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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Correction of the postoperative deviation deformity in duplicated thumbs

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  • presenting/speaker Yongkang Jiang - Shanghai Ninth People's Hospital, Shanghai, China

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-887

doi: 10.3205/19ifssh1369, urn:nbn:de:0183-19ifssh13699

Published: February 6, 2020

© 2020 Jiang.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Residual deformities are often seen in thumb duplication after reconstruction, where the axis deviation is the most common. The purpose of this study was to describe our operation for correcting the postoperative deviation deformity, and to evaluate the appearance and function outcomes.

Methods: 54 thumbs with deviation deformity in 45 patients with thumb duplication after reconstruction in other hospitals were enrolled and operated between 2014 and 2017 in our hospital. The average age at time of surgery was 13.1 years old and the average time of follow-up was 31 months. The surgical procedures included osteotomy, reconstructing the joint capsule, tightening the collateral ligament, centralizing the extensor pollicis longus tendon, repositioning the abductor pollicis brevis muscle and arthrodesis. Kirschner wire fixation was applied for 4-6 weeks and brace fixation for 3 months. The subjective evaluation was given by patients or patients' parents on both the functional and cosmetic results. The modified Tada scoring system was used for objective evaluation.

Results and Conclusions: In these patients with thumb duplication, the most common type was type IV (26/54) preoperatively according to the Wassel classification, and the right thumb was more affected (36/54). The mean range of motion (ROM) for the metacarpophalangeal joint (MCPJ) was 78° and at the interphalangeal joint (IPJ) was 56°. No joint instability in the MCPJ and IPJ was found, and slight mal-alignment was observed in 4 thumbs at the MCPJ and 7 thumbs at the IPJ. 39 good (72.2%), 13 fair (24.1%) and 2 poor (3.7%) was obtained based on the modified Tada scoring system. The patients or patients' parents were satisfied with the function and appearance of the reconstructed thumbs in 49 patients (90.7%).

Multiple surgical techniques should be chosen and applied according the patients individually to achieve a satisfactory appearance and good function for patients with thumb duplication with postoperative deviation deformity.