1
|
Hamsho S, Sleiay M, Alaswad M, Alsmodi H, Al‐Hakeem K. A 23-year-old patient with bilateral hypoplastic thumbs and toes: A case report. Clin Case Rep 2024; 12:e8567. [PMID: 38444917 PMCID: PMC10912101 DOI: 10.1002/ccr3.8567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
Key Clinical Message However, it is noteworthy that certain patients with minor functional limitations in their hand may have experienced undiagnosed thumb hypoplasia during their childhood years. These individuals may have successfully adapted to their condition without seeking medical intervention and may express a preference for nonintervention (as in this case). Abstract Thumb hypoplasia is a congenital underdevelopment of the thumb, accounting for 5%-15% of congenital hand disorders. It occurs equally among both genders and can affect both thumbs. The condition is categorized using Blauth's classification with Type I being the mildest form. We report a 23-year-old Syrian male presented with a bilateral restriction in opposition movement when using a pen or razor. Clinical examination and x-ray imaging revealed a bilateral Type I hypoplastic thumb with bilateral minimal hypoplasia of the toes. Despite the surgical treatment options available, the patient opted not to undergo surgery due to his adaptation to his condition. Hypoplastic thumb Type I is a congenital condition characterized by underdevelopment of the thumb. Bilateral thumb hypoplasia with toes hypoplasia is extremely rare. A full systemic evaluation should be done due to its associations with other syndromic manifestations and treatment options are discussed concerning the best functional outcomes and patient preferences.
Collapse
Affiliation(s)
- Suaad Hamsho
- Rheumatology Department, Faculty of MedicineDamascus UniversityDamascusSyria
| | | | | | | | | |
Collapse
|
2
|
Ozols D, Laucis R, Osins R, Berezovska MM, Kalnina L, Mikitins A, Petersons A. The Extensor Indicis Proprius Transposition for the Ulnar Collateral Ligament Stabilization in Thumb Hypoplasia Grades II-IIIa. Tech Hand Up Extrem Surg 2023; 27:73-78. [PMID: 36193683 DOI: 10.1097/bth.0000000000000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Congenital upper extremity deformities are rare, the reported incidence is from 0.15% to 0.2%. The thumb is very important for a hand's functionality, as it provides up to 50% of its total performance. Proper pinch grip formation at the age of 12 to 16 months is part of normal development; however, no functional development can affect a child's psychoemotional development. Well-described techniques such as third or fourth superficial flexor transposition can be found in the literature. There is a paucity of studies on using the extensor indicis proprius (EIP) transposition for stabilization of the ulnar collateral ligament for the first metacarpophalangeal joint (MCPJ). Techniques for the usage of EIP tendon for the reconstruction of absent extensor pollicis longus tendon are more commonly practiced as they create abduction and extension for the thumb hypoplasia grade II-IIIa. We performed EIP transposition with subperiosteally fixation for the ulnar collateral ligament stabilization for thumb hypoplasia patients with a mean age of 38 months (11 to 128) and grade II (n=9), grade IIIa (n=4), and grade IIIb (n=1). Long-term follow-up (2 to 10 y) for the esthetical and functional study was performed. Patients and parents are satisfied with functional and esthetic outcomes. We believe that the EIP tendon transposition can be an alternative method for thumb hypoplasia patients grade II-IIIa reconstruction.
Collapse
Affiliation(s)
- Dzintars Ozols
- Department of Paediatric Surgery, Riga Stradins University
- Department of Paediatric Surgery, Children Clinical University Hospital
- Department of Hand and Plastic Surgery, Microsurgery Centre of Latvia, Riga East University Hospital, Riga, Latvia
| | - Rudolfs Laucis
- Department of Paediatric Surgery, Riga Stradins University
| | - Reinis Osins
- Department of Paediatric Surgery, Riga Stradins University
| | - Marisa Maija Berezovska
- Department of Paediatric Surgery, Riga Stradins University
- Department of Paediatric Surgery, Children Clinical University Hospital
| | - Linda Kalnina
- Department of Paediatric Surgery, Riga Stradins University
| | | | - Aigars Petersons
- Department of Paediatric Surgery, Riga Stradins University
- Department of Paediatric Surgery, Children Clinical University Hospital
| |
Collapse
|
3
|
Donnelly MR, Bekisz JM, Rocks M, García Medrano B, Mayer J, Pan JD, Mohan M, Venkatramani H, Henri Hacquebord J. General Population and Surgeon Preferences for Pollicization Versus Toe-To-Thumb Transfer for Reconstruction of Traumatic Thumb Loss in Adults: An International, Multi-Center Survey Study. J Hand Surg Am 2023:S0363-5023(22)00726-2. [PMID: 36732128 DOI: 10.1016/j.jhsa.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 11/22/2022] [Accepted: 12/08/2022] [Indexed: 02/01/2023]
Abstract
