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Developing a pollicization outcomes measure.

Dan A Zlotolow1, Rick Tosti1, Sarah Ashworth1

  • 1Department of Orthopaedic Surgery, Shriners Hospitals for Children, Philadelphia, PA; Department of Orthopaedic Surgery and Sports Medicine, Temple University School of Medicine, Philadelphia, PA; University of Maryland Medical Center, Baltimore, MD.

The Journal of Hand Surgery
|August 6, 2014
PubMed
Summary
This summary is machine-generated.

Objective measures like composite flexion and joint range of motion best predict patient satisfaction after index finger pollicization for thumb hypoplasia. These key criteria indicate a successful surgical outcome.

Keywords:
Outcomepollicizationthumb hypoplasia

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Area of Science:

  • Orthopedic surgery
  • Hand surgery
  • Pediatric orthopedics

Background:

  • Thumb hypoplasia presents a significant functional and aesthetic challenge.
  • Index finger pollicization is a common surgical reconstructive technique for thumb hypoplasia.
  • Evaluating the success of pollicization requires correlating objective surgical outcomes with subjective patient and caregiver perceptions.

Purpose of the Study:

  • To identify objective surgical criteria that correlate with subjective assessments of thumb appearance and function after index finger pollicization.
  • To determine which objective measurements best predict a favorable outcome in patients with thumb hypoplasia.

Main Methods:

  • A cohort of 35 patients (42 pollicizations) underwent comprehensive subjective and objective evaluations.
  • Subjective assessments included surgeon, therapist, and caregiver ratings of the pollicized digit's appearance and function, alongside a caregiver questionnaire.
  • Objective measures encompassed appearance, strength, range of motion (ROM), stability, and object manipulation ability. Linear regression analysis correlated subjective and objective data.

Main Results:

  • Significant correlations were found between combined subjective scores and objective measures of palmar abduction, lateral pinch, tip pinch, and object pick-up tests (bead, die, table tennis ball).
  • The strongest correlations were observed with composite flexion, metacarpophalangeal (MCP) joint ROM, interphalangeal (IP) joint ROM, and the sticker test.
  • The sticker test, MCP joint ROM, and IP joint ROM also correlated highly with children's preference for using their reconstructed thumb for small object manipulation.

Conclusions:

  • Composite flexion, MCP and IP joint arcs of motion, and the sticker test are critical objective parameters that strongly correlate with subjective impressions of successful outcomes after index finger pollicization.
  • These specific objective measures appear to be the most crucial indicators for assessing the success of pollicization surgery in improving thumb function and appearance.