and 1 in Japan, we hypothesized that there would be a similar presentation of forearm deficiency severity, thumb hypoplasia severity, and associated syndromes between the 2 cohorts. Patients with RLD were identified via a comprehensive chart review at 2 pediatric hospital cohorts, 1 in the United States and 1 in Japan, capturing patients presenting over 15 years. We assessed RLD and thumb hypoplasia severity via a modified Bayne and Klug and modified Blauth classifications. The relationship between these 2 diagnoses and the presence of common medical conditions were evaluated and correlated. A total of 194 Japanese patients with 290 involved extremities were compared with 107 U.S. patients with 174 involved extremities. The U.S. cohort had a significantly more severe RLD, and a higher rate of bilaterality (63% vs 50%, respectively). A total of 131 Japanese patients (68%) and 41 U.S. patients (38%) had associated medical syndromes/associations, most frequently vertebral abnormalities, anal atresia, cardiac abnormalities, tracheoesophageal fistula and/or esophageal atresia, renal agenesis and dysplasia, and limb defects (VACTERL; 46 Japanese, 14 U.S.), Holt-Oram (44 Japanese, 5 U.S.), and thrombocytopenia absent radius syndrome (0 Japanese, 12 U.S.). Correlation analysis showed that increased RLD severity was associated with increased thumb hypoplasia severity in both groups, with 95% of modified Bayne and Klug III, IV, or V patients having severely affected thumbs (type IIIb, IV, or V). The U.S. patients had a more severe RLD and a higher rate of bilaterality. Japanese patients had a higher incidence of associated syndromes and radial polydactyly. Both cohorts showed that increased forearm severity was associated with more severe thumb hypoplasia. Differential diagnosis/symptom prevalence study III.

Thumb Hypoplasia Occurring in Patients With Preaxial Polydactyly

Thumb polydactyly and thumb hypoplasia are generally regarded as separate clinicalentities. However, several case reports indicate that hypoplasia of both the thumb andthe radius can occur in patients with thumb polydactyly and improved understanding of thegenetics of the developing upper limb may give an embryologic explanation for this occurrence. Our hypothesis was that patients with preaxial polydactyly can have ipsilateral thumb hypoplasia that may not be recognized until after surgical reconstruction of the extra digit. We searched our surgical database for all procedures performed on patients with a diagnosis of preaxial polydactyly between 2002 and 2014. We reviewed the medical record for demographic data, surgical procedures, and follow-up information. In addition, all available radiographs were reviewed. Through this, we identified patients with a diagnosis of ipsilateral thumb hypoplasia, including when in the course of treatment the diagnosis was made, and any related subsequent procedures. We reviewed 132 patients who underwent reconstruction of thumb polydactyly, 10 of whom were identified as having evidence of ipsilateral thumb hypoplasia, an incidence of 8.2%. The diagnosis of thumb hypoplasia was made before surgery in 3 of the 10 patients. One additional patient was noted to have a duplicate thumb on one side and a hypoplastic thumb on the contralateral side. This study supports the hypothesis that children with preaxial polydactyly can have ipsilateral thumb hypoplasia that may not be noted before surgery. In this study group, 8% of patients with preaxial polydactyly had ipsilateral hypoplasia. Prognostic IV.

Variation of Extrinsic Tendons of the Thumb in Type IIIA Hypoplastic Thumbs

The purpose of this study was to identify the variety of anatomical abnormalities of extrinsic tendons in type IIIA hypoplastic thumbs. We reviewed 79 thumbs in 67 patients. Opponensplasty, stabilizing of the thumb metacarpophalangeal joint, and widening of the first web space were performed in all patients. At the time of surgery, we made detailed observations of the anatomical abnormalities of the extrinsic tendons of the thumb. Fifty thumbs (50 of 79; 63%) had an interconnection between the flexor pollicis longus (FPL) and the extensor pollicis longus (EPL) tendons. Twenty-six thumbs (26 of 79; 33%) had bifurcations (25 [32%] bifurcated from the FPL; 1 [1%] bifurcated from the EPL). There were 25 FPL abnormalities (4 [5%] complete absence; 8 [10%] proximal absence; 2 [3%] distal absence; 11 [14%] tendon hypoplasia) and 7 EPL abnormalities (2 [3%] proximal absence; 5 [6%] tendon hypoplasia). Interconnections between the FPL and the EPL tendons and a duplicated FPL were observed frequently. The present study investigates the detailed anatomy of the type IIIA hypoplastic thumbs. The data might help improve the design of surgical procedures.

