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.
Purpose:
To evaluate which objective criteria correlated with subjective impressions of outcome following index finger pollicization for thumb hypoplasia.
Methods:
Forty-two pollicizations in 35 patients were assessed by a comprehensive subjective and objective measurement analysis. In the subjective measures, the surgeon, therapist, and caregiver rated how the pollicized digit "looks like a thumb" and "works like a thumb." The caregiver also completed a subjective questionnaire. For objective results, we measured appearance, strength, range of motion, stability, and ability to pick up objects. The subjective results were then correlated with objective data via a linear regression analysis.
Results:
When combining the total subjective score for "looks like a thumb," "works like a thumb," and the caregiver questionnaire, we found significant correlation scores for palmar abduction, lateral pinch, tip pinch, and picking up a bead, a die, and a table tennis ball. The strongest correlations were found with composite flexion, metacarpophalangeal (MCP) joint range of motion, interphalangeal (IP) joint range of motion, and the sticker test. Three of these 4 items (sticker test and MCP joint and IP arcs of motion) also correlated best with children who preferred using their thumbs for small object acquisition instead of scissor pinch.
Conclusions:
Composite flexion, MCP and IP joint arcs of motion, and the sticker test correlated the strongest with the subjective criteria. These parameters appear to be the most critical measures that impress a good outcome following pollicization.
Type Of Study/Level Of Evidence:
Prognostic IV.
