Surgical reconstruction in Wassel type IV thumb duplication

Area of Science:

• Orthopedic surgery
• Pediatric orthopedics
• Hand surgery

Background:

• Wassel type IV thumb duplication is a complex congenital anomaly.
• Treatment often involves surgical correction to improve function and aesthetics.
• Evaluating outcomes of single-stage reconstruction is crucial for guiding clinical practice.

Purpose of the Study:

• To review outcomes of Wassel type IV thumb duplication treated with a single reconstructive procedure.
• To assess functional and aesthetic results using validated scoring systems.
• To identify factors influencing patient satisfaction.

Main Methods:

• Retrospective review of patients with Wassel type IV thumb duplication undergoing single reconstructive surgery.
• Mean follow-up of 76.9 months.
• Objective assessment using Tada and ALURRA scoring systems, measuring thumb length, girth, range of motion (MCP, IP joints), and angular deformities.

Main Results:

• Mean ALURRA score: 21; Mean Tada score: 5.25.
• Operated thumb achieved ~95% length, ~89% girth, and ~80% nail width compared to the non-operated side.
• Mean range of motion was 75.1% (IP joint) and 80.1% (MCP joint) of the unaffected thumb.
• MCP joint malalignment negatively correlated with Tada, ALURRA, and VAS scores.

Conclusions:

• Single-stage surgical reconstruction can effectively restore thumb function and stability in Wassel type IV duplications.
• Patient satisfaction is significantly influenced by the degree of angular deformity and the cosmetic outcome.
• Addressing angular deformities is key to optimizing functional and aesthetic results.