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[Optimal surgical timing and treatment of thumb duplication in children]
Zhong-Wei Jia1, De-Ming Bai1, Jiang-Tao Long1
1Department of Orthpaedic, Shanxi Provincial Children's Hospital, Taiyuan 030013, China.
Insights
Optimal surgical timing for congenital thumb duplication depends on Wassel classification and ossification centers. Individualized surgical methods focusing on ligament, tendon, and capsule reconstruction yield good functional and aesthetic outcomes.
Area of Science:
- Pediatric Orthopedics
- Congenital Hand Anomalies
- Surgical Reconstruction
Context:
- Congenital thumb duplication is a complex hand anomaly requiring precise surgical intervention.
- Wassel classification system aids in categorizing thumb duplication severity.
- Optimal timing and technique are crucial for successful outcomes.
Purpose:
- To determine the ideal surgical timing for congenital thumb duplication based on developmental milestones.
- To evaluate the effectiveness of individualized surgical techniques for thumb duplication.
- To correlate surgical outcomes with Wassel classification and patient age.
Summary:
- A study of 132 patients with congenital thumb duplication analyzed surgical timing and methods.
- Outcomes were assessed using the Tada standard, with 77% excellent or good results.
- Key surgical elements include collateral ligament, tendon, and articular capsule reconstruction.
Impact:
- Establishes evidence-based guidelines for surgical timing in congenital thumb duplication.
- Highlights the importance of individualized surgical approaches for optimal functional and aesthetic results.
- Provides valuable data for pediatric orthopedic surgeons managing these complex cases.
Objective:
To investigate the optimal surgical timing and treatment of congenital duplication of the thumb in children.
Methods:
A clinical study was performed on 154 fingers of the 132 patients (including 85 males, 47 females;mean age (1.53 +/- 2.47) years; ranged from 2 months to 13 years). Duplicated thumbs were surgically treated from December 2007 to February 2012. All patients underwent detailed physical examination and radiological assessment. Surgical methods should be selected according to the age, Wassel classification and deformity. The operation steps included resection of the most hypoplastic thumb, followed by skin flap plasty, tendon shift (transplantation) , reconstruction of collateral ligament and articular capsule. 11 cases over the age of 6 underwent osteotomy discretion as appropriate.
Results:
A total of 117 fingers of the 104 patients were followed up for an average 36. 7 months (range,6-55 months). We adopted upgrade Tada standard to evaluate the follow-up results as excellent in 77 thumbs, good in 21 thumbs, fair in 15 thumbs and poor in 4 thumbs. Three thumbs appeared secondary angular deformity 2 years after operation and one thumb appeared residual osteoepiphysis in the radial side of metacarpophalangeal joint 3 years after operation. The appearance and the function were almost normal after second operation.
Conclusions:
The optimal surgical timing of congenital duplication of thumb should be based on the appearance of thumb ossification center. The surgical timing of Wassel type- I and II should be chosen at 1. 5 years old when the ossification center of distal phalanx appears, Wassel type-III and IV should be chosen at 1 year old when the ossification center of proximal phalanx appears, Wassel type-V and VI should be chosen at 2. 5 years old when the ossification center of metacarpal appears, and Wassel type-VII should be chosen at 2. 5 years old. The surgical method should be selected on individualized principle. The key points are reconstruction of collateral ligament, tendon and articular capsule and correction of ulnar deviation (or radial deviation).
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