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Thumb Duplication Surgical Treatment: Outcomes and Results
Maria Pia Monjardino1, Marcos Carvalho1, Pedro Sá Cardoso1
1Department of Pediatric Orthopaedics, Hospital Pediátrico de Coimbra - CHUC, EPE, Coimbra, Portugal.
Insights
Surgical correction of pediatric thumb duplication yields good functional and esthetic outcomes. Early surgery timing and proper alignment are crucial for optimal results and parent satisfaction.
Area of Science:
- Pediatric Orthopedics
- Hand Surgery
- Congenital Hand Anomalies
Background:
- Thumb duplication is a common congenital hand anomaly.
- Surgical intervention is necessary to restore function and improve aesthetics.
- Evaluating outcomes is crucial for refining treatment strategies.
Purpose of the Study:
- To assess functional and esthetic outcomes of pediatric thumb duplication surgery.
- To correlate surgical techniques and patient factors with outcomes.
- To provide insights into optimal surgical timing and management.
Main Methods:
- Retrospective analysis of 11 pediatric patients with thumb duplication treated between 2012-2017.
- Classification using the Wassel-Flatt system.
- Outcomes evaluated using Tada, Horii, and Tien scores, assessing joint mobility, stability, alignment, and parent satisfaction.
Main Results:
- The majority of patients (73%) had Wassel-Flatt type IV duplication.
- High rates of good outcomes were observed: 82% (Tada), 73% (Horii), and 100% (Tien).
- Younger age at surgery correlated with poorer alignment (P=.047), impacting overall scores.
Conclusions:
- Excision and reconstruction effectively treat thumb duplication, yielding good clinical results and high parent satisfaction.
- Optimal surgical timing is vital for favorable esthetic outcomes.
- Postoperative angular deformity significantly influences patient satisfaction.
Aim:
This study aims to evaluate functional and esthetic outcomes of thumb duplication correction in pediatric age.
Methods:
Retrospective study including all pediatric patients with thumb duplication undergoing surgical treatment between 2012 and 2017. We analyzed demographic data, surgical technique, and surgical outcomes considering Tada, Horii, and Tien scores, according to the following parameters: active mobility of the metacarpophalangeal and interphalangeal joints, stability, alignment, and family's opinion about cosmetic and function of the thumb. The Wassel-Flatt classification was used to classify the duplicated thumbs.
Results:
A total of 11 patients were included, predominantly male (ratio 1.8:1), with a median age at time of surgery of 19[10-26] months and a median follow-up time after surgery of 23 [3-63] months. The Wassel- Flatt type IV thumb was the most frequent (73%). The postoperative evaluation revealed that 82% of patients had good results in Tada score, 73% had good results in Horii score, and all patients showed good results in Tien score. We found a relation between lower age and fair postoperative alignment (P = .047) and between fair postoperative alignment and fair final Tada (P = .022), Horii (P = .006), and Tien (P = .009) scores.
Conclusions:
Excision and reconstruction procedures are good options in the treatment of thumb duplication providing good clinical results, with excellent parent satisfaction. Timing of surgery is important for favorable esthetic outcomes, while angular deformity is a determining factor that for postoperative dissatisfaction.
