1
|
Sletten IN, Klungsøyr K, Garratt A, Jokihaara J. Patient-reported function, quality of life and prosthesis wear in adults born with one hand: a national cohort study. J Hand Surg Eur Vol 2024; 49:1126-1133. [PMID: 38126703 DOI: 10.1177/17531934231222017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
We invited individuals aged above 16 years with a congenital transverse reduction deficiency at and above the wrist born in Norway between 1970 and 2006 to complete the short version of the Disabilities of the Arm, Shoulder and Hand Outcome Measure, the 5-Level EuroQoL-5-Dimension instrument, the RAND 36-Item Short Form Health Survey and a single-item questionnaire on arm function, appearance, pain and prosthesis wear. Of 154 eligible participants, 58 (38%) responded. Their scores were not different from the general population. All had been offered prostheses, and 56 (97%) had been fitted at a median age of 1 year (interquartile range 0-2.8). Of the participants, 37 (64%) were still prosthesis wearers, while 21 (36%) were non-wearers or using gripping devices only. Prosthesis wearers had higher levels of 'vitality' as assessed by the RAND-36 and rated their arm appearance higher, but there were no other score differences, indicating that prosthesis rejection is not associated with worse functional outcomes.Level of evidence: III.
Collapse
Affiliation(s)
| | - Kari Klungsøyr
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Andrew Garratt
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Jarkko Jokihaara
- Department of Hand Surgery, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| |
Collapse
|
2
|
Stoll C, Alembik Y, Roth MP. Associated Anomalies in Radial Ray Deficiency. Am J Med Genet A 2024:e63874. [PMID: 39315659 DOI: 10.1002/ajmg.a.63874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 08/20/2024] [Accepted: 08/23/2024] [Indexed: 09/25/2024]
Abstract
Radial ray deficiency (RRD) may be isolated, without other congenital anomalies or co-occurring with other, non-RRD, congenital anomalies. The prevalence and the types of co-occurring anomalies are variable in the reported studies. The aim of this study was to obtain the prevalence and the types of co-occurring congenital anomalies among cases with RRD in a geographically well-characterized population of 387,067 consecutive births in northeastern France from 1979 to 2007 including live births, stillbirths and terminations of pregnancy. During the study period 83 cases with RRD were ascertained (prevalence of 2.14 per 10,000 births), 63 cases (75.9%) had co-occurring anomalies. Cases with co-occurring anomalies were divided into chromosomal anomalies (18 cases, 22%), syndromic conditions (syndromes and associations, 23 cases, 28%), and multiple congenital anomalies (MCA) (22 cases, 26%). Trisomies 18 and autosomal deletions were the most common chromosomal abnormalities. Thrombocytopenia absent radii syndrome, VACTERL association, Fanconi anemia, Roberts syndrome, and Holt-Oram syndrome were the most common syndromic conditions. Anomalies in the musculoskeletal, the cardiovascular, the urinary, and the orofacial system were the most common co-occurring anomalies in cases with MCA. As cases with RRD have often co-occurring congenital anomalies, a multidisciplinary checkup of these cases is recommended.
Collapse
Affiliation(s)
- Claude Stoll
- Faculté de Médecine, Laboratoire de Génétique Médicale, Strasbourg, France
| | - Yves Alembik
- Faculté de Médecine, Laboratoire de Génétique Médicale, Strasbourg, France
| | - Marie-Paule Roth
- Faculté de Médecine, Laboratoire de Génétique Médicale, Strasbourg, France
| |
Collapse
|
3
|
Wachtmeister A, Tettamanti G, Nordgren I, Norrby C, Laurell T, Lu Y, Skarin Nordenvall A, Nordgren A. Cancer risk in individuals with polydactyly: a Swedish population-based cohort study. Br J Cancer 2024; 131:755-762. [PMID: 38951698 PMCID: PMC11333495 DOI: 10.1038/s41416-024-02770-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Polydactyly is a feature of several cancer predisposition syndromes (CPS), however, cancer risk in individuals with polydactyly is largely unknown. METHODS We performed a matched cohort study using data from Swedish national registers. We included 6694 individuals with polydactyly, born in Sweden between 1970-2017. Polydactyly was categorised as thumb polydactyly, finger polydactyly, polydactyly+ (additional birth defects and/or intellectual disability) or isolated polydactyly. Each exposed individual was matched to 50 comparisons by sex, birth year and birth county. Associations were estimated through Cox proportional hazard models. FINDINGS An increased childhood cancer risk was found in males (HR 4.24, 95% CI 2.03-8.84) and females (HR 3.32, 95% CI 1.44-7.63) with polydactyly+. Isolated polydactyly was associated with cancer in childhood (HR 1.87, 95% CI 1.05-3.33) and young adulthood (HR 2.30, 95% CI 1.17-4.50) in males but not in females. The increased cancer risk remained after exclusion of two known CPS: Down syndrome and neurofibromatosis. The highest site-specific cancer risk was observed for kidney cancer and leukaemia. CONCLUSIONS An increased cancer risk was found in individuals with polydactyly, especially in males and in individuals with polydactyly+. We encourage future research about polydactyly and cancer associations and emphasise the importance of clinical phenotyping.
Collapse
Affiliation(s)
| | - Giorgio Tettamanti
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ida Nordgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Christina Norrby
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Laurell
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Hand Surgery, Södersjukhuset, Stockholm, Sweden
| | - Yunxia Lu
- Department of Population Health and Disease Prevention & Department of Epidemiology and Biostatistics, Program in Public Health, University of California, Irvine, CA, USA
| | - Anna Skarin Nordenvall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ann Nordgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Genetics and Genomics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Biomedicine, Department of Laboratory Medicine, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
4
|
Murphy GRF, Feneck E, Paget J, Sivakumar B, Smith G, Logan MPO. Investigating the role connective tissue fibroblasts play in the altered muscle anatomy associated with the limb abnormality, Radial Dysplasia. J Anat 2024; 245:217-230. [PMID: 38624036 PMCID: PMC11259744 DOI: 10.1111/joa.14040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 02/13/2024] [Accepted: 03/10/2024] [Indexed: 04/17/2024] Open
Abstract
Radial dysplasia (RD) is a congenital upper limb birth defect that presents with changes to the upper limb anatomy, including a shortened or absent radius, bowed ulna, thumb malformations, a radially deviated hand and a range of muscle and tendon malformations, including absent or abnormally shaped muscle bundles. Current treatments to address wrist instability caused by a shortened or absent radius frequently require an initial soft tissue distraction intervention followed by a wrist stabilisation procedure. Following these surgical interventions, however, recurrence of the wrist deviation remains a common, long-term problem following treatment. The impact of the abnormal soft connective tissue (muscle and tendon) anatomy on the clinical presentation of RD and the complications following surgery are not understood. To address this, we have examined the muscle, fascia and the fascial irregular connective tissue (ICT) fibroblasts found within soft connective tissues, from RD patients. We show that ICT fibroblasts isolated from RD patients are functionally abnormal when compared to the same cells isolated from control patients and secrete a relatively disordered extracellular matrix (ECM). Furthermore, we show that ICT fibroblast dysfunction is a unifying feature found in RD patients, even when the RD clinical presentation is caused by distinct genetic syndromes.
Collapse
Affiliation(s)
- George R. F. Murphy
- Randall Centre of Cell and Molecular BiophysicsKing's College LondonLondonUK
- Plastic and Reconstructive Surgery DepartmentGreat Ormond Street Hospital for ChildrenLondonUK
| | - Eleanor Feneck
- Randall Centre of Cell and Molecular BiophysicsKing's College LondonLondonUK
| | - James Paget
- Targeted Therapy Team, Chester Beatty LaboratoriesInstitute of Cancer ResearchLondonUK
| | - Branavan Sivakumar
- Plastic and Reconstructive Surgery DepartmentGreat Ormond Street Hospital for ChildrenLondonUK
| | - Gill Smith
- Plastic and Reconstructive Surgery DepartmentGreat Ormond Street Hospital for ChildrenLondonUK
| | - Malcolm P. O. Logan
- Randall Centre of Cell and Molecular BiophysicsKing's College LondonLondonUK
| |
Collapse
|
5
|
Moura SRB, Nakachima LR, Santos JBGD, Belloti JC, Fernandes CH, Faloppa F, Moraes VYD, Sabongi RG. Prevalence of Congenital Anomalies of the Upper Limbs in Brazil: a descriptive cross-sectional study. SAO PAULO MED J 2024; 142:e2023349. [PMID: 38896746 DOI: 10.1590/1516-3180.2023.0349.r1.08042024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 04/08/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Congenital Anomalies of the Upper Limb (CAUL) are a group of structural or functional abnormalities that develop during intrauterine life and can lead to limb dysfunction. OBJECTIVES To analyze the prevalence of congenital anomalies of the upper limbs in Brazil and assess maternal and neonatal variables. DESIGN AND SETTING A cross-sectional, descriptive study was conducted on congenital upper limb malformations among live births across Brazil. METHODS The study spanned from 2010 to 2019. Data were sourced from the Department of Informatics of the Unified Health System (DATASUS) and the Live Birth Information System (SINASC) portal. Analyses focused on the information reported in field 41 of the Live Birth Declaration Form entered into the computerized system. RESULTS The most common anomaly in Brazil was supernumerary fingers, classified as ICD-Q69.0, affecting 11,708 children, with a prevalence of 4.02 per 10,000 live births. Mothers aged over 40 years had a 36% higher prevalence of having children with CAUL than mothers under 40 years old (OR = 1.36; 95% CI 1.19-1.56). Newborns weighing ≥ 2,499 g were 2.64 times more likely to have CAUL compared to those weighing ≥ 2,500 g (OR = 2.64; 95% CI 2.55-2.73). CONCLUSION There was an observed increase in the reporting of CAUL cases over the decade studied. This trend serves as an alert for health agencies, as understanding the prevalence of CAUL and its associated factors is crucial for preventive medicine.
Collapse
Affiliation(s)
- Samuel Ricardo Batista Moura
- Hand Surgeon, Department of Orthopedics and Traumatology, Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo (SP), Brazil
| | - Luis Renato Nakachima
- Adjunct Professor, Department of Orthopedics and Traumatology. Discipline of Hand and Upper Limb Surgery, Escola Paulista de Medicina - Universidade Federal de São Paulo (EPMUNIFESP), São Paulo (SP), Brazil
| | - João Baptista Gomes Dos Santos
- Adjunct Professor, Department of Orthopedics and Traumatology, Escola Paulista de Medicina - Universidade Federal de São Paulo (EPMUNIFESP), São Paulo (SP), Brazil
| | - João Carlos Belloti
- Adjunct Professor, Department of Orthopedics and Traumatology, Escola Paulista de Medicina - Universidade Federal de São Paulo (EPMUNIFESP), São Paulo (SP), Brazil
| | - Carlos Henrique Fernandes
- Adjunct Professor, Department of Orthopedics and Traumatology, Escola Paulista de Medicina - Universidade Federal de São Paulo (EPMUNIFESP), São Paulo (SP), Brazil
| | - Flavio Faloppa
- Full Professor, Department of Orthopedics and Traumatology, Escola Paulista de Medicina - Universidade Federal de São Paulo (EPMUNIFESP), São Paulo (SP), Brazil
| | - Vinicius Ynoe de Moraes
- Orthopedic Surgeon, Department of Orthopedics and Traumatology, Escola Paulista de Medicina - Universidade Federal de São Paulo (EPMUNIFESP), São Paulo (SP), Brazil
| | - Rodrigo Guerra Sabongi
- Hand Surgeon, Department of Orthopedics and Traumatology, Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo (SP), Brazil
| |
Collapse
|
6
|
Sletten IN, Jokihaara J, Klungsøyr K. Prevalence, infant outcomes and gestational risk factors for transverse reduction deficiencies at or above the wrist: a population-based study. J Hand Surg Eur Vol 2024:17531934241249913. [PMID: 38780050 DOI: 10.1177/17531934241249913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
We identified individuals born in Norway between 1970 and 2019 with transverse reduction deficiency at or above the wrist (TRDAW) from the Medical Birth Registry of Norway and from the CULA (congenital upper limb anomaly) North Oslo Registry. Infant outcomes and parental factors were compared for 202 individuals with TRDAW to 2,741,013 living individuals without TRDAW born during the same period. We found an overall TRDAW prevalence of 0.74/10,000. Infants with TRDAW had a higher risk for being small for gestational age, an Apgar score <7 and transfer to neonatal intensive care units after delivery. Nine of the infants with TRDAW had associated anomalies, most commonly in the lower limb, and at a higher proportion than the reference population. Other than twin pregnancies, we are unable to identify with certainty any other risk factors for TRDAW.Level of evidence: I.