AN UNUSUAL PRESENTATION OF FLOATING THUMB

Thumb hypoplasia has a varying range from slight hypoplasia to total absence. Type IV hypoplasia, also known as floating thumb, includes two small phalanges attached to the hand with a thin skin bridge containing neurovascular bundle. A fifteen days old boy had a mass-like floating thumb, unlikely to frequently encountered. The family was advised to seek genetic counseling for accompanying abnormalities of the baby. Six days later, the baby showed up with the congested thumb. As an urgent treatment, the congested hypoplastic thumb was amputated under local anesthesia.

Bilateral isolated absence of flexor pollicis longus tendon: report on a rare case management

Introduction: In human, the flexor pollicis longus (FPL) is an important muscle for function of the hand. Thumb aplasia and hypoplasia represent a large spectrum of deficiencies. One of the variants of type I thumb hypoplasia is the absence or hypoplastic of FPL tendon without deficiency of other thenar muscle. Although rare, we found several literatures reporting the cases. In treating pediatric thumb disease especially for this condition, we have to carefully diagnose the problem to set our goal of treatment. Methods: We presented a case of 8-year-old male with bilateral inability to flex both thumbs at the interphalangeal (IP) joint. His parents realized this condition after he was involved in school activity. On physical examination, we concluded that the patient has absence of FPL and proceeded for reconstruction with tendon transfer from 4th flexor digitorum superficialis (FDS) and dorsal capsule release. Results: We performed surgery and postoperatively observed the active movement of IP joint. The treatment improved the active flexion of the IP joint around 60 degrees. Conclusion: The absence of IP crease is one of the clear signs of FPL absence or hypoplasia. The usage of dorsal capsule release and tendon transfer in treating FPL absence or hypoplasia without any other thenar anomalies is proven to be adequate and feasible

Reversed vascularized second metatarsal flap for reconstruction of Manske type IIIB and IV thumb hypoplasia with reduced donor site morbidity.

The predominant method for Manske type IIIB and IV thumb hypoplasia is pollicization. However, for those who are not willing to sacrifice the index finger, a method that could reconstruct a functionally capable and aesthetically acceptable thumb remains desirable. This study aimed to investigate and assess the functional and radiographic outcomes of utilizing a reversed vascularized second metatarsal composite flap for thumb reconstruction as a new alternative. From May 2014 to January 2017, 15 patients with Manske type IIIB or IV thumb hypoplasia who were admitted to the Department of Hand Surgery, Beijing Jishuitan Hospital were included in this study. An osteocutaneous flap containing a section of second metatarsal and its distal head was transferred in reversed position to reconstruct carpometacarpal joint. The donor site was reconstructed by a split half of the third metatarsal. Various functional reconstructions were commenced at second stage. The reconstructed thumbs were evaluated using the Kapandji score, pinch force, and the capacities of performing daily activities through a detailed questionnaire. Among these 15 patients (seven type IIIB and eight type IV), there were ten boys and five girls with median age of 4.2 years (range: 2.0-7.0 years). There were seven right, three left, and five bilateral thumbs for whom only the right thumb received surgery. There were 14 metatarsal flaps survived (14/15). With an average follow-up of 19.2 months, the reconstructed thumbs had acceptable functional and aesthetic outcomes and the donor foot presented in decent appearance without signs of impaired function. All 15 children have improved the Kapandji score (from 0 to an average of 6.7), pinch force (from 0 to an average of 1.5 kg), with ability of grip and pen holding. X-ray indicated continuous bone growth. Patients and parents had good acceptance of the new thumb. Reconstruction of an unstable hypoplastic thumb (Manske type IIIB and IV) with use of a vascularized metatarsal is an effective strategy. It offers an alternative solution for parents insisting on saving the thumb.

