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Functional outcome for children with thumb aplasia undergoing pollicization
Kimberly Goldie Staines1, Ramsey Majzoub, John Thornby
1HealthSouth, Baylor College of Medicine, St. Luke's Episcopal Hospital, Houston, Texas, USA.
Insights
Pollicization surgery for congenital thumb aplasia improves appearance and social interaction, though grip and pinch strength are reduced. Comprehensive functional assessments are crucial for evaluating outcomes in pediatric hand surgery.
Area of Science:
- Pediatric Orthopedics
- Hand Surgery
- Developmental Pediatrics
Background:
- Evaluating hand function in young patients presents challenges.
- Assessing functional recovery after surgery for congenital anomalies is vital for developmental progress.
Purpose of the Study:
- To evaluate the functional outcomes of pollicization surgery in children with congenital thumb aplasia.
- To assess the impact of pollicization on hand function, strength, and patient-reported satisfaction.
Main Methods:
- 10 children (12 extremities) with prior pollicization for thumb aplasia underwent evaluation.
- Methods included radiographs, range of motion, grip/pinch strength, parent questionnaires, and functional tests (Jebsen, Functional Dexterity Test).
Main Results:
- Operated hands showed significantly reduced grip (2 kg vs. 5.6 kg) and pinch strength (1.0 kg vs. 2.1 kg) compared to non-operated hands.
- While range of motion and overall Jebsen test times were comparable, specific tasks like checker stacking and page turning showed differences.
- Children reported satisfaction with appearance and social interactions, but difficulties handling small objects requiring pinch strength were noted.
Conclusions:
- Pollicization is a beneficial procedure for children with thumb aplasia.
- Comprehensive, multi-faceted functional outcome evaluations using age-appropriate norms are essential for congenital hand conditions.
Background:
Hand function is difficult to evaluate in young patients. It is helpful to assess young children after surgery for trauma or congenital anomaly to see how they cope as they progress through their developmental milestones.
Methods:
Functional outcome in 10 children (12 upper extremities) who had previous pollicization for a congenitally absent or severely hypoplastic thumb were evaluated by standard radiographs, thumb total active range of motion, grip and pinch strength, parent questionnaire, modified Jebsen functional testing, and a pegboard Functional Dexterity Test.
Results:
Grip strength was significantly less (p = 0.008) in the hands that had been operated on (mean, 2 kg) compared with the hands that had not been operated on (mean, 5.6 kg). Pinch strength was also significantly less (p = 0.008) in the hands that had been operated on (mean, 1.0 kg) compared with those that had not been operated on (mean, 2.1 kg). In most, hands that had been operated on and those that had not been operated on tested outside the 2-SD range of age-matched normals for pinch and grip strength and also for the Functional Dexterity Test. In contrast, total Jebsen Hand Function Test time was not significantly different from hands that had not been operated on, except that some subtests were significantly different, such as checker stacking (p = 0.016; mean difference, 7.2 seconds) and page turning (p = 0.031; mean difference, -10 seconds). The total active range of motion in hands that had been operated on and those that had not been operated on was also not significantly different. All children used their reconstructed thumbs in a normal pattern. Parent questionnaires revealed satisfaction with appearance and good social interactions. Functional activities showed greatest difficulty handling small objects, especially when simultaneous pinch strength was required, such as fastening buttons and small snaps.
Conclusions:
This study demonstrates the importance of evaluating multiple aspects of functional outcome for congenital hand problems and of using comparative age-appropriate validated norms. Pollicization is a rewarding procedure for children with thumb aplasia.