Collapse
Affiliation(s)
| | - Jarkko Jokihaara
- Department of Hand Surgery, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Kari Klungsøyr
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| |
Collapse
|
7
|
Alghamdi MS, Alenazi AM, Alghadier M, Elnaggar RK, Alshehri MM, Alqahtani BA, Al-Nowaisri K, Ghazal H, Alodaibi F, Alhowimel AS. Demographic and clinical characteristics of children with limb loss in Saudi Arabia: A retrospective study. Prosthet Orthot Int 2024; 48:170-175. [PMID: 37068016 DOI: 10.1097/pxr.0000000000000236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/05/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE The aim of this study was to describe the demographic and clinical characteristics of children with limb loss in Saudi Arabia. METHODS This is a retrospective study on children attending a limb loss clinic in a tertiary hospital in Riyadh, Saudi Arabia, between July 2012 and June 2020. Descriptive statistics were computed to describe the sample characteristics. A Chi-Squared test was conducted to explore the relationship between a child's sex with the type of limb loss (congenital or acquired) and extent of limb loss (major and minor) and the association between child's age and the mechanism of injury in traumatic limb loss. RESULTS A total of 122 children aged 2-16 years were included of whom 52% were boys. Congenital limb loss represented 57% of the sample with upper extremity loss accounting for 63.7% of all limb loss in this type. Trauma-related limb loss represented the most frequent etiology (88.2%) in the acquired limb loss group. Road traffic accidents accounted for 51.7% of the mechanism of injuries in trauma-related limb loss. Child's sex was not associated with the type of limb loss nor the extent of limb loss ( p > 0.05). In addition, child's age was not associated with the mechanism of injury in traumatic limb loss ( p > 0.05). CONCLUSION Child's sex was not a determinant of type nor the extent of limb loss. Most of the acquired limb loss was trauma-related with road traffic accidents as the most common mechanism of injury. The findings of this study illuminate the importance of ongoing prosthetic care for children with a limb loss because young children may require multiple prostheses as they grow in age and size.
Collapse
Affiliation(s)
- Mohammed S Alghamdi
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Aqeel M Alenazi
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Mshari Alghadier
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Ragab K Elnaggar
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Mohammed M Alshehri
- Physical Therapy Department, College of Applied Medical Science, Jazan University, Jazan, Saudi Arabia
- Medical Research Center, Jazan University, Jazan, Saudi Arabia
| | - Bader A Alqahtani
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Khalid Al-Nowaisri
- Department of Physical Therapy, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Haitham Ghazal
- Department of Physical Therapy, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Faris Alodaibi
- Department of Health and Rehabilitation Science, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed S Alhowimel
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| |
Collapse
|
8
|
Dwivedi N, Goldfarb CA, Wall LB. Functional Outcomes and Health-Related Quality of Life of Adults With Congenital Below-Elbow Amputation in North America. J Hand Surg Am 2024; 49:378.e1-378.e9. [PMID: 36041946 DOI: 10.1016/j.jhsa.2022.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 05/24/2022] [Accepted: 07/06/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Congenital below-elbow amputation (BEA) is a common upper-extremity anomaly and generally encompasses 2 diagnoses, symbrachydactyly and transverse deficiency. Little is known about the physical, mental, and social well-being of adults with congenital BEA. A deeper understanding of longitudinal outcomes within this population may help guide family conversations and counseling for patients with congenital BEA. METHODS The Shriners Hospitals for Children Health Outcomes Network was queried to identify all patients currently >18 years of age who had been seen as a child between 1975 and 2019 for congenital BEA at 1 of 20 Shriners Hospitals across North America. A unique health survey examining physical functioning, mental health, social outcomes, and health-related quality of life was constructed and sent by mail or in electronic form to eligible patients. RESULTS A total of 64 questionnaires were completed. Patients ranged between 18 and 34 years of age, and 70% were female. Nearly two-thirds of patients (64%) reported that a prosthesis was not required and only 14% reported daily prosthetic use. Although respondents reported below-average Patient-Reported Outcomes Measurement Information System (PROMIS) upper-extremity scores, there were no differences in Short-Form 12 or Quick Disabilities of the Arm, Shoulder, and Hand scores relative to the US general population. Study participants had lower PROMIS Pain Intensity and higher PROMIS satisfaction with social roles and activities scores than the US general population, translating to clinically meaningful differences. CONCLUSIONS Although adults with congenital BEA report lower upper-extremity functional scores than the general population, they report no clear differences from normative values in self-efficacy, psychosocial well-being, health-related quality of life, or global life satisfaction. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
Collapse
Affiliation(s)
- Nishant Dwivedi
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Charles A Goldfarb
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO; Shriner's Hospital for Children, Saint Louis, MO
| | - Lindley B Wall
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO; Shriner's Hospital for Children, Saint Louis, MO.
| |
Collapse
|
9
|
Ganju N, Mantilla-Rivas E, Martinez PF, Manrique M, Escandón JM, Shah S, Rogers AE, Boyajian MJ, Oh AK, Rogers GF. A Retrospective Review of Patient-reported Outcomes after Postaxial Polydactyly Ligation and Surgical Excision. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5557. [PMID: 38751604 PMCID: PMC11095962 DOI: 10.1097/gox.0000000000005557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/04/2023] [Indexed: 05/18/2024]
Abstract
Background Interventions for type B postaxial polydactyly include suture ligation and surgical excision, yet there is a paucity of literature comparing the outcomes of these procedures. This study sought to compare patient-reported long-term outcomes of postaxial digit excision. Methods A six-question survey was distributed from January 2021 to March 2022 to patients who underwent treatment for type B postaxial polydactyly at a single pediatric institution from 2010 to 2016. Patients were queried about the incidence of pain sensitivity, keloid healing, and/or persistent presence of bump ("nubbin") at the treatment site. Results A total of 158 responses accounting for 258 digits were attained for a 53% response rate. The majority of digits (67.4%, n = 174) were surgically excised. Median age at procedure was 49 days: 13.0 days for ligation, 63.0 days for surgical excision. Median age at survey was 8 [IQR 5.4-10.2] years. Short-term (<30 days after procedure) complications rate was 1.6%. The rate of a raised or sensitive scar was 39.5% (ligation 51.5% versus surgery 35.4%, P < 0.05). The likelihood of postoperative sensitivity (P = 0.80) was similar among groups. However, the odds of a residual bump or raised scar at the surgical site was significantly higher in the ligation group (P = 0.001). These findings remained significant in the adjusted analysis. Conclusion This study suggests that suture ligation can be used in select cases without increasing the prevalence of long-term pain or sensitivity, albeit with greater risk of a bump or raised scar at the excision site compared with surgical excision.
Collapse
Affiliation(s)
- Nakul Ganju
- From the Division of Plastic and Reconstructive Surgery, Children’s National Hospital, Washington, D.C
| | - Esperanza Mantilla-Rivas
- From the Division of Plastic and Reconstructive Surgery, Children’s National Hospital, Washington, D.C
| | - Paul F. Martinez
- From the Division of Plastic and Reconstructive Surgery, Children’s National Hospital, Washington, D.C
| | - Monica Manrique
- From the Division of Plastic and Reconstructive Surgery, Children’s National Hospital, Washington, D.C
| | - Joseph M. Escandón
- From the Division of Plastic and Reconstructive Surgery, Children’s National Hospital, Washington, D.C
| | - Samay Shah
- From the Division of Plastic and Reconstructive Surgery, Children’s National Hospital, Washington, D.C
| | - Ashley E. Rogers
- From the Division of Plastic and Reconstructive Surgery, Children’s National Hospital, Washington, D.C
| | - Michael J. Boyajian
- From the Division of Plastic and Reconstructive Surgery, Children’s National Hospital, Washington, D.C
| | - Albert K. Oh
- From the Division of Plastic and Reconstructive Surgery, Children’s National Hospital, Washington, D.C
| | - Gary F. Rogers
- From the Division of Plastic and Reconstructive Surgery, Children’s National Hospital, Washington, D.C
| |
Collapse
|
10
|
McCarter JH, Zeledon RA, Cole SH, Layon SA, Nguyen JL. Common Pediatric Hand Anomalies. Semin Plast Surg 2023; 37:275-286. [PMID: 38098681 PMCID: PMC10718657 DOI: 10.1055/s-0043-1777096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Upper extremity congenital anomalies in the newborn are second only to congenital heart anomalies. Some of the more commonly encountered upper extremity anomalies are trigger thumb, thumb hypoplasia, polydactyly, syndactyly, and amniotic band syndrome. While some conditions occur in isolation, others are known to commonly occur in association with syndromes. Familiarity with these conditions is important not only to provide adequate evaluation and workup of these patients but also to deliver appropriate surgical intervention and prepare parents with appropriate expectations. In this article, we outline the etiology, classification, surgical management, and outcomes of these five commonly encountered upper extremity congenital anomalies.
Collapse
Affiliation(s)
- Jacob H. McCarter
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Ricardo A. Zeledon
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Samuel H. Cole
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Sarah A. Layon
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Jenny Lee Nguyen
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| |
Collapse
|
11
|
Cevik J, Salehi O, Gaston J, Rozen WM. Maternal Cigarette Smoking and Congenital Upper and Lower Limb Differences: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:4181. [PMID: 37445217 DOI: 10.3390/jcm12134181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Maternal smoking during pregnancy has been associated with adverse effects on foetal development, including congenital limb anomalies. This systematic review aimed to provide an updated assessment of the association between maternal smoking during pregnancy and the risk of congenital limb anomalies. A systematic search was conducted to identify relevant studies published up to February 2023. Studies reporting on the relationship between maternal smoking during pregnancy and congenital digital anomalies or congenital limb reduction defects were included. Two independent reviewers screened the studies, extracted data, and assessed the quality of the included studies. Meta-analyses were performed to estimate the pooled odds ratios with 95% confidence intervals using fixed and random-effects models. In total, 37 publications comprising 11 cohort and 26 case-control studies were included in the systematic review. The meta-analysis demonstrated a significant increased risk of congenital limb reduction defects (pooled OR: 1.27, 95% CI: 1.18-1.38) in infants born to mothers who smoked during pregnancy. Similarly, a significant relationship was observed for the development of polydactyly/syndactyly/adactyly when considered as a single group (pooled OR: 1.32, 95% CI: 1.25-1.40). Yet, in contrast, no significant association was observed when polydactyly (pooled OR: 1.06, 95% CI: 0.88-1.27) or syndactyly (pooled OR: 0.91, 95% CI: 0.77-1.08) were considered individually. This systematic review provides updated evidence of a significant relationship between maternal smoking during pregnancy and increased risk of congenital limb anomalies. These findings highlight the potential detrimental effects of smoking on foetal limb development and underscore the importance of smoking cessation interventions for pregnant women to mitigate these risks.