PURPOSE Data objectively comparing outcomes following pollicization versus toe-to-thumb transfer for reconstruction after traumatic thumb amputation in adults remains sparse. Given that this decision is reliant on personal preference, it is important to understand the subjective nature of these preferences, particularly in the context of culture. The purpose of this study was to compare Eastern and Western societal and hand surgeon preferences for pollicization versus toe-to-thumb transfer for traumatic thumb reconstruction. METHODS Investigators from 6 international locations recruited local hand surgeons and members of the general population. Austria, Germany, the United States, and Spain were grouped as "Western" nations. China and India separately represented "Eastern" nations. Participants completed a questionnaire evaluating their personal preferences for pollicization and toe-to-thumb transfer. The questions posed to the general population and hand surgeons were identical. Demographic data were also collected. RESULTS When comparing the Western nations, China, and India, there was no difference in personal preferences within the general population for pollicization versus toe-to-thumb transfer. In contrast, most Indian hand surgeons favored toe-to-thumb transfer and most Western surgeons were uncertain about which procedure they would favor. Surgeons had more optimistic expectations regarding postoperative hand function, new thumb sensation, and hand appearance following pollicization than the general population. Similarly, for toe-to-thumb transfer, a greater proportion of surgeons predicted good-to-excellent function, sensation, and appearance. CONCLUSIONS There was no clear, observed "East" versus "West" difference in the general population's personal preferences for pollicization versus toe-to-thumb transfer among study participants. The members of the general population and hand surgeons had different outcome expectations. CLINICAL RELEVANCE Understanding how culture influences patient and hand surgeon preferences for pollicization versus toe-to-thumb transfer may help guide future decision-making for traumatic thumb reconstruction.
Collapse
Affiliation(s)
- Megan Rose Donnelly
- Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Jonathan M Bekisz
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY
| | - Madeline Rocks
- Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Belén García Medrano
- Department of Trauma and Orthopedic Surgery, HM Montepríncipe Madrid, Madrid, Spain
| | - Johannes Mayer
- Department of Plastic, Aesthetic and Reconstructive Surgery, University Hospital St Poelten, St Poelten, Austria; Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Jia-Dong Pan
- Department of Hand Surgery, Ningbo 6th Hospital, Ningbo, China
| | - Monusha Mohan
- Plastic & Trauma Reconstructive Surgery, Department of Plastic, Hand and Reconstructive Micro Surgery, Ganga Hospital, Coimbatore, India
| | - Hari Venkatramani
- Plastic & Trauma Reconstructive Surgery, Department of Plastic, Hand and Reconstructive Micro Surgery, Ganga Hospital, Coimbatore, India
| | - Jacques Henri Hacquebord
- Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, New York, NY; Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY.
| |
Collapse
|
4
|
Ince B, Dadaci M. Thumb Reconstruction Using Transfer of the Ring Finger Without Vascular Anastomosis. J Hand Surg Am 2022; 47:686.e1-686.e6. [PMID: 34454778 DOI: 10.1016/j.jhsa.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 04/02/2021] [Accepted: 06/09/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE This study describes the results of the ring finger transfer technique for thumb reconstruction. METHODS Five fingers of 4 patients aged 23-57 years who presented to our clinic with an amputated thumb between 2017 and 2019 were included in this study. The results were assessed using Disabilities of Arm, Shoulder, Hand (DASH) scoring. Active range of motion, grip and pinch strengths, Kapandji scores, and static 2-point discrimination were measured. RESULTS The mean age of the patients (3 men, 1 woman) was 37 years (23-57 years). The level of amputation was the proximal phalanx in 3 digits and metacarpal in 2 digits. The average procedure time of was 89 ± 12 minutes. The average follow-up duration was 13 months (12-16 months). There was no total or partial digit necrosis in any patient. The mean preoperative shortened DASH score was 52.5 ± 6.7, and the mean postoperative score was 5.3 ± 6.5. The mean preoperative DASH Work Module score was 81.2 ± 18.8 and the mean postoperative score was 13.8 ± 7.5. Two-point discrimination was normal. CONCLUSIONS Transfer of the ring finger to reconstruct the amputated thumb is an alternative reconstruction method for patients who do not accept toe-to-thumb and pollicization techniques. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Bilsev Ince
- Department of Plastic & Reconstructive and Aesthetic Surgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.