Pollicisation dans la prise en charge des hypoplasies et aplasies congénitales du pouce, résultats fonctionnels, à propos de 13 cas

Pollicization of the index finger as a treatment for aplasia and severe congenital thumb hypoplasia remains a demanding surgical procedure. In aplasias, it is generally well-accepted, less in hypoplasias. However, it is often the only solution to give back to the child the possibilities of a pollici-digital grip, guaranteeing an excellent function of the hand. We decided to evaluate the long-term results of this intervention. We reviewed all children operated of index pollicization for a congenital aplasia or hypoplasia of the thumb between 2006 and 2018. The evaluation was performed with a specialized reeducator. The analytical and functional characteristics of the neo-thumbs were evaluated, as well as the consequences on the daily life of the child. Thirteen pollicisations were performed on 10 patients. The mean age at surgery was 21 months (10; 43). It was a Blauth stage IIIB in 1 case, IV in 5 cases, and V in 7 cases. Seven children, and eight hands, could be evaluated. The average postoperative follow-up was 6.5 years. The mean age at the examination was 7.7 years (3.3, 12.1). The mean Percival score was 18 out of 22. The adapted video-assisted scoring system had an average score of 11 out of 14. Children described a momentary psychosocial discomfort for 5 of them, and still present in 3 of them. The pollicization of the index finger in congenital aplasia or severe hypoplasia (stage IIIB and IV) of the thumb remains for us the only way to create a sensitive thumb, mobile, with satisfactory strength and appearance, and to bring a normal function of the hand. The evaluation of our functional results are good to very good in the majority of patients, and show the benefits give by this intervention.

Long-term outcomes after pollicization: a mean 11-year follow-up study.

This study evaluates the long-term results of pollicization for a congenitally absent or severely hypoplastic thumb. Twenty-nine patients with 34 pollicizations were divided to two groups: those with simple thumb hypoplasia (22 pollicizations) and those with radial longitudinal dysplasia (12 pollicizations). The patients were followed from 1.3 to 32 years, with a mean follow-up time of 11 years. The patients were examined clinically and radiologically, and they completed a questionnaire concerning satisfaction with appearance, function, and social interaction. The Percival score was also calculated. In both groups, grip and pinch strengths of the operated hands were inferior to the normative age-related values. Radiologically, flattening of the original metacarpal head was found in 20 out of the 34 operated hands. We found better patient satisfaction in the simple hypoplasia group than in the radial longitudinal dysplasia group. The functional outcomes and patients' satisfaction did not correlate with the age of patients at operation. Level of evidence: IV.

Methods for Congenital Thumb Hypoplasia Reconstruction. A Review of the Outcomes for Ten Years of Surgical Treatment.

Background and objectives: Congenital thumb hypoplasia is a rare deformity of upper extremity. The incidence for thumb hypoplasia grade II–V is 1:10,000 newborns per year in Latvia. A technique for extensor indicis proprius (EIP) tendon transfer with subperiosteal fixation was developed and used for thumb hypoplasia grades II and IIIa. Pollicization or second-toe-to-hand transplantation with metatarsophalangeal (MTP) joint arthrodesis was used for the reconstruction of hypoplasia grade IIIb–V. The aim of this retrospective cohort study is to evaluate the outcomes for reconstruction techniques used in one surgical center during a ten-year period by one surgeon to evaluate functional and aesthetical outcomes for new techniques. Materials and Methods: In total, 21 patients were operated on during 2007–2017, and 18 of these patients were involved in this study. Long-term follow-up was completed to evaluate the functions and aesthetics of the hands. Results: disabilities of the arm, shoulder and hand (DASH) was 9.35 (8–10.7) for the second-toe-to-hand with MTP joint arthrodesis transplantation method for pollicization method 19.8 (6–26.7), and for the EIP tendon transposition, 14.54 (0.9–56.3). Conclusions: The postoperative functional parameters of congenital hand hypoplasia patients, regardless of the surgical method, are worse than the functional results of healthy patients. The use of the second-toe-to-hand with MTP joint arthrodesis transplantation method provides patients with congenital hand IIIb–V hypoplasia a stable and functional first finger formation. The functional results are comparable to the clinical results of the pollicization method while ensuring the creation of a five-digit hand.