Collapse
Affiliation(s)
- Jevan Cevik
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Melbourne, VIC 3199, Australia
- Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC 3199, Australia
| | - Omar Salehi
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Melbourne, VIC 3199, Australia
- Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC 3199, Australia
| | - James Gaston
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Melbourne, VIC 3199, Australia
- Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC 3199, Australia
| | - Warren M Rozen
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Melbourne, VIC 3199, Australia
- Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC 3199, Australia
| |
Collapse
|
12
|
Nietosvaara NN, Sommarhem AJ, Stenroos A, Nietosvaara AY, Grahn P. Factors affecting hand cosmesis and the aesthetic impact of surgery on congenital hand differences in Finland. J Hand Surg Eur Vol 2023; 48:333-340. [PMID: 36448515 PMCID: PMC10012396 DOI: 10.1177/17531934221139698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
We assessed the appearance and cosmetic impact of surgery in congenitally different hands in Finland. A questionnaire was sent to 1165 respondents (786 female) with a mean age of 33 years (range 3-84). Participants were shown nine image pairs and seven pairs of pre- and postoperative images twice in a random order and asked to choose the more cosmetically pleasing one. We found that the appearance and number of fingers had an important aesthetic role, with higher number and more normal appearing digits consistently scoring higher than its counterpart (range 59-99%). Postoperative appearances were perceived as better than preoperative ones in syndactyly (98%), thumb duplication (92%), cleft hand (93%) and radial dysplasia (99%). Toe transfer and pollicization had little impact on cosmesis. This study demonstrated that surgery could improve cosmesis in congenitally different hands and overall, most respondents prefer an appearance that is as close as possible to normality. Level of evidence: IV.
Collapse
Affiliation(s)
- Noora N Nietosvaara
- Department of Pediatric Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Finland.,Department of Surgery, Central Hospital of South Karelia, Lappeenranta, Finland.,Department of Pediatric Surgery, Kuopio University Hospital, University of Eastern Finland, Finland
| | - Antti J Sommarhem
- Department of Surgery, Central Hospital of South Karelia, Lappeenranta, Finland
| | - Antti Stenroos
- Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Finland
| | - Aarno Y Nietosvaara
- Department of Pediatric Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Finland.,Department of Pediatric Surgery, Kuopio University Hospital, University of Eastern Finland, Finland
| | - Petra Grahn
- Department of Pediatric Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Finland
| |
Collapse
|
13
|
van Nieuwenhoven CA, Mann M, Hülsemann W. The unsolved problem of radial longitudinal dysplasia: how can we reliably prevent recurrence, preserve growth and optimize function? J Hand Surg Eur Vol 2023; 48:222-229. [PMID: 36649124 DOI: 10.1177/17531934221146893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Congenital radial longitudinal dysplasia remains an 'unsolved problem' in hand surgery. The challenges presented by the skeletal deficiency of the distal radius and soft tissue dysplasia of the severe radial longitudinal deficiency have been addressed by a number of techniques that aim to stabilize the position of the hand relative to the forearm and optimize forearm growth and hand function. Analysis of hand function and position in these children is difficult because of the abnormal 'wrist' mechanics, and the published results of the techniques used to date often lack a standardized approach and importantly the perception of function from the patient's perspective. The existing data is reviewed and compared with the results of cohorts from two major congenital upper limb centres. Soft tissue distraction prior to radialization or centralization may offer benefit in ulnar growth and forearm length but there is a need for further research into the long-term functional outcomes of the various techniques available to determine the optimal choice for these children.Level of evidence: V.
Collapse
Affiliation(s)
- Christianne A van Nieuwenhoven
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Max Mann
- Kath. Kinderkrankenhaus Willemstift GmbH, Hamburg, Germany
| | | |
Collapse
|
14
|
SAIT A, ACHARYA AM, BHAT AK. Epidemiology of Congenital Hand Differences at a Tertiary Hospital in Southern India – Establishment of a New Registry and Assessment Using Both the Swanson/IFSSH and the Oberg, Manske and Tonkin Classifications. J Hand Surg Asian Pac Vol 2022; 27:801-809. [DOI: 10.1142/s2424835522500825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: In resource challenged nations, the true magnitude of the congenital hand differences (CHD) remain unknown due to a lack of nation-wide surveillance system. We created a hospital-based registry system with the aim to determine the prevalence and distribution of CHD and compare the Swanson/IFSSH (SI) and Oberg, Manske and Tonkin (OMT) classifications. Methods: Data of children aged 0 to 18 years with CHD was entered into the online registry and classified based on the SI and OMT classifications from January 2018 to December 2021. The prevalence and distribution of CHD and risk factors like family history were summarised using descriptive analysis. Syndromic and heredity associations were further analysed using Fischer exact test and odds ratio. Clustered columns were used to compare the two classification systems. Results: A total of 307 patients with CHD presented during the study with a prevalence of 2.4/1,000 patients. Among them, 164 were unilateral, 21 were born of consanguineous marriages (7.6%) and 10 (3.6%) had a family history of CHD. Although not statistically significant, bilateral involvement was twice as likely to be hereditary compared to unilateral involvement. A total of 10 different syndromes were identified among 27 patients of which Holt–Oram syndrome was most common. The most common CHD was Radial longitudinal defificiency (111). A total of 82 (27%) children had other associated anomalies that could not be grouped as a syndrome. Two patients could not be classified using either SI or OMT classifications. Conclusions: The online registry established an efficient way to store and analyse data related to CHD. It provides new information on its prevalence in South India, which is similar to the existing literature. Most of the CHD can be grouped in both the SI and OMT classifications. However, there still remains some conditions that are unclassifiable. There is a need for a national registry of CDH for effective management, funding and research. Level of Evidence: Level IV (Epidemiological)
Collapse
Affiliation(s)
- Anika SAIT
- Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College & Hospital, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Ashwath M. ACHARYA
- Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College & Hospital, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Anil K. BHAT
- Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College & Hospital, Manipal, Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
15
|
Frantz LM, Wall LB, Goldfarb CA. Media Depiction of Birth Differences of the Upper Extremity: Accuracy of Shared Diagnoses. J Pediatr Orthop 2022; 42:e753-e755. [PMID: 35576061 DOI: 10.1097/bpo.0000000000002185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND To assess the diagnostic accuracy of public representation of congenital differences of the upper extremities. We hypothesized that there is an over-diagnosis of certain diagnoses such as amniotic constriction band and under-diagnosis of others such as symbrachydactyly and radial deficiency. METHODS Publicly shared images and associated diagnoses were searched on publicly available news media and social media accounts published from October 2018 through November 2021 using key terms such as "amniotic band syndrome," "congenital arm amputation," and "3D prosthetic arm" as well as The Lucky Fin Project account on Instagram. The images were collected and reviewed by 2 congenital hand surgeons. The surgeons' diagnoses were then compared to the reported diagnoses associated with each image to assess accuracy. RESULTS A total of 100 images were collected with the reported diagnosis associated with each image. Two images were removed due to evidence of prior surgery. The hand surgeons' diagnosis disagreed with the reported diagnosis in 60 of 98 (61%) images. Of those 60 inaccurate diagnoses, 2/3 were reported as amniotic constriction band. CONCLUSIONS Media and social media depictions of congenital upper extremity differences are frequently inaccurate, and our search demonstrated that the amniotic constriction band is the most commonly reported, inaccurate diagnosis. Accuracy of diagnosis in public media is important given the impact a diagnosis has on those viewing and sharing the images. LEVEL OF EVIDENCE Level IV, diagnostic.
Collapse
Affiliation(s)
- Lisa M Frantz
- University of Kansas School of Medicine, Wichita, KS
| | | | | |
Collapse
|
16
|
Battraw MA, Fitzgerald J, Joiner WM, James MA, Bagley AM, Schofield JS. A review of upper limb pediatric prostheses and perspectives on future advancements. Prosthet Orthot Int 2022; 46:267-273. [PMID: 35085179 DOI: 10.1097/pxr.0000000000000094] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 12/08/2021] [Indexed: 02/03/2023]
Abstract
Many complex factors affect whether a child with a congenital upper limb deficiency will wear a prosthetic limb. Ultimately, for a child to wear and use their prosthesis, it must facilitate the effective performance of daily tasks and promote healthy social interactions. Although numerous pediatric devices are available, most provide a single open-close grasp (if a grasping function is available at all) and often offer nonanthropomorphic appearances, falling short of meeting these criteria. In this narrative review, we provide a critical assessment of the state of upper limb prostheses for children. We summarize literature using quality of life measures and categorize driving factors affecting prosthesis use into two main groupings: psychosocial and physical functioning. We define psychosocial functioning as factors related to social inclusion/exclusion, emotional function, independence, and school functioning. Physical functioning is defined as factors associated with the physical use of a prosthesis. The reviewed literature suggests that psychosocial domains of quality of life may be influenced by a congenital limb deficiency, and currently available prostheses provide little benefit in the physical functioning domains. Finally, we discuss technological advancements in adult prostheses that have yet to be leveraged for pediatric devices, including describing recently developed adult electric hands that may improve physical functioning through multiple grasping configurations and provide more hand-like cosmesis. We outline actions necessary to translate similar technologies for children and discuss further strategies to begin removing barriers to pediatric device adoption.
Collapse
Affiliation(s)
- Marcus A Battraw
- Department of Mechanical and Aerospace Engineering, University of California, Davis, CA
| | - Justin Fitzgerald
- Departments of Neurobiology, Physiology and Behavior, Neurology, University of California, Davis, CA
| | - Wilsaan M Joiner
- Departments of Neurobiology, Physiology and Behavior, Neurology, University of California, Davis, CA
| | - Michelle A James
- Shriners Hospital for Children, Northern California, Sacramento, CA
| | - Anita M Bagley
- Shriners Hospital for Children, Northern California, Sacramento, CA
| | - Jonathon S Schofield
- Department of Mechanical and Aerospace Engineering, University of California, Davis, CA
| |
Collapse
|
17
|
Zeyl VG, Chen SD, Kalliainen LK. An uncommon clinical presentation of polydactyly. J Hand Surg Eur Vol 2022; 47:658-660. [PMID: 35128992 DOI: 10.1177/17531934221076291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Victoria G Zeyl
- Division of Plastic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Sonja D Chen
- Division of Plastic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Loree K Kalliainen
- Division of Plastic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| |
Collapse
|
18
|
Pai G M, Kamath BJ. Congenital hand differences: Prevalence among school going children in Mangalore city. J Orthop 2022; 31:17-21. [PMID: 35342274 PMCID: PMC8942796 DOI: 10.1016/j.jor.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/12/2022] [Accepted: 03/16/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Congenital upper extremity anomalies are present in 1 in every 626 live births. They are mostly isolated phenomena but can also be associated with other congenital deformities and may be the only external feature of a syndromic entity. A study on it in India, especially the southern part, is limited. As the quality of life gets compromised, there is a need to identify and diagnose the anomalies at the earliest. Current study is aimed to identify congenital hand deformities among the school-going population in the coastal city of Mangalore.A cross sectional study was done in the schools in Mangalore city. By simple random sampling, 35 out of 70 schools were selected, and 10,000 children in age group of 5-15years were included by non-probability sampling after taking their consent from school authorities and parents. Data was analyzed by FISHER's exact test. Result 41 cases of congenital hand anomalies were identified with 23 boys and 18 girls. Twelve children had bilateral involvement. 28 cases where of polydactyly followed by four cases of acrosyndactyly with constriction band, three cases each of syndactyly and camptodactyly,one case of lobster hand and one case each of transverse deficiency of hand and forearm. Associated lower limb anomalies were seen in 9 cases. Familial associations were seen in 6 cases, and 1 polydactyly child had a downs syndrome association. All cases[4cases] of acrosyndactyly with constriction band syndrome were operated at childhood, and most other deformities were unoperated. Polydactyly[duplication] tops the list and needs further studies to look into genetic, environmental, and regional variations. Conclusion The prevalence of congenital hand difference in Mangalore is 41 per 10000 school-going children examined. . A future national registry in India should be the way forward to assess the true prevalence and risk factors.