| | - Mehmet Dadaci
- Department of Plastic & Reconstructive and Aesthetic Surgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| |
Collapse
|
5
|
Schippers SM, Reist H, An Q, Buckwalter V JA. Natural History of Poland Syndrome: A Long-term Study of Functional and Psychosocial Outcomes. Hand (N Y) 2022; 17:684-690. [PMID: 34002631 PMCID: PMC9274885 DOI: 10.1177/1558944720963864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Poland syndrome (PS) is a congenital condition characterized by pectoralis hypoplasia and an ipsilateral hand anomaly that frequently necessitates surgery in childhood. This study aimed to determine long-term functional and psychosocial implications of PS. METHODS Patients underwent strength testing of their affected limb by comparing with their contralateral arm. They completed Disabilities of the Arm, Shoulder, and Hand (DASH), 36-item Short-Form Health Survey (SF-36), and several Patient-Reported Outcome Measurement Information System (PROMIS) surveys. Aggregate scores were compared with population norms. RESULTS Twenty-eight patients were enrolled, and 16 returned for strength testing. The average age was 42 years (range, 18-65 years), and the average follow-up was 25 years (range, 1-52 years). Dynamometer testing showed decreased strength in shoulder internal rotation and abduction/adduction, hand grip, and key pinch/tip pinch. Average DASH and SF-36 scores were comparable with population norms. The PROMIS Upper Extremity score (46.2) was significantly lower than the average 50 (SD, 10.0); the Social Roles score (57.3) indicated significantly less disability than the general population. Seventy-nine percent reported higher than average satisfaction with life, 82% had normal self-esteem, and 21% and 4% met screening criteria for depression and anxiety, respectively. The Derriford Appearance Scale revealed that 68% of patients identified PS as their most self-conscious feature, with 36% reporting subsequent life adjustments. CONCLUSIONS This cohort of PS patients self-reported more favorable functional, psychological, and emotional outcomes than expected based on significant shoulder and hand strength deficits. Despite these deficits, patients make adaptations, allowing fulfilling lives with psychosocial functioning similar to their peers.
Collapse
Affiliation(s)
- Sarah M. Schippers
- University of Iowa Hospitals & Clinics, Iowa City, USA,Sarah M. Schippers, Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA.
| | - Hailee Reist
- University of Iowa Hospitals & Clinics, Iowa City, USA
| | - Qiang An
- University of Iowa Hospitals & Clinics, Iowa City, USA
| | | |
Collapse
|
6
|
Balakrishnan G, Vijayaragavan S, Somesh B. Restoration of Five Digit Hand in Type III B & C Thumb Hypoplasia-A Game Changer in Surgical Management. Indian J Plast Surg 2021; 53:349-356. [PMID: 33402764 PMCID: PMC7775210 DOI: 10.1055/s-0040-1718858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background
Hypoplasia of thumb is the second common congenital difference of the thumb, next only to duplication. It may occur as an isolated hand difference or as a part of radial longitudinal deficiency. In approximately 60% of these children, the radius shows hypoplasia. The incidence of thumb hypoplasia is one in 100,000 live births. In 50% of these children, the other hand will also have similar deficiency, although variable in severity. Hypoplasia of thumb has been classified into five major categories, according to the increasing severity of hypoplasia. Type III hypoplasia of thumb is characterized by skeletal hypoplasia involving the first metacarpal and carpometacarpal joint, absent intrinsic muscles and rudimentary extrinsic muscles. It was further subclassified into types A, B & C. Type III B, described by Manske and McCarroll, involves extensive deficiency of extrinsic and intrinsic musculature with aplasia of the metacarpal base. Type III C, described by Buck-Gramcko, has hypoplastic metacarpal head.
Methods
It is widely believed that reconstruction of Type III B & C hypoplastic thumb will not be functionally useful, and they are often included in the indications for pollicization in thumb hypoplasia. In India, we frequently come across parents, who are not willing to remove the hypoplastic digit. This forced us to find out a way to reconstruct the hypoplastic thumb into a functionally useful digit. We describe our surgical technique of reconstruction of hypoplastic thumbs and our experience in utilization of the technique in five children with Type III B & C hypoplasia of thumb. Carpometacarpal joint of thumb was reconstructed and stabilized with a toe phalangeal transfer in the first stage and an opponensplasty was done in the second stage to improve movement.
Results
In all the five operated children, our surgical technique yielded a stable thumb which was functional. The donor site morbidity was acceptable. The parents were satisfied with the appearance and functional improvement.
Conclusion
Surgical reconstruction of hypoplastic thumbs of Type III B & C is possible, and conversion of these poorly developed remnants into a useful digit by our surgical technique is a gamechanger in the management of thumb hypoplasia.
Collapse
Affiliation(s)
- G Balakrishnan
- Department of Plastic, Hand & Microsurgery, Right Hospitals, Kilpauk, Chennai, Tamil Nadu, India.,The Tamil Nadu Dr. MGR Medical University, Chennai, Tamil Nadu, India
| | - S Vijayaragavan
- Department of Plastic, Hand & Microsurgery, Right Hospitals, Kilpauk, Chennai, Tamil Nadu, India
| | - B Somesh
- Department of Plastic, Hand & Microsurgery, Right Hospitals, Kilpauk, Chennai, Tamil Nadu, India
| |
Collapse
|
7
|
Crowdsourcing the aesthetics of thumb repair in pediatric thumb hypoplasia. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-020-01712-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|