The transverse bone in cleft hand: a case cohort analysis of outcome after surgical reconstruction
Alexander W Aleem1, Lindley B Wall1, M Claire Manske1
1Department of Orthopaedic Surgery, Shriner's Hospital for Children and St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO.
Purpose:
To evaluate the implications of the transverse bone in cleft hand by assessing outcomes after reconstruction in comparison with a control group.
Methods:
This study is a retrospective review of 23 hands in 18 patients following surgical reconstruction of the cleft hand. Eleven hands had a transverse bone component, and 12 hands (control group) did not. Patients and their families were contacted to assess overall satisfaction following reconstruction. Clinical and radiographic records were reviewed to assess aesthetic and functional outcomes, the need for additional surgery, and radiographic divergence angles.
Results:
There was no difference in aesthetic or functional subjective outcomes. There was no statistically significant difference in any objective outcome measure between the two groups. The use of the cleft for pinch was more dependent on the status of the index finger and the preoperative thumb-index webspace rather than the presence of a transverse bone. Eleven (4 transverse and 7 control) hands required additional surgery to address abnormal function or posture of the index and ring fingers. Preoperative radiographic divergence angles were larger in the transverse bone group than in the control group, whereas postoperative divergence angles were nearly equivalent.
Conclusions:
Similar outcomes between the two groups demonstrate that the presence of a transverse bone in cleft hand was not associated with worse outcomes following cleft reconstruction. Preoperative narrowing of the thumb webspace and postoperative index finger metacarpophalangeal joint abnormality are associated with worse functional outcomes.
Type Of Study/Level Of Evidence:
Therapeutic Level III.