Collapse
Affiliation(s)
- Mithun Pai G
- Department of Hand Surgery, Kasturba Medical College, Manipal, India
- Manipal Academy of Higher Education, Manipal, India
- Corresponding author. Department of Hand Surgery, Kasturba Medical College, Manipal, India.
| | - B.N. Jagannath Kamath
- Manipal Academy of Higher Education, Manipal, India
- Department of Orthopaedics, Kasturba Medical College, Mangalore, India
| |
Collapse
|
19
|
Chan CCH, Stirling PHC, Lam WL. The impact of socioeconomic deprivation on congenital hand differences: A retrospective cohort study. HAND SURGERY & REHABILITATION 2021; 41:265-269. [PMID: 34954407 DOI: 10.1016/j.hansur.2021.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/01/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
Socioeconomic deprivation is an established risk factor for a range of adverse perinatal and infant outcomes. The primary aim of this study was to investigate any association between socioeconomic deprivation and the prevalence of Congenital Hand Differences (CHDs). This retrospective cross-sectional study was undertaken at a single tertiary referral center over a five year period (March 2015 to February 2020). The inclusion criterion was all patients referred for a review at a CHD clinic. As a measure of socioeconomic status, patients were assigned to a deprivation quintile using the Scottish Index of Multiple Deprivation (SIMD): quintile 1 indicates the most deprived area and quintile 5 indicates the least deprived area. CHDs were classified according to the Oberg-Manske-Tonkin (OMT) Classification. During the study period 259 patients were identified. The overall prevalence of CHD was 15 per 100,000 per year, mean referral age was 2.6 years (Standard Deviation: 4 years) and 135 patients (52%) were female. Areas of greater social deprivation had a significantly higher prevalence of CHD (22 per 100,000 per year in quintile 1 vs. 13 per 100,000 per year in quintile 5; p < 0.001), surgery (75% of patients in quintile 1 vs 43% of patients in quintile 5; p = 0.003), and younger referral age (1.5 years in quintile 1 vs 4.4 years in quintile 5; p = 0.003). This study has shown a greater CHD prevalence rate amongst patients from more socially deprived areas. In the most deprived group, the patient referral age was also significantly younger and surgical intervention rate was higher.
Collapse
Affiliation(s)
- C C H Chan
- University of Edinburgh, School of Medicine, Chancellor's Building, Edinburgh, EH16 4TJ, United Kingdom.
| | - P H C Stirling
- Royal Infirmary of Edinburgh, Trauma and Orthopaedics Department, 51 Little France Cres, Edinburgh EH16 4SA, United Kingdom
| | - W L Lam
- Royal Hospital for Sick Children, Plastic Surgery Department, 50 Little France Cres, Edinburgh EH16 4TJ, United Kingdom
| |
Collapse
|
20
|
Improving Understanding and Outcomes in Congenital Hand Differences. Plast Reconstr Surg 2021; 148:769e-774e. [PMID: 34705781 DOI: 10.1097/prs.0000000000008413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY It is very important for us, the surgeons, to understand the difficulties of parents who have a baby with a congenital hand difference, not only because the parents are the decision makers for the operation but also because they need consolation and care to overcome their distress. The psychological and physical developmental milestones of the child with a congenital hand difference should be considered to achieve a satisfactory surgical outcome from the viewpoint of both the surgeon and the child. Even experts in congenital hand differences may have difficulties in decision-making with regard to certain entities because of the clinical diversity and rarity. Communication among surgeons who are interested in congenital hand differences, through social networking services or other communication tools, is very helpful and effective for the exchange of knowledge and experiences. Although the final decision should be made by the surgeon, many questions and answers from friends and colleagues will lead to better decisions.
Collapse
|
21
|
Lake A, Cerza SP, Butler L, Oishi S, Brown A. The impact of therapeutic camp on children with congenital hand differences. COGENT PSYCHOLOGY 2021. [DOI: 10.1080/23311908.2021.1938439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Amy Lake
- Department of Therapy Services, Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - Shelby Parker Cerza
- Department of Clinical and Orthopaedic Research, Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - Lesley Butler
- Department of Clinical and Orthopaedic Research, Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - Scott Oishi
- Center of Excellence in Hand Disorders & Department of Hand Surgery, Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - Andrea Brown
- Department of Child Life Services, Scottish Rite Hospital for Children, Dallas, Texas, USA
| |
Collapse
|
22
|
Vuillermin C, Canizares MF, Bauer AS, Miller PE, Goldfarb CA. Congenital Upper Limb Differences Registry (CoULD): Registry Inclusion Effect. J Hand Surg Am 2021; 46:515.e1-515.e11. [PMID: 33423846 DOI: 10.1016/j.jhsa.2020.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/11/2020] [Accepted: 11/13/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To advance the understanding of the epidemiology and treatment outcomes of congenital upper limb differences, a multicenter registry for Congenital Upper Limb Differences (CoULD) was established. After 4 years of recruitment, we sought to examine whether the relative frequency of congenital conditions compares with prior cross-sectional research and how the data have matured over time by (1) comparing our registry population with previous studies in similar populations and (2) evaluating the change over time of relative frequencies of selected conditions within the CoULD registry cohort, specifically to investigate for registry inclusion effects. METHODS Data from the 2 founding centers in the CoULD registry were analyzed over a 4-year period. We compared patients included in the CoULD registry against 2 prior studies by matching each condition according to the Oberg-Manske-Tonkin classification system. The relative frequency of 4 representative conditions was calculated to evaluate change over time and to determine when the inception cohort effect diminished. RESULTS The CoULD cohort of 1,381 patients was found to have notable differences compared with a 1-year cross-sectional cohort from the U.S. Midwest and a Swedish birth registry. Each of these registries had differences from the CoULD population in prevalence for approximately 33% of the diagnosis categories. The CoULD registry identified and included more pathologies of late presentation and those that do not commonly require surgical care. Changes in relative frequencies of incident and prevalent conditions, the registry inclusion effect, occurred early and stabilized by the third year. CONCLUSIONS The CoULD registry captures a different relative frequency of conditions than prior studies in similar populations. The findings highlight the CoULD registry may be a more accurate representation of clinical practice in tertiary referral centers; however, it is important to note that there was a registry inclusion effect identified. CLINICAL RELEVANCE Inclusion criteria are an important consideration with any longitudinal data collection method and data should display stability prior to registry reporting.
Collapse
Affiliation(s)
- Carley Vuillermin
- Harvard Medical School, Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA.
| | - Maria F Canizares
- Harvard Medical School, Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA
| | - Andrea S Bauer
- Harvard Medical School, Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA
| | - Patricia E Miller
- Harvard Medical School, Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA
| | - Charles A Goldfarb
- Washington University School of Medicine, Department of Orthopedic Surgery, St. Louis Children's Hospital, St. Louis, MO; Department of Orthopedic Surgery, Shriners Hospitals for Children-St. Louis, St. Louis, MO
| | | |
Collapse
|
23
|
McDougall L, Kennedy J, Coombs C, Penington A. The psychosocial impact of congenital hand and upper limb differences on children: a qualitative study. J Hand Surg Eur Vol 2021; 46:391-397. [PMID: 33121298 DOI: 10.1177/1753193420967527] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This qualitative study explored the psychosocial concerns of children born with congenital hand and upper limb differences (CHULDs) from the point of view of these children and their parents. Qualitative, in-depth, semi-structured interviews were conducted face-to-face with eight parent-child dyads. Open format questions allowed spontaneous emergence of relevant themes, followed by guided questioning. Thematic analysis of audio-recorded and transcribed interviews found that children as young as 5 years old had unique and meaningful opinions about their CHULD, of which parents were sometimes unaware. Children reported that unsolicited questions from peers caused significant stress, and this increased around the time of surgery. All children used planned responses to peers as an effective coping mechanism. Children also identified positive aspects of their difference, including an increased sense of determination and an appreciation for being unique. Strategies that may improve psychosocial outcomes for children with CHULDs are discussed.Level of evidence: IV.
Collapse
Affiliation(s)
- Lucy McDougall
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Joanne Kennedy
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Christopher Coombs
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,The Department of Plastic and Maxillofacial Surgery, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Anthony Penington
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,The Department of Plastic and Maxillofacial Surgery, The Royal Children's Hospital, Parkville, Victoria, Australia
| |
Collapse
|
24
|
Shin YH, Baek GH, Kim YJ, Kim MJ, Kim JK. Epidemiology of congenital upper limb anomalies in Korea: A nationwide population-based study. PLoS One 2021; 16:e0248105. [PMID: 33690710 PMCID: PMC7943020 DOI: 10.1371/journal.pone.0248105] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/20/2021] [Indexed: 12/11/2022] Open
Abstract
This study aimed to analyze the epidemiology of congenital upper limb anomalies (CULA) in Korea. We evaluated the incidence of each type of CULA, the presence of coexisting anomalies and the surgical treatment status in CULA patients. We conducted a retrospective cohort study of patients aged < 1 year between 2007 and 2016 who were registered with CULA in the Health Insurance Review and Assessment Service of Korea. In total, 10,704 patients had CULA, including 6,174 boys (57.7%) and 4,530 girls (42.3%). The mean annual incidence of CULA was 23.5 per 10,000 live births; it was significantly higher in boys than in girls (26.3 vs. 20.5, p < 0.001). Among the four categories of CULA—polydactyly, syndactyly, limb deficiency, and other anomalies—polydactyly was the most common. In total, 4,149 patients (38.8%) had other congenital anomalies and coexisting anomalies of the circulatory system (24.9%) were the most common. In total 4,776 patients (44.6%) underwent operative treatment for CULA within minimum three years of the diagnosis. The proportion of patients who underwent surgical treatment was significantly higher for polydactyly (73.4% vs. 16.8%, p < 0.001) and syndactyly (65.3% vs. 41.5%, p < 0.001), but it was significantly lower in limb deficiency (27.6% vs. 45.4%, p < 0.001) and other anomalies (10.0% vs. 69.8%, p < 0.001) than rest of CULA patients. Among the patients who had operations, 21.5% underwent multiple operations. The proportion of patients who underwent multiple operations was significantly higher in syndactyly (35.6% vs. 18.1%, p < 0.001), but it was significantly lower in polydactyly (4.0% vs. 95.5%, p < 0.001) and other anomalies (17.9% vs. 21.9%, p < 0.001) than rest of CULA patients. These results could provide a basis for estimating the national healthcare costs for CULA and the required number of CULA specialists.
