Article
Outcome of 32 pollicisations for thumb hypoplasia or aplasia during the period 1987–2016
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Authors
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Ida Neergård Sletten
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
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Magne Røkkum
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
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Inger Helen Bolstad
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
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Anne Birgit Stavenes
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
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Mona Irene Winge
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Pollicisation of the index for thumb hypoplasia or aplasia is performed to create pinch and cylinder grip. The objective was to investigate the clinical outcome in our institution
Methods: Twenty-five consecutive patients (32 thumbs) had their anomaly classified using OMT, modified Bayne and modified Blauth criteria. Associated anomalies, operative technique, complications, and additional surgeries were recorded. Reach Out©, QuickDASH©, EQ-5D©, and visual analogue scales (VAS) on thumb function and appearance quantified upper extremity function and life quality. Thumb ROM, Kapandji score, sensibility, grip and pinch strength, and results of four functional tests were recorded.
Results and Conclusions: Age at time of operation was median 26(12-101) months. 3/25 patients had unilateral CULA as their only malformation. 16/25 had bilateral CULA, and 13/25 had a syndrome. 14/25 underwent additional upper limb surgery. For 11/32 thumbs, there was abnormal axis formation of the entire ipsilateral upper limb. Modified Buck-Gramcko technique was used in 31/32 pollicisations. There was one iatrogenic vein laceration repaired micro-surgically, and one postoperative thumb malrotation, which required a later osteotomy. Further 5/31 cases had additional thumb surgeries.
Twenty-three patients/30 thumbs came for follow-up (94%), aged median 12 (2-33) years. Patients >8 years reported median VAS 78 (5-100) on thumb function, and median VAS 72 (14-100) on thumb appearance. Adult patients reported inclusion of their thumb in pinch grip median 92 (10-100)% of the time, and in cylinder grip median 97 (3-100)% of the time. Reach Out was median 17 (1-37), QuickDASH was median 7 (5-39), EQ-5D-3L index was median 1.00 (0.62-1.00), and EQ VAS was median 90 (50-100). Active arc motion was median 38 (0-70)° in the IPJ, and median 50 (0-105)° in the MCPJ. 24/30 thumbs could palmarly be abducted to the tip of the 3rd finger. 15/30 thumbs had a Kapandji score of 6 or higher. Grip strength was median 25 (3-65)%, and pinch strength was median 30 (0-79)% of reference values. All thumb pulps had intact 2-3 mm two-point discrimination. For 26/30 thumbs, picking up a pearl, a dice and a table tennis ball was easy. The sticker test was easy in 18/30 cases.
Most patients were satisfied with their result. Abnormal anatomy was found in the pollicised indices of the four patients who failed all four functional tests (immobile joints due to severe RLD modified Bayne type 4, or absent flexor tendons).
