Article
Correction of Radially Deviated Wassel Type III Thumb Polydactyly Using Modified Open-Wedge Osteotomy vs Conventional Closed-Wedge Osteotomy in 51 Children
Search Medline for
Authors
-
Xiaofei Tian
- Children’s Hospital of Chongqing Medical University, Chongqing, China
| Published: | February 6, 2020 |
|---|
Outline
Text
Objectives/Interrogation: To report a novel modified technique used to correct radially deviated Wassel type III thumb polydactyly by using open-wedge osteotomy (OWO) to restore the normal length of the thumb and to compare the technique with the conventional closed-wedge osteotomy (CWO).
Methods: 30 children suffered unilaterally from radially deviated Wassel type III polydactyly and the radial deviation of the interphalangeal joint of unlar main thumbs ranged from 15° to 45°. After removal of the radial hypoplastic thumb, the ulnar thumb was corrected by modified OWO. The wedge-shaped bone defect was reconstructed with a bone graft taken from the resected thumb, and the soft tissue flap of the resected thumb was merged to preserved thumb. The length of the thumb, radial deviation and range of motion of the interphalangeal (IP) join were assessed. For comparison, we also retrospectively collected another group of 21 children treated with conventional CWO. Significant difference was set at p<0.05.
Results and Conclusions: The average age at surgery was 1.5 years (range, 1-2.3 years). At the final follow-up of 3.4 years (range, 2-5.4 years), the mean length of the affected thumbs reached 96% (range, 92%-100%) of the opposite thumbs. The mean radial deviation of IP joints was 6° (range, 0°-15°). The average functional point was 12 points (range, 10-14 points), and the mean cosmetic score was 3.7 (range, 3-4 points). In comparison group, the average age at surgery was 1.7 years (range, 1-2.8 years). At the final follow-up of 4.6 years (range, 3-5.2 years), the mean length of the affected thumbs reached 83% (range, 75%-92%) of the opposite thumbs. The mean radial deviation of IP joints was 7° (range, 0°-14°). The average functional point was 10 points (range, 9-12 points), and the mean cosmetic score was 2.4 (range, 2-3 points). Bone healing was achieved in both groups, and slightly small nails were deemed acceptable. Stability of IP joint was archived in all children, and no revision surgery was required. There were significant differences with regard to the length of thumb, functional and cosmetic scores (p<0.05).
For the correction of radially deviated Wassel Type III thumb polydactyly, the modified OWO can more effectively restore the normal length of thumb comparing with the conventional CWO, and the rebalance of the flexor pollicis longus could prevent radial deviation recurring and the flap transfer could achieve better contour of the thumb.