Collapse
Affiliation(s)
- Young Ho Shin
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Goo Hyun Baek
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min-ju Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Kwang Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
25
|
Prevalence of congenital limb defects in Uttarakhand state in India – A hospital-based retrospective cross-sectional study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2020.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
26
|
Syvänen J, Raitio A, Helenius I, Löyttyniemi E, Lahesmaa-Korpinen AM, Gissler M, Nietosvaara Y. Prevalence and risk factors of radial ray deficiencies: A population-based case-control study. Am J Med Genet A 2020; 185:759-765. [PMID: 33369153 DOI: 10.1002/ajmg.a.62033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/25/2020] [Accepted: 12/02/2020] [Indexed: 12/17/2022]
Abstract
Radial ray deficiency is the most common congenital deficiency of the upper limb. The aim of our study was to investigate maternal risk factors for radial ray deficiencies. We conducted a nationwide population-based case-control study using national registers. All cases with a radial ray deficiency born between 1996 and 2008 were included in the study and compared with five controls without limb deficiency. In total, 115 (10 isolated, 18 with multiple congenital anomalies, and 87 syndromic) cases with radial ray deficiencies were identified and compared with 575 matched controls. The total prevalence in Finland was 1.22 per 10,000 births. No significant risk factors were observed for nonsyndromic cases. In the syndromic group, advanced maternal age (≥35 years) increased the risk of radial aplasia (aOR 2.45, 95% CI 1.37-4.36), and a similar association was observed with multiple pregnancy (aOR 2.97, 1.16-7.62) and male sex (aOR 1.96, 1.18-3.25). Valproic acid was also a risk factor (p = .002). In conclusion, novel associations in the syndromic group of advanced maternal age and multiple pregnancy and increased risk of radial ray deficiencies were observed. Also, early reports on increased risk of RRD associated with valproate and male sex were supported by our results.
Collapse
Affiliation(s)
- Johanna Syvänen
- Department of Pediatric Surgery and Orthopedics, University of Turku and Turku University Hospital, Turku, Finland
| | - Arimatias Raitio
- Department of Pediatric Surgery and Orthopedics, University of Turku and Turku University Hospital, Turku, Finland
| | - Ilkka Helenius
- Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eliisa Löyttyniemi
- Department of Biostatistics, University of Turku and Turku University Hospital, Turku, Finland
| | | | - Mika Gissler
- Information Services Department, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Yrjänä Nietosvaara
- Department of Pediatric Surgery, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
27
|
New Simple Technique for Syndactyly Release. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2842. [PMID: 33133902 PMCID: PMC7572197 DOI: 10.1097/gox.0000000000002842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/20/2020] [Indexed: 11/26/2022]
Abstract
Can good functional and cosmetic result be achieved in syndactyly separation using a straight midline incision with a hexagonal dorsal skin flap?
Collapse
|
28
|
Evaluation and Management of Preaxial Polydactyly. Curr Rev Musculoskelet Med 2020; 13:545-551. [PMID: 32472371 DOI: 10.1007/s12178-020-09644-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW To provide a current review of the embryology, classification, evaluation, surgical management, and clinical outcomes related to preaxial polydactyly. RECENT FINDINGS Recent studies include a proposed embryologic link between preaxial polydactyly and other congenital abnormalities, an evaluation of long-term postsurgical outcomes, and an examination of important predictors for postsurgical outcomes. Preaxial polydactyly, while relatively uncommon, is a complex congenital hand abnormality that requires careful preoperative classification and proper surgical intervention timing to yield optimal outcomes.
Collapse
|
29
|
Chopan M, Sayadi L, Chim H, Buchanan PJ. To Tie or Not to Tie: A Systematic Review of Postaxial Polydactyly and Outcomes of Suture Ligation Versus Surgical Excision. Hand (N Y) 2020; 15:303-310. [PMID: 30417703 PMCID: PMC7225879 DOI: 10.1177/1558944718810885] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: Ulnar polydactyly is frequently encountered in the newborn nursery and is commonly treated with bedside suture ligation. However, growing concern about the complications associated with suture ligation has led some practitioners to advocate for primary surgical excision instead. Thus, we set out to compare outcomes of suture ligation and surgical excision by systematic appraisal of the literature. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic review was performed to identify studies published between 1950 and 2017 that described outcomes of suture ligation, surgical excision, or both. Baseline characteristics, complications, and study quality were extracted for each included article. Results: A total of 900 articles were reviewed, of which 10 studies (8 case series, 2 comparative analyses) met the inclusion criteria. There was considerable heterogeneity among the studies with respect to patient characteristics and reported outcomes. There were 2 retrospective case series of suture ligation that reported no acute complications and a variable proportion of patients with residual remnants or neuromas. Studies evaluating surgical ligation reported no acute or long-term complications, with only 1 case series reporting a small percentage of residual remnants. However, in the largest cohort analysis, the difference in complication rate was reported to be as high as 23.5% for suture ligation compared with 3% for surgical excision. Conclusions: There is a paucity of literature limiting the comparison of suture ligation and surgical excision for ulnar polydactyly. Further studies are required to determine the optimal treatment.
Collapse
Affiliation(s)
| | | | - Harvey Chim
- University of Florida Health, Gainesville, USA
| | - Patrick J. Buchanan
- University of Florida Health, Gainesville, USA,Patrick J. Buchanan, Division of Plastic & Reconstructive Surgery, College of Medicine, University of Florida Health, 1600 SW Archer Road, Gainesville, FL 32608, USA.
| |
Collapse
|
30
|
Ozturk K, Kastamoni Y, Dursun A, Albay S. Prevalence of the extensor digitorum, extensor digiti minimi and extensor indicis tendons and their variations. HAND SURGERY & REHABILITATION 2020; 39:320-327. [PMID: 32259596 DOI: 10.1016/j.hansur.2020.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/19/2020] [Accepted: 02/22/2020] [Indexed: 12/17/2022]
Abstract
We aimed to investigate tendon variations of the extensor digitorum (ED), extensor digiti minimi (EDM), and extensor indicis proprius (EIP) muscles. Our study was performed on 43 fetal cadavers (86 extremities), aged between 17 and 40 weeks of gestation. The number of ED tendons varied from three to six, proximal to the extensor retinaculum (ER), and from three to eight, distal to the ER. The ED most often had four tendons, both proximally and distally from the ER. The ED tendons of the fourth finger were observed to be most frequently duplicated. The most common juncturae tendinum (JT) was type 1 in the second intermetacarpal space (IMCS), type 2 in the third IMCS, and type 3r in the fourth IMCS according to von Schroeder classification. The number of EIP and EDM tendons varied from one to two and from one to five, respectively. The EIP double tendons inserted both into the ulnar and palmar sides of the extensor digitorum of the second finger, which had not been reported in the literature. In our study, 7% of hands had variant muscles. In 4.7% of hands, the extensor indicis et medii communis was observed, while the extensor medii proprius and the extensor digitorum brevis manus were observed in 1.2% and 1.2% of hands, respectively. Knowing the prevalence of the ED, EDM and EIP tendons and their variations in the fetal period should help to treat partial loss of hand function or injury after birth and to correct congenital hand deformities.
Collapse
Affiliation(s)
- K Ozturk
- Department of Anatomy, Faculty of Medicine, Suleyman Demirel University, Çünür, Süleyman Demirel Cd, 32260 Merkez/Isparta, Turkey.
| | - Y Kastamoni
- Department of Anatomy, Faculty of Medicine, Suleyman Demirel University, Çünür, Süleyman Demirel Cd, 32260 Merkez/Isparta, Turkey.
| | - A Dursun
- Department of Anatomy, Faculty of Medicine, Suleyman Demirel University, Çünür, Süleyman Demirel Cd, 32260 Merkez/Isparta, Turkey.
| | - S Albay
- Department of Anatomy, Faculty of Medicine, Suleyman Demirel University, Çünür, Süleyman Demirel Cd, 32260 Merkez/Isparta, Turkey.
| |
Collapse
|
31
|
Kim J, Gong HS, Kim HS, Seok HS, Oh S, Baek GH. Parenting stress in mothers of children with congenital hand or foot differences and its effect on the surgical decision-making for their children. J Orthop Surg (Hong Kong) 2020; 27:2309499019838900. [PMID: 30939996 DOI: 10.1177/2309499019838900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The main purposes of this study were to assess the levels of parenting stress in the mothers of children with congenital hand or foot differences and to evaluate the effects of this stress on the preferred roles of mothers in surgical decision-making for their children. METHODS This study included 89 mothers of children with polydactyly of the hand, polydactyly of the foot, a hypoplastic thumb, or macrodactyly. The parenting stress level was assessed using the Parenting Stress Index-Short Form (PSI-SF). Additionally, the mothers were requested to indicate their preferred and retrospectively perceived levels of involvement in surgical decision-making for their children using the Control Preferences Scale, which is comprised of five levels ranging from fully active to fully passive. RESULTS The average PSI-SF scores were 73.9, and 15 mothers (17%) had a clinically significant level of stress (PSI-SF ≥ 90). In the mothers of children with polydactyly of the foot, the PSI score was associated with the preferred role in surgical decision-making. CONCLUSION The assessment of parenting stress levels in the mothers of children with congenital hand or foot differences can play an important role in the screening of candidates who require psychiatric treatment or support. An evaluation of the PSI in mothers of children with congenital hand or foot differences may aid physicians to modify their style of decision-making based on the preferred role of the mother. Level of evidence: Level IV Therapeutic study.
Collapse
Affiliation(s)
- Jihyeung Kim
- 1 Department of Orthopaedic Surgery, Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Hyun Sik Gong
- 1 Department of Orthopaedic Surgery, Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Hong Seok Kim
- 1 Department of Orthopaedic Surgery, Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Hyun Sik Seok
- 1 Department of Orthopaedic Surgery, Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Sohee Oh
- 2 Department of Biostatistics, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Goo Hyun Baek
- 1 Department of Orthopaedic Surgery, Seoul National University, College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
32
|
Halverson SJ, Takayama S, Ochi K, Seki A, Wall LB, Goldfarb CA. Radial Longitudinal Deficiency: Severity Differences Between U.S. and Japanese Cohorts. J Hand Surg Am 2020; 45:196-202.e2. [PMID: 31959377 DOI: 10.1016/j.jhsa.2019.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 10/23/2019] [Accepted: 12/04/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Radial longitudinal deficiency (RLD) presents on a spectrum of severity and associated diagnoses. The literature is limited in describing patient presentation without comparative data between countries. In a study comparing 2 cohorts of patients, 1 in the United States and 1 in Japan, we hypothesized that there would be a similar presentation of forearm deficiency severity, thumb hypoplasia severity, and associated syndromes between the 2 cohorts. METHODS Patients with RLD were identified via a comprehensive chart review at 2 pediatric hospital cohorts, 1 in the United States and 1 in Japan, capturing patients presenting over 15 years. We assessed RLD and thumb hypoplasia severity via a modified Bayne and Klug and modified Blauth classifications. The relationship between these 2 diagnoses and the presence of common medical conditions were evaluated and correlated. RESULTS A total of 194 Japanese patients with 290 involved extremities were compared with 107 U.S. patients with 174 involved extremities. The U.S. cohort had a significantly more severe RLD, and a higher rate of bilaterality (63% vs 50%, respectively). A total of 131 Japanese patients (68%) and 41 U.S. patients (38%) had associated medical syndromes/associations, most frequently vertebral abnormalities, anal atresia, cardiac abnormalities, tracheoesophageal fistula and/or esophageal atresia, renal agenesis and dysplasia, and limb defects (VACTERL; 46 Japanese, 14 U.S.), Holt-Oram (44 Japanese, 5 U.S.), and thrombocytopenia absent radius syndrome (0 Japanese, 12 U.S.). Correlation analysis showed that increased RLD severity was associated with increased thumb hypoplasia severity in both groups, with 95% of modified Bayne and Klug III, IV, or V patients having severely affected thumbs (type IIIb, IV, or V). CONCLUSIONS The U.S. patients had a more severe RLD and a higher rate of bilaterality. Japanese patients had a higher incidence of associated syndromes and radial polydactyly. Both cohorts showed that increased forearm severity was associated with more severe thumb hypoplasia. TYPE OF STUDY/LEVEL OF EVIDENCE Differential diagnosis/symptom prevalence study III.