Long-Term Evaluation of The Functional and Esthetical Outcomes for The New Method of The Toe-To-Hand Transfer for Full-Length Thumb Reconstruction in Congenital Thumb’s Hypoplasia in Children

Abstract Congenital thumb hypoplasia is a rare deformity of the upper extremity. Incidence of thumb hypoplasia type I–V was 2–3 and type IIIb-V was 0.5–1 per 20 000 newborns per year in Latvia. The classification of thumb hypoplasia was created by Blauth in 1967 (type I to V). The base of the metacarpal bone is absent for hypoplasia type IIIb–V; therefore, toe-to hand transplantation is not recommended. A stable first carpometacarpal joint has been considered a mandatory factor for successful toe-to-hand transplantation. A technique for toe-to-hand transplantation for thumb hypoplasia type IIIb–V patients has been described in literature but overall results were not better than pollicisation. The aim of this study is to describe a new technique for thumb reconstruction with a second toe transfer with metatarsophalangeal joint arthrodesis, which can provide a 5-digit hand and restore the functionality of the thumb for thumb hypoplasia IIIb–V. Long-term follow up was done to evaluate the functions and aesthetics of the hands. A survey to evaluate aesthetical outcome for the transplantation method and pollicisation method was completed by 290 respondents. The overall population rated the aesthetic outcomes of the new transplantation method significantly higher than for pollicisation (p < 0.0001).

Parenting stress in mothers of children with congenital hand or foot differences and its effect on the surgical decision-making for their children.

The main purposes of this study were to assess the levels of parenting stress in the mothers of children with congenital hand or foot differences and to evaluate the effects of this stress on the preferred roles of mothers in surgical decision-making for their children. This study included 89 mothers of children with polydactyly of the hand, polydactyly of the foot, a hypoplastic thumb, or macrodactyly. The parenting stress level was assessed using the Parenting Stress Index-Short Form (PSI-SF). Additionally, the mothers were requested to indicate their preferred and retrospectively perceived levels of involvement in surgical decision-making for their children using the Control Preferences Scale, which is comprised of five levels ranging from fully active to fully passive. The average PSI-SF scores were 73.9, and 15 mothers (17%) had a clinically significant level of stress (PSI-SF ≥ 90). In the mothers of children with polydactyly of the foot, the PSI score was associated with the preferred role in surgical decision-making. The assessment of parenting stress levels in the mothers of children with congenital hand or foot differences can play an important role in the screening of candidates who require psychiatric treatment or support. An evaluation of the PSI in mothers of children with congenital hand or foot differences may aid physicians to modify their style of decision-making based on the preferred role of the mother. Level of evidence: Level IV Therapeutic study.

Lower Extremity Surgical Treatment to Improve Function in a Patient with Gollop-Wolfgang Complex

Gollop-Wolfgang Complex (GWC) includes congenital absence of the tibia with ipsilateral distal femur bifurcation associated with hand/foot ectrodactyly. A 20-month-old male presented with GWC, including left bifid distal femur with ipsilateral tibial hemimelia and absent extensor mechanism, hypoplastic bilateral thumbs, and right foot tarsal-type preaxial polydactyly. Left through-knee amputation preserving growth and contralateral polydactyly reconstruction were performed. Complications of wound infection and dehiscence were successfully treated. Patient is 44 months old and ambulating with left knee disarticulation prosthesis and right supramalleolar orthosis. Through-knee amputation and prosthetic fitting provides limb function for GWC patients with tibial hemimelia lacking an extensor mechanism.

