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Congenital clasped thumb: a review of forty-three cases
Insights
Congenital clasped thumb treatment varied by severity. Splinting effectively treated milder cases, while surgical interventions improved outcomes for severe deformities and arthrogryposis multiplex congenita.
Area of Science:
- Orthopedics
- Pediatric Hand Surgery
Background:
- Congenital clasped thumb is a common hand deformity.
- It can present with or without contractures and is associated with arthrogryposis multiplex congenita.
Purpose of the Study:
- To evaluate treatment outcomes for congenital clasped thumb.
- To differentiate treatment effectiveness based on deformity severity and associated conditions.
Main Methods:
- Retrospective review of 43 patients (75 hands) over 10 years.
- Classification into three groups: no contracture, palmar contracture, and arthrogryposis multiplex congenita.
- Treatment modalities included splinting, surgery (soft tissue release, skin grafts, extensor reconstruction), and conservative management.
Main Results:
- Splinting yielded good results in patients without contractures, suggesting flexor muscle predominance.
- Surgical intervention for severe deformities or those unresponsive to splinting resulted in satisfactory outcomes in 12 out of 16 hands.
- Mean follow-up was 32 months, with evaluations based on joint mobility.
Conclusions:
- Splinting is effective for mild congenital clasped thumb.
- Surgical management is indicated for severe cases and those with arthrogryposis multiplex congenita.
- Treatment should be tailored to the specific presentation of congenital clasped thumb.
Abstract:
Over a 10-year period, 43 patients (75 hands) with congenital clasped thumb were seen in our institution. Three groups were identified: group I, 14 patients (24 hands) without contracture; group II, 14 patients (21 hands) with contractures of the palmar side; and group III, 15 patients (30 hands) with arthrogryposis multiplex congenita. Forty-two hands were treated with splinting alone and 16 hands with surgery. The remaining 17 hands were followed conservatively without splinting or surgery. The mean follow-up was 32 months. The results were evaluated by active abduction of the carpometacarpal joint and extension of metacarpophalangeal joint. All patients in group I showed good response to splinting, and the cause of the deformity appeared to be the predominance of the flexor muscles. In groups II and III, 10 patients (16 hands) who had severe deformity or no response to splinting were treated by release of the palmar soft tissues, skin grafts, and reconstruction of the extensors. Satisfactory results were obtained in 12 of 16 hands.