Collapse
Affiliation(s)
- Schuyler J Halverson
- Department of Orthopaedic Surgery, Washington University School of Medicine and Shriners Hospital for Children, St. Louis, MO
| | - Shinichiro Takayama
- Department of Orthopaedic Surgery, Tokyo Dental College Ichikawa General Hospital, Tokyo, Japan
| | - Kensuki Ochi
- Department of Orthopaedic Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Atsuhito Seki
- Department of Orthopaedic Surgery, Tokyo Dental College Ichikawa General Hospital, Tokyo, Japan
| | - Lindley B Wall
- Department of Orthopaedic Surgery, Washington University School of Medicine and Shriners Hospital for Children, St. Louis, MO
| | - Charles A Goldfarb
- Department of Orthopaedic Surgery, Washington University School of Medicine and Shriners Hospital for Children, St. Louis, MO.
| |
Collapse
|
33
|
Nietosvaara NN, Sommarhem AJ, Puhakka JM, Tan RES, Schalamon J, Nietosvaara AY. Appearance of congenital hand anomalies. Scand J Surg 2020; 110:434-440. [PMID: 32106765 PMCID: PMC8551435 DOI: 10.1177/1457496920903987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background and objective: Impact of appearance of congenital hand anomalies has not previously been reported. The purpose of this study was to describe the common perception about how different congenitally malformed hands look. Methods: We developed a questionnaire in a game format to evaluate the appearance of different hands. Altogether 1450 (954 females) 4- to 84-year-old residents (296 children) of two European and one Asian (n = 102) country were asked to rate the appearance of different looking hands on a five-point pictorial Likert-type scale. Standardized photographs of the dorsal aspect of 17 different congenitally malformed non-operated hands and a normal hand were presented to respondents. Significance of age, gender, nationality, and profession of the respondents was assessed. Results: The respondents’ ranking order of the hands was nearly consistent. The normal hand (mean = 4.43, standard deviation = 0.85, Md = 5) and clinodactyly (mean = 4.37, standard deviation = 0.86, Md = 5) were perceived to have the best appearance. Symbrachydactyly (mean = 1.42, standard deviation = 0.68, Md = 1) and radial club hand (mean = 1.40, standard deviation = 0.68, Md = 1) received the lowest scores. Adults rated the appearance of hands higher than children regarding 14 hands, females higher than men regarding 15 hands, and Europeans higher than Asians in 4 hands (p < 0.05, respectively). Europeans rated four-finger hand (mean = 3.21, standard deviation = 1.18, Md = 3) better looking than six-finger hand (mean = 2.92, standard deviation = 1.18, Md = 3, p < 0.005), whereas Asians gave higher scores to six-finger hand (mean = 2.66, standard deviation = 1.26, Md = 3) compared to four-finger hand (mean = 2.51, standard deviation = 1.14, Md = 2). Medical doctors and nurses gave higher scores compared to the other profession groups, school children, and high school students in five hands (p < 0.05). Conclusions: A normal hand is perceived distinctly better looking than most congenitally different hands. Different malformations’ appearance was ranked very coherently in the same order despite of participants’ age, gender, nationality, or profession. Asians seem to prefer an additional digit to a four-finger hand.
Collapse
Affiliation(s)
- Noora N Nietosvaara
- Department of Pediatric Orthopedics and Hand Surgery, New Children's Hospital, Helsinki University Hospital, Stenbäckinkatu 9, Helsinki, 00290, Finland
| | - Antti J Sommarhem
- Department of Pediatric Orthopedics and Hand Surgery, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Jani M Puhakka
- Department of Pediatric Orthopedics and Hand Surgery, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Ruth E S Tan
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - Johannes Schalamon
- Department of Pediatric Surgery, Medical University of Graz, Graz, Austria
| | - Aarno Y Nietosvaara
- Department of Pediatric Orthopedics and Hand Surgery, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
34
|
Evaluation of hand anomalies in children admitted to a tertiary health center in eastern Anatolia. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.676938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
35
|
Farr A, Wachutka E, Bettelheim D, Windsperger K, Farr S. Perinatal outcomes of infants with congenital limb malformations: an observational study from a tertiary referral center in Central Europe. BMC Pregnancy Childbirth 2020; 20:35. [PMID: 31931744 PMCID: PMC6958570 DOI: 10.1186/s12884-020-2720-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/03/2020] [Indexed: 01/03/2023] Open
Abstract
Background Congenital limb malformations are rare, and their perinatal outcomes are not well described. This study analyzed the perinatal outcomes of infants with congenital limb malformations. Methods All infants with congenital limb malformations who underwent prenatal assessment and delivery at our tertiary referral center from 2004 through 2017 were retrospectively identified. Neonatal outcome parameters were assessed, and the predictors of worse perinatal outcomes were determined. Results One hundred twenty-four cases of congenital limb malformations were identified, of which 104 (83.9%) were analyzed. The upper limb was affected in 15 patients (14.4%), the lower limb in 49 (47.1%), and both limbs in 40 (38.5%) patients. A fetal syndrome was identified in 66 patients (63.5%); clubfoot and longitudinal reduction defects were the most frequent malformations. In total, 38 patients (36.5%) underwent termination, seven (6.7%) had stillbirth, and 59 (56.7%) had live-born delivery. Rates of preterm delivery and transfer to the Neonatal Intensive Care Unit were 42.4 and 25.4%, respectively. Localization of the malformation was a determinant of perinatal outcome (P = .006) and preterm delivery (P = .046). Conclusions Congenital limb malformations frequently occur bilaterally and are associated with poor perinatal outcomes, including high rates of stillbirth and preterm delivery. Multidisciplinary care and referral to a perinatal center are warranted.
Collapse
Affiliation(s)
- Alex Farr
- Department of Obstetrics and Gynecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
| | - Eva Wachutka
- Department of Obstetrics and Gynecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Dieter Bettelheim
- Department of Obstetrics and Gynecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Karin Windsperger
- Department of Obstetrics and Gynecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Sebastian Farr
- Department of Pediatric Orthopedics and Adult Foot and Ankle Surgery, Orthopedic Hospital Speising, Vienna, Austria
| |
Collapse
|
36
|
Wall LB, Vuillermin C, Miller PE, Bae DS, Goldfarb CA. Convergent Validity of PODCI and PROMIS Domains in Congenital Upper Limb Anomalies. J Hand Surg Am 2020; 45:33-40. [PMID: 31543292 DOI: 10.1016/j.jhsa.2019.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/08/2019] [Accepted: 08/06/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE This study evaluates the perceived functional and psychosocial impact of upper limb congenital anomalies prior to surgical intervention, utilizing the Pediatric Outcomes Data Collection Instrument (PODCI) and Patient-Reported Outcomes Measure Information System (PROMIS) domains. We hypothesized that scores will be in the normal range and that the 2 outcomes measures will have strong convergent validity. METHODS A multicenter prospectively collected database of congenital upper limb patients, the CoULD (Congenital Upper Limb Differences) study group, was utilized. Demographic information was collected, and anomalies were classified by the Oberg-Manske-Tonkin (OMT) classification. Scores for PODCI subscales of Upper Extremity (UE) function, Pain/comfort, and Happiness and PROMIS domain of UE function, Pain, Depression, Anxiety, and Peer relations were collected. Ceiling and floor effects and convergent validity for PODCI and PROMIS domains were calculated. RESULTS Three hundred fifty-nine patients, average age 10 years and 55% male, were included. Two hundred forty-one patients had a malformation of the entire limb and 231 had a hand plate malformation. Four patients had a deformation, 118 dysplasia, and 45 a syndrome. There was no difference between the PODCI and the PROMIS ceiling or floor effects for the UE domains. The ceiling effect for PROMIS Pain domain (46%) was similar to the floor effect of the PODCI Pain subscale and no difference was seen between the floor effect of PODCI Happiness and PROMIS Depression domains. Convergent validity was obtained for the UE and Pain domains, and also between PODCI Happiness and PROMIS Depression subscales. CONCLUSIONS The PROMIS domains for UE function, Pain, and Depression are comparable with PODCI scores in congenital upper extremity anomalies. CLINICAL RELEVANCE Given the large burden placed on patients with the lengthy PODCI questionnaire, consideration of replacing the PODCI with the more quickly obtained PROMIS scores may reduce patient burden and provide similar information in this population.
Collapse
Affiliation(s)
- Lindley B Wall
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO.
| | - Carley Vuillermin
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - Patricia E Miller
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - Donald S Bae
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - Charles A Goldfarb
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO
| | | |
Collapse
|
37
|
Nowosad K, Hordyjewska-Kowalczyk E, Tylzanowski P. Mutations in gene regulatory elements linked to human limb malformations. J Med Genet 2019; 57:361-370. [PMID: 31857429 DOI: 10.1136/jmedgenet-2019-106369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/09/2019] [Accepted: 11/03/2019] [Indexed: 01/08/2023]
Abstract
Most of the human genome has a regulatory function in gene expression. The technological progress made in recent years permitted the revision of old and discovery of new mutations outside of the protein-coding regions that do affect human limb morphology. Steadily increasing discovery rate of such mutations suggests that until now the largely neglected part of the genome rises to its well-deserved prominence. In this review, we describe the recent technological advances permitting this unprecedented advance in identifying non-coding mutations. We especially focus on the mutations in cis-regulatory elements such as enhancers, and trans-regulatory elements such as miRNA and long non-coding RNA, linked to hereditary or inborn limb defects. We also discuss the role of chromatin organisation and enhancer-promoter interactions in the aetiology of limb malformations.
Collapse
Affiliation(s)
- Karol Nowosad
- Department of Biochemistry and Molecular Biology, Medical University of Lublin, Lublin, Poland.,The Postgraduate School of Molecular Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Hordyjewska-Kowalczyk
- Department of Biochemistry and Molecular Biology, Medical University of Lublin, Lublin, Poland.,The Postgraduate School of Molecular Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Przemko Tylzanowski
- Department of Biochemistry and Molecular Biology, Medical University of Lublin, Lublin, Poland .,Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, University of Leuven, Leuven, Belgium
| |
Collapse
|
38
|
Swarup I, Zhang Y, Do H, Daluiski A. Epidemiology of syndactyly in New York State. World J Orthop 2019; 10:387-393. [PMID: 31840019 PMCID: PMC6908446 DOI: 10.5312/wjo.v10.i11.387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/22/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is paucity of literature focusing on the incidence and surgical management of syndactyly. In this study, we describe the incidence and rates of surgical management of patients with syndactyly in New York State.
AIM To describe the incidence and surgical management of patients with syndactyly using an America's population-based database.
METHODS We conducted a retrospective study using the New York State Statewide Planning and Research Cooperative System. All patients with a diagnosis of syndactyly at birth were identified and followed longitudinally to determine yearly incidence as well as demographic and surgical factors. Descriptive statistics and univariate analyses were used.
