Long term functional outcomes after early childhood pollicization
Nina Lightdale-Miric1, Nicole M Mueske2, Emily L Lawrence3
1Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA; Orthopaedic Surgery Department, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Insights
Pollicization surgery for thumb hypoplasia can lead to weakness but often achieves adequate dexterity. Poorer outcomes are linked to older age at surgery and radial absence.
Area of Science:
- Pediatric Orthopedics
- Hand Surgery
- Congenital Hand Differences
Background:
- Pollicization is a surgical procedure to treat thumb hypoplasia/aplasia.
- Key outcomes include hand strength, function, dexterity, and quality of life.
Purpose of the Study:
- Evaluate outcomes of pollicization in early childhood.
- Identify predictors of surgical success.
Main Methods:
- Retrospective cohort study of 8 children (10 hands) 3-15 years post-surgery.
- Assessments included physical exams, questionnaires, grip/pinch strength, and dexterity tests (Box and Blocks, 9-hole pegboard, S-D tests).
Main Results:
- Pollicized hands demonstrated poor strength and functional test performance.
- Six of 10 hands had normal dexterity but reduced force stability.
- Older age at surgery, limited joint motion, and radial absence predicted poorer outcomes.
Conclusions:
- Pollicization yields reduced strength and function but often normal dexterity via compensatory strategies.
- Most children achieve adequate dexterity despite weakness, except those operated on at an older age or with severe involvement.
Study Design:
Retrospective Cohort
Introduction:
Important outcomes of polliciation to treat thumb hypoplasia/aplasia include strength, function, dexterity, and quality of life.
Purpose Of The Study:
To evaluate outcomes and examine predictors of outcome after early childhood pollicization.
Methods:
8 children (10 hands) were evaluated 3-15 years after surgery. Physical examination, questionnaires, grip and pinch strength, Box and Blocks, 9-hole pegboard, and strength-dexterity (S-D) tests were performed.
Results:
Pollicized hands had poor strength and performance on functional tests. Six of 10 pollicized hands had normal dexterity scores but less stability in maintaining a steady-state force. Predictors of poorer outcomes included older age at surgery, reduced metacarpophalangeal and interphalangeal range of motion, and radial absence.
Discussion:
Pollicization resulted in poor strength and overall function, but normal dexterity was often achieved using altered control strategies.
Conclusions:
Most children should obtain adequate dexterity despite weakness after pollicization except older or severely involved children.
Level Of Evidence:
IV.
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