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Functional outcomes of children with index pollicizations for thumb deficiency
David T Netscher1, Oluseyi Aliu, Brinkley K Sandvall
1Department of Orthopedic Surgery and Division of Plastic Surgery, Baylor College of Medicine, Houston, TX 77030, USA. netscher@bcm.edu
Insights
Index pollicization shows promising functional outcomes for thumb aplasia, though operated hands remain weaker than normal. Patient and parent perspectives are favorable, supporting optimistic views on this surgical intervention.
Area of Science:
- Orthopedic surgery
- Hand surgery
- Pediatric orthopedics
Background:
- Index pollicization is a reconstructive surgical technique for thumb aplasia or severe hypoplasia.
- Assessing functional outcomes is crucial for evaluating the success of this procedure.
Purpose of the Study:
- To comprehensively evaluate outcomes after index pollicization for isolated thumb aplasia.
- To compare operated hand function with contralateral nonoperated hands and normative data.
- To assess patient and parent satisfaction with the surgical results.
Main Methods:
- Evaluated 22 hands (18 patients) using grip strength, pinch strength, Functional Dexterity Test (FDT), and Jebsen Hand Function Test (JHFT).
- Compared operated hands, contralateral hands, and patient-reported outcomes with published normal data.
- Utilized a graphical snapshot to synthesize various outcome measures for a global assessment.
Main Results:
- Operated hands showed significantly lower grip and pinch strength compared to normal nondominant hands.
- Timed FDT results were considerably longer in operated hands versus normal data.
- Contralateral nonoperated hands were weaker than normal dominant hands; however, parent and patient satisfaction scores were favorable.
Conclusions:
- Index pollicization demonstrates favorable subjective outcomes and warrants an optimistic outlook for thumb reconstruction.
- Objective functional measures indicate limitations compared to normal hands, yet patient and parent perspectives are positive.
- A graphical snapshot aids in visualizing and tracking functional progress over time.
Purpose:
To gain a comprehensive perspective on outcomes by performing an array of tests on patients who had undergone index pollicization for isolated thumb aplasia or severe hypoplasia in the absence of clinical radial dysplasia; this led us to create a graphical snapshot for future comparison. Another purpose was to compare the function of the contralateral hand and to compare parent and patient perspectives.
Methods:
We evaluated 22 hands (18 patients) by grip as well as lateral and tripod pinch strength tests; the pegboard Functional Dexterity Test (FDT); the Jebsen Hand Function Test (JHFT); and a parent/patient questionnaire. We compared operated hands with both contralateral nonoperated hands and nondominant hands in published normal data. We also compared contralateral nonoperated hands with dominant hands in published normal data, and FDT results and JHFT outcomes in children greater than 6 years old with published normal data. We evaluated questionnaire results.
Results:
Mean grip as well as lateral and tripod pinch strength in operated hands were 3.4, 1.2, and 1.2 kg, and in normal nondominant hands were 11.7, 4.4, and 3.9 kg, respectively. Patients' contralateral nonoperated hands were weaker than normal dominant hands. Mean timed FDT results in operated hands was 127 seconds, compared with 44 seconds in published normal data. In 2 of 5 JHFT subtests administered, no difference existed between operated hands and published normal data. A graphical snapshot took various outcome measures into consideration and showed a global assessment. Mean parent and patient questionnaire scores were 10 and 22, respectively (best = 12; worst = 60).
Conclusions:
Comprehensive subjective and objective outcome testing suggested that an optimistic view of function after index pollicization is warranted. A graphical snapshot followed function over time. The contralateral hand fared worse than published normal data. Parent and patient perspectives were favorable.
Type Of Study/Level Of Evidence:
Therapeutic III.