RESULTS There were 3306 newborns with a syndactyly diagnosis between 1997 and 2014 in New York State. The overall incidence was 0.074% or 7 cases per 10000 live births. A small number of patients underwent surgical correction in New York State (178 patients, 5.4%). Among the surgical patients, most of the operations were performed before the age of two (79%). Approximately 87% of surgeries were performed at teaching hospitals, and 52% of procedures were performed by plastic surgeons. Skin grafting was performed in 15% of cases. Patients having surgery in New York State were more likely to have Medicaid insurance compared to patients not having surgery (P = 0.02).
CONCLUSION Syndactyly occurs in approximately 7 per 10000 live births, and the majority of patients undergo surgical correction before age two. There may be several barriers to care including the availability of specialized hand surgeons, access to teaching hospitals, and insurance status.
Collapse
Affiliation(s)
- Ishaan Swarup
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, United States
| | - Yi Zhang
- Healthcare Research Institute, Hospital for Special Surgery, New York, NY 10021, United States
| | - Huong Do
- Healthcare Research Institute, Hospital for Special Surgery, New York, NY 10021, United States
| | - Aaron Daluiski
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, United States
| |
Collapse
|
39
|
Klungsøyr K, Nordtveit TI, Kaastad TS, Solberg S, Sletten IN, Vik AK. Epidemiology of limb reduction defects as registered in the Medical Birth Registry of Norway, 1970-2016: Population based study. PLoS One 2019; 14:e0219930. [PMID: 31314783 PMCID: PMC6636750 DOI: 10.1371/journal.pone.0219930] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/03/2019] [Indexed: 12/05/2022] Open
Abstract
Background Following the Thalidomide disaster, the Medical Birth Registry of Norway (MBRN) was established in 1967, with epidemiological surveillance of congenital anomalies as one main aim. Limb reduction defects (LRD) constitute a rare and heterogeneous anomaly group, where correct registration and classification is important for surveillance and research. We aimed at reviewing and recoding LRD cases in the MBRN using the same classification system for all years, and evaluate time trends, characteristics and risk factors, 1970–2016. Methods After reviewing and recoding LRD cases using International Classification of Diseases (ICD), 10th version, for all years, time trends, association with major anomalies, risk factors and infant outcomes were calculated. Generalized linear models for the binomial family with log link gave relative risks (RR) with 95% confidence intervals (CI). Classification of LRD as suggested by European surveillance of congenital anomalies (EUROCAT) was attempted. Results Overall LRD prevalence, 1970–2016, was 4.4 per 10 000, slightly increasing during 1970–1981, followed by relatively stable rates. There were more defects in upper than lower limbs. Defects in hands/fingers were most common, but unspecific descriptions prevented classification of LRD according to EUROCAT. A majority of cases had associated anomalies, the most common being other limb defects, followed by cardiac defects and anomalies in the nervous and digestive systems. From 1999, 26% of LRD cases were terminated, more than 90% of these had associated major anomalies. Stillbirth, neonatal and infant mortality were higher among infants with LRD, also related to associated anomalies. Pre-gestational diabetes was associated with a more than three times increased risk of offspring total LRD, while no association with maternal epilepsy was found. Taking folate/multivitamin supplements before and/or during pregnancy was associated with lower risk of offspring LRD (adjusted RR 0.7; 95% CI 0.6–0.9), while daily smoking did not significantly increase the risk. Conclusion The MBRN now has information on LRD coded by ICD-10 from 1970, but information is not specific enough to use other recommended classification systems. Collecting radiographic descriptions and/or more details from hospital records would improve the quality of the registry data. Taking folate supplements before/during pregnancy may reduce the risk of offspring LRD.
Collapse
Affiliation(s)
- Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
- * E-mail:
| | | | - Trine Sand Kaastad
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Department for Quality and Patient Safety, Oslo University Hospital, Oslo, Norway
| | - Sigrun Solberg
- Orthopaedic Clinic, Haukeland University Hospital, Bergen, Norway
| | | | - Anne-Karin Vik
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- National Professional Network for Dysmelia, Norwegian National Advisory Unit on Rare Disorders TRS, Oslo, Norway
| |
Collapse
|
40
|
Characterization of Hand Anomalies Associated With Möbius Syndrome. J Hand Surg Am 2019; 44:548-555. [PMID: 31031024 DOI: 10.1016/j.jhsa.2019.02.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 01/15/2019] [Accepted: 02/26/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the distinguishing morphological characteristics of the upper extremities in children with Möbius syndrome. METHODS Twenty-seven involved extremities in 14 patients with a diagnosis of Möbius syndrome were identified at 2 institutions. Medical records, radiographs, and clinical photographs were evaluated. Congenital hand differences were classified according to the Oberg, Manske, and Tonkin classification, and hands with symbrachydactyly were classified by the Blauth and Gekeler classification. The presence of other congenital anomalies was catalogued. RESULTS There was bilateral involvement in 93% of patients with congenital hand anomalies. Twelve patients demonstrated congenital hand anomalies and 2 patients had been diagnosed with arthrogryposis. Among the 12 patients with congenital hand anomalies, 21 hands were classifiable as symbrachydactyly by the Oberg, Manske, and Tonkin classification and could be categorized by the Blauth and Gekeler classification. Short finger type was the most common subtype of symbrachydactyly, present in 13 hands. Eleven of these 13 patients (85%) were primarily affected on the radial side of the hand. Proximal arm involvement was identified in 2 patients with symbrachydactyly, both of whom had Poland syndrome and an absent pectoralis major. CONCLUSIONS Symbrachydactyly in Möbius syndrome differs from the typical presentation of symbrachydactyly. Characteristically, there is a bilateral presentation with a strong predilection for radially based brachydactyly. These described characteristics may help the hand surgeon appropriately assess patients, especially those with radial-sided symbrachydactyly. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.
Collapse
|
41
|
Murphy GRF, Logan M, Smith G, Sivakumar B. RADIATE - Radial Dysplasia Assessment, Treatment and Aetiology: protocol for the development of a core outcome set using a Delphi survey. Trials 2019; 20:339. [PMID: 31182155 PMCID: PMC6558817 DOI: 10.1186/s13063-019-3459-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 05/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Radial dysplasia (RD) is a disfiguring, potentially disabling congenital upper limb anomaly. Multiple surgical techniques are in current use, with little agreement on the optimal treatment approach. At present, no core outcome set exists specifically for RD, and the literature is dominated by retrospective case series. A recent systematic review by this group demonstrated significant heterogeneity on which outcomes are measured and how they are measured. METHODS/DESIGN The RADIATE study will conduct a three-round online Delphi process, involving adult RD patients, the parents of children with RD, hand surgeons and hand therapists. The initial list of outcomes was drawn from our recent systematic review and will be supplemented by suggestions from the stakeholder groups. Following the Delphi process, outcomes that meet the consensus in definition will be ratified at a final consensus meeting. We will then follow the COSMIN guidelines to select outcome measurement instruments. Where appropriate, these will overlap with the outcome measures specified in the forthcoming standard set for congenital upper limb anomalies published by the International Consortium for Health Outcomes Measurement. DISCUSSION The Radial Dysplasia Assessment, Treatment and Aetiology (RADIATE) study aims to address the uncertainty in the treatment of RD, and to begin to answer the question 'What is the most appropriate treatment of the forearm and hand for children with RD?' by establishing a core outcome set. TRIAL REGISTRATION COMET initiative study, 902 . Registered in May 2016.
Collapse
Affiliation(s)
- George R F Murphy
- Department of Plastic Surgery, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK. .,Randall Division of Cell and Molecular Biophysics, Guy's Campus, King's College London, London, SE1 1UL, UK.
| | - Malcolm Logan
- Randall Division of Cell and Molecular Biophysics, Guy's Campus, King's College London, London, SE1 1UL, UK
| | - Gill Smith
- Department of Plastic Surgery, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Bran Sivakumar
- Department of Plastic Surgery, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| |
Collapse
|
42
|
Symbrachydactyly: Assessing Indications for Operative Treatment. Tech Orthop 2019. [DOI: 10.1097/bto.0000000000000334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
43
|
Pinto Netto HDB, Pais AP, Vitorio SC, Brandão R, Moreira AAD, Molinaro Neto LR. CASE STUDY OF CONGENITAL ANOMALIES OF THE UPPER LIMB IN REFERENCE AMBULATORY CARE FACILITY. ACTA ORTOPEDICA BRASILEIRA 2018; 26:325-327. [PMID: 30464714 PMCID: PMC6220662 DOI: 10.1590/1413-785220182605197649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective The epidemiological profile of congenital anomalies of the upper limbs (CAULs) is of major relevance to monitoring and planning. A study of this profile may reveal if there is prevalence of some specific type of malformation in comparison to a more comprehensive epidemiological sample. The Latin American Collaborative Study of Congenital Malformations (ECLAMC) has an extensive database, providing an excellent source of comparison. This study aims to evaluate the epidemiological profile of CAULs at the hand surgery department of the Hospital Federal da Lagoa (HFL) in Brazil, and compare it to the ECLAMC data. Methods We conducted a retrospective analysis of patients who underwent treatment at the pediatric outpatient hand surgery clinic. The sample universe consisted of 126 patients (4 of these patients presented with 2 simultaneous anomalies), totaling 130 malformations. Results The results demonstrated that the comparable pathologies have significantly similar incidence rates. It is worth noting the polydactylies (pre- and post-axial), where the percentile of incidence in the ECLAMC was higher. Conclusion This study showed that the epidemiological profile of patients who underwent treatment at this hospital was equivalent to that found in the ECLAMC database. Level of evidence III, Retrospective epidemiological study.
Collapse
|
44
|
Bae DS, Canizares MF, Miller PE, Waters PM, Goldfarb CA. Functional Impact of Congenital Hand Differences: Early Results From the Congenital Upper Limb Differences (CoULD) Registry. J Hand Surg Am 2018; 43:321-330. [PMID: 29241842 DOI: 10.1016/j.jhsa.2017.10.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 08/31/2017] [Accepted: 10/02/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To characterize the functional, emotional, and social impact of congenital upper limb differences on affected children and families before treatment, using validated functional outcome instruments. METHODS From June 2014 to March 2016, 586 children with congenital upper limb differences from 2 pediatric hospitals were enrolled in the Congenital Upper Limb Differences registry. Demographic, clinical, and radiographic data were collected, and diagnoses categorized according to the Oberg-Manske-Tonkin classification. Functional outcomes were assessed in 301 patients using the Pediatric Outcomes Data Collection Instrument (PODCI) and Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) function, pain, anxiety, depression, and peer relationships modules. RESULTS The cohort had high median PODCI scores in all domains, ranging from 83 to 100 in children and adolescents. Patients had decreased PROMIS UE scores compared with population norms; however, they showed low scores for pain, anxiety, depression and higher scores in the peer relationship domain, respectively. Patients with entire limb involvement had higher PROMIS pain scores and lower PODCI UE and global functioning than those with differences limited only to the hand. Compared with those with bilateral involvement, patients with unilateral differences reported higher scores for PODCI sports global functioning, better PROMIS UE function, and lower pain scores. Additional orthopedic conditions and medical comorbidities negatively influenced all PODCI scores and PROMIS pain and UE function domains. CONCLUSIONS Children with congenital hand differences report decreased upper limb function but better peer relationships and positive emotional states compared with population norms. CLINICAL RELEVANCE The Congenital Upper Limb Differences registry is a valid source of information related to congenital upper limb differences in clinical practice. With continuous enrollment and longitudinal follow-up, the registry will increase the understanding of UE function and psychosocial aspects of health in pediatric population.