Pollicization of the Index Finger in the United States: Early Readmission and Complications

Pollicization is a well-accepted treatment for thumb hypoplasia, yet little is known about the reasons why patients return early in the postoperative period and complications that occur after surgery. The purpose of this investigation was to describe 30-day returns, readmission, and complication rates after pollicization in the United States. A total of 459 pollicization procedures performed in 408 patients at 38 U.S. pediatric hospitals from 2003 to 2014 were identified using the Pediatric Health Information System database. A stepwise search strategy identified returns and readmissions within 30 days after pollicization to quantify complications and/or additional procedures. Risk factors for readmission and complications were compared across groups using uni- and multivariable general linear modeling. There were 61 patients who returned to the hospital (emergency department, ambulatory surgery, or inpatient hospitalization) within 30 days of their pollicization. Of those, 39 patients returned for suture removal, cast changes, or other expected aspects of postoperative care. The remaining 22 patients had a total of 26 complications, accounting for a 4.8% complication rate. The majority had vascular complications and wound problems. Single complications ranging from wound infection to hemorrhage were found in 20 cases. Overall, 35 of the 61 returns were readmitted to the hospital for treatment of complications or additional procedures. There was no effect of age group, diagnosis, geographical region, or physician subspecialty on the likelihood of complication or readmission. Sixty-one patients returned within 30 days of their pollicization, and 22 presented with a complication (4.8%), most commonly vascular in nature. These baseline data are informative because they identify opportunities for future preventative measures and quality improvement. Therapeutic IV.

Inter- and Intrarater Reliability of the Thumb Grasp and Pinch Assessment for Children Following Index Pollicization for Congenital Thumb Hypoplasia

The Thumb Grasp and Pinch (T-GAP) assessment quantifies functional hand use in children with congenital thumb hypoplasia by categorizing grasp and thumb use patterns during assessment activities that encourage a variety of grasp and pinch styles. This study aims to demonstrate interrater and intrarater reliability results of the T-GAP. A retrospective review was performed of children who had undergone index finger pollicization for congenital thumb hypoplasia and subsequent evaluation with videotaping of the T-GAP assessment. Following a training period, 4 occupational therapists scored 11 T-GAP videos on 2 separate occasions, separated by at least 2 weeks. Intraclass correlation coefficients (ICCs), standard error of measurements, minimum detectable change (MDC), and Pearson correlation coefficients were calculated. The T-GAP raw scores were 16 to 55, demonstrating a range of mild to severe hand grasp differences. The ICCs for the interrater reliability trials were 0.887 and 0.901. Intrarater ICCs were all above 0.88. The MDC for each trial was 8.1 and 6.7 points. Pearson correlation coefficients calculated for each rater and each pair of raters were above 0.8 in all cases. Interrater and intrarater reliability testing results for the T-GAP were excellent in all cases; this strongly suggests that results from T-GAP assessments are reliable. The high ICCs suggest that raters can classify and score children's hand function consistently. This study, in conjunction with previous work, suggests that the T-GAP may be an ideal approach to assessing the outcomes of pollicization and provide a means of ongoing assessment of children's grip and pinch function.

A rare manifestation of Fanconi anemia

Fanconi anemia is an inherited pancytopenia, primarily inherited as autosomal recessive form. It occurs in all racial and ethnic groups. Majority of patients have both physical and haematological abnormalities, about one-third of patients will have normal physical features but abnormal haematological findings and unknown percentage have physical anomalies and normal haematological findings. The diagnosis is based on characteristic physical anomalies and abnormal haematological findings, which is confirmed with a lymphocytic chromosomal breakage study using Diepoxy butane (DEB). The report here is about a two and half years old female child who presented with physical features in the form of short stature, microcephaly, left hypoplastic thumb and congenital heart disease without haematological abnormalities. Chromosomal study was suggestive of Fanconi’s anemia.