Collapse
Affiliation(s)
- Donald S Bae
- Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, MA.
| | - Maria F Canizares
- Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, MA
| | - Patricia E Miller
- Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, MA
| | - Peter M Waters
- Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, MA
| | - Charles A Goldfarb
- Department of Orthopaedic Surgery, Shriners Hospitals for Children-St. Louis, St. Louis, MO; Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO
| |
Collapse
|
45
|
Recurrence rate of radial deviation following the centralization surgery of radial club hand. Med J Islam Repub Iran 2018; 32:18. [PMID: 30159269 PMCID: PMC6108290 DOI: 10.14196/mjiri.32.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Indexed: 11/25/2022] Open
Abstract
Background: Congenital radial club hand (RCH), as a rare congenital deformity of the upper extremity, is characterized by a wide spectrum of malformations including radial deviation. Centralization surgery is the standard treatment for severe cases that have been associated with a high rate of recurrence. This study reports the long-term results and recurrence rate of radial deviation following the centralization surgery of RCH.
Methods: The medical records of 13 congenital RCH patients (16 hands), who underwent centralization surgery, were reviewed retrospectively. Hand-forearm angle (HFA), hand-forearm position (HFP), and ulnar bow (UB) were used to assess forearm angles.
Results: The mean age of the patients was 19.4±8.9 months, and their mean follow-up was 62.1±39.9 months. The mean HFA correction was 29.4°±23.9°, the mean HFA recurrence was 13.3°±13.7°, the mean correction of HFP was 13.4±7.3 mm, and the mean recurrence of HFP was 1.4±2.8 mm. The mean UB showed 7.6°±12.5° correction immediately after surgery and a further 3.6°±7.3° at the last follow-up (overall 11.2°±17.6°). A number of 12 out of 13 parents were completely satisfied with the results.
Conclusion: According to our results, an acceptable long-term result is expected after the centralization surgery of RCH. However, the risk of the recurrent radial deviation is high and needs to be optimized in future investigations.
Collapse
|
46
|
Mavrogenis AF, Markatos K, Nikolaou V, Gartziou-Tatti A, Soucacos PN. Congenital anomalies of the limbs in mythology and antiquity. INTERNATIONAL ORTHOPAEDICS 2018; 42:957-965. [DOI: 10.1007/s00264-018-3776-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 11/30/2022]
|
47
|
Murphy GR, Logan MP, Smith G, Sivakumar B, Smith P. Correction of "Wrist" Deformity in Radial Dysplasia: A Systematic Review and Meta-Analysis. J Bone Joint Surg Am 2017; 99:2120-2126. [PMID: 29257019 PMCID: PMC5805276 DOI: 10.2106/jbjs.17.00164] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radial dysplasia affects 1 in 6,000 to 8,000 births, classically presenting with a shortened, bowed ulna and radially deviated hand. The optimal treatment remains unclear, with several opposing approaches advocated. This review aims to clarify the long-term outcomes of nonsurgical and surgical treatment of the "wrist" deformity. METHODS The Embase, MEDLINE, PubMed, Cochrane Central, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform (ICTRP) databases were searched for published and unpublished studies reporting long-term outcomes of surgical or nonsurgical treatment of children with radial dysplasia. Results were not restricted by date or language. Primary outcomes were hand-forearm angle, ulnar length, and "wrist" active range of motion (ROM). Studies were assessed using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) criteria. Data for the change in hand-forearm angle were pooled using random-effects meta-analysis, and mean differences and 95% confidence intervals were obtained. Primary outcome data at last follow-up were pooled, and means and standard deviations were obtained. The PROSPERO registration of this study was CRD42016036665. RESULTS Of 104 studies identified, 12 were included in this review. Five were retrospective cohort studies and 7 were case series. No randomized studies were found. Study quality was low or very low according to the GRADE criteria. The hand-forearm angle of nonsurgically treated patients worsened during childhood, from 66° to 84°, whereas "wrist" active ROM, at 61°, was better than that for most surgically treated patients. Ulnar length with nonsurgical treatment was predicted to be 64% of normal, but was not directly reported. Isolated soft-tissue release provided a modest reduction in hand-forearm angle compared with nonsurgical treatment. Soft-tissue distraction with centralization or radialization achieved the best hand-forearm angle correction (16° radial deviation). Radialization maintained better "wrist" active ROM (46°) and ulnar length than centralization. Microvascular second metatarsophalangeal joint transfer yielded better reported "wrist" active ROM (83°) and good ulnar length compared with other surgical techniques, but a slightly worse hand-forearm angle (28°). CONCLUSIONS There was low-quality evidence that soft-tissue distraction plus centralization or radialization achieved the best correction of the hand-forearm angle for children with radial dysplasia. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- George R.F. Murphy
- Department of Plastic and Reconstructive Surgery, Great Ormond St. Hospital for Children, London, United Kingdom,Randall Division of Cell and Molecular Biophysics, Guy’s Campus, King’s College London, London, United Kingdom,E-mail address for G.R.F. Murphy:
| | - Malcolm P.O. Logan
- Randall Division of Cell and Molecular Biophysics, Guy’s Campus, King’s College London, London, United Kingdom
| | - Gill Smith
- Department of Plastic and Reconstructive Surgery, Great Ormond St. Hospital for Children, London, United Kingdom
| | - Branavan Sivakumar
- Department of Plastic and Reconstructive Surgery, Great Ormond St. Hospital for Children, London, United Kingdom,The Portland Hospital for Women and Children, London, United Kingdom
| | - Paul Smith
- The Portland Hospital for Women and Children, London, United Kingdom
| |
Collapse
|
48
|
Goodell PB, Bauer AS, Oishi S, Arner M, Laurell T, Taylor SL, James MA. Functional Assessment of Children and Adolescents with Symbrachydactyly: A Unilateral Hand Malformation. J Bone Joint Surg Am 2017; 99:1119-1128. [PMID: 28678125 PMCID: PMC5490334 DOI: 10.2106/jbjs.16.01283] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We studied children and adolescents with symbrachydactyly to determine whether hand function depends on digit opposability and whether scores for function and quality-of-life measures differ from population norms. METHODS Participants were grouped on the basis of hand morphology: Group A lacked opposable digits, and Group B had ≥2 digits that were opposable. The groups were compared with each other and with norms with respect to pinch strength, the performance of bimanual activities and in-hand manipulation, and questionnaires regarding psychosocial status and the ability to perform activities of daily living (ADLs). Participants and parents also rated the appearance and function of the hand. RESULTS Pinch strength was higher for participants in Group B (4.1 compared with 2.4 kg; p = 0.008), but the groups did not differ with respect to the proportion of participants outside of pinch norms. Participants in Group B were more likely to actively use their affected hand to perform bimanual activities (p ≤ 0.0009), and to use normal or supination strategies to accomplish in-hand manipulation (p = 0.031). The groups did not differ in the proportion of ADLs rated "difficult" or "impossible," and both groups tested within normal limits for psychosocial function. Participants from both groups and their parents rated their satisfaction with hand appearance and function similarly high. CONCLUSIONS Participants with ≥2 opposable digits incorporated their hand better in bimanual activities and used more effective strategies to accomplish in-hand manipulation than those who did not. These groups reported no difference in the ability to perform ADLs or with psychosocial function, which was within the normal range. Children and adolescents with symbrachydactyly demonstrated and reported a high level of function in all domains of validated function tests. This study provides information to help parents of children with a unilateral hand malformation understand their child's potential function, and assist surgeons with recommending treatment. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Parker B. Goodell
- Department of Public Health Sciences, Division of Biostatistics (S.L.T), Department of Orthopaedic Surgery (M.A.J.), University of California, Davis, School of Medicine (P.B.G.), Sacramento, California
| | - Andrea S. Bauer
- Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | - Scott Oishi
- Charles E. Seay, Jr. Hand Center, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Marianne Arner
- Department of Clinical Science and Education (M.A.), Department of Molecular Medicine and Surgery (T.L.), and Center of Molecular Medicine (T.L.), Karolinska Institutet, Stockholm, Sweden,Department of Hand Surgery (M.A. and T.L.), Södersjukhuset, Stockholm, Sweden
| | - Tobias Laurell
- Department of Clinical Science and Education (M.A.), Department of Molecular Medicine and Surgery (T.L.), and Center of Molecular Medicine (T.L.), Karolinska Institutet, Stockholm, Sweden,Department of Hand Surgery (M.A. and T.L.), Södersjukhuset, Stockholm, Sweden
| | - Sandra L. Taylor
- Department of Public Health Sciences, Division of Biostatistics (S.L.T), Department of Orthopaedic Surgery (M.A.J.), University of California, Davis, School of Medicine (P.B.G.), Sacramento, California
| | - Michelle A. James
- Department of Public Health Sciences, Division of Biostatistics (S.L.T), Department of Orthopaedic Surgery (M.A.J.), University of California, Davis, School of Medicine (P.B.G.), Sacramento, California,Department of Orthopaedic Surgery, Shriners Hospitals for Children-Northern California, Sacramento, California,E-mail address for M.A. James:
| |
Collapse
|
49
|
The Prevalence of Congenital Hand and Upper Extremity Anomalies Based Upon the New York Congenital Malformations Registry. J Pediatr Orthop 2017; 37:144-148. [PMID: 27078227 PMCID: PMC5063649 DOI: 10.1097/bpo.0000000000000748] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There have been few publications regarding the prevalence of congenital upper extremity anomalies and no recent reports from the United States. The purpose of this investigation was to examine the prevalence of congenital upper extremity anomalies in the total birth population of New York State over a 19-year period utilizing the New York Congenital Malformations Registry (NYCMR) database. METHODS The NYCMR includes children with at least 1 birth anomaly diagnosed by 2 years of age and listed by diagnosis code. We scrutinized these codes for specific upper extremity anomalies, including polydactyly, syndactyly, reduction defects, clubhand malformations, and syndromes with upper limb anomalies. We included children born between 1992 and 2010. RESULTS There were a total of 4,883,072 live births in New York State during the study period. The overall prevalence of congenital upper extremity anomalies was 27.2 cases per 10,000 live births. Polydactyly was most common with 12,418 cases and a prevalence rate of 23.4 per 10,000 live births. The next most common anomalies included syndactyly with 627 cases affecting the hands (1498 total) and reduction defects (1111 cases). Specific syndromes were quite rare and were noted in a total of 215 live births. The prevalence of anomalies was higher in New York City compared with New York State populations at 33.0 and 21.9 per 10,000 live births, respectively. CONCLUSIONS The NYCMR data demonstrate that congenital upper extremity anomalies are more common than previously reported. This is in large part due to the high prevalence of polydactyly. Although registries are imperfect, such data are helpful in monitoring prevalence rates over time, identifying potential causes or associations, and guiding health care planning and future research. LEVEL OF EVIDENCE Level I-diagnostic.
Collapse
|
50
|
Carlsson IK, Dahlin LB, Rosberg HE. Congenital thumb anomalies and the consequences for daily life: patients’ long-term experience after corrective surgery. A qualitative study. Disabil Rehabil 2016; 40:69-75. [DOI: 10.1080/09638288.2016.1243159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- I. K. Carlsson
- Department of Translational Medicine – Hand Surgery, Skane University Hospital, Lund University, Sweden
| | - L. B. Dahlin
- Department of Translational Medicine – Hand Surgery, Skane University Hospital, Lund University, Sweden
| | - H.-E. Rosberg
- Department of Translational Medicine – Hand Surgery, Skane University Hospital, Lund University, Sweden
| |
Collapse
|