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Teodonno F, Maffeis J, Guero S. Spontaneous improvement of bilateral clinodactyly of the little finger with trapezoidal phalanx: a case report with a 15-year follow-up. J Hand Surg Eur Vol 2024; 49:106-108. [PMID: 37666237 DOI: 10.1177/17531934231194674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
Clinodactyly can be produced by a longitudinal epiphyseal bracket that generates either a 'delta' or 'trapezoidal' phalanx. We present a case with a 15-year follow-up of bilateral clinodactyly of the little finger, to emphasize a 'wait-and-see' approach as self-remodelling of his phalanges occurred during growth.
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Affiliation(s)
| | - Jacopo Maffeis
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
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2
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Kodama A, Ishibashi S, Munemori M, Tsuji K, Adachi N. On-Top Osteotomy of the Phalanx Base Combined With Modified Bilhaut: Cloquet Procedure for Atypical Radial Polydactyly. Cureus 2024; 16:e53285. [PMID: 38435922 PMCID: PMC10905421 DOI: 10.7759/cureus.53285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 03/05/2024] Open
Abstract
In this report, we present the combination of on-top plasty with a modified Bilhaut-Cloquet procedure for treating atypical radial polydactyly with duplication at the metacarpophalangeal (MP) joint and triphalangism of the radial and ulnar phalanges, hypoplastic middle phalanx of the radial thumb, and hypoplastic phalanx base of the ulnar thumb. To preserve the stable MP and interphalangeal joints of the radial and ulnar thumbs, respectively, on-top plasty involved osteotomizing the middle phalanx and transferring the distal end of the middle phalanx of the ulnar finger to the phalanx base of the radial thumb. A modified Bilhaut-Cloquet procedure was used to combine the tips and nails of both thumbs. Twelve months postoperatively, good joint alignment and thumb tip appearance were achieved. On-top plasties effectively combined the desirable parts of both thumbs. The modified Bilhaut-Cloquet technique is particularly well-suited for atypical cases, such as the present case.
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Affiliation(s)
- Akira Kodama
- Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Shigeki Ishibashi
- Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Masaru Munemori
- Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Kentarou Tsuji
- Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Nobuo Adachi
- Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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4
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Balakrishnan G, Vijayaragavan S, Balakrishnan S. Omega Flap Technique: Revisiting Conventional Wisdom. Hand (N Y) 2022; 17:1039-1047. [PMID: 33593092 PMCID: PMC9608292 DOI: 10.1177/1558944721990786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Various surgical techniques have been described for the release of syndactylized fingers. In our experience, the omega flap technique, which includes a dorsal truncated flap and an anchor incision on the volar side, stands out as a good technique to release syndactyly. Incidentally, in symbrachydactyly also, the fused digits can be released using this technique. Despite this, we could find no reference in the recent years. We would like to stress the ease and importance of this technique, hoping many practicing hand surgeons will benefit from this. Our purpose was to revisit this technique and expose it to the younger generation of hand surgeons. We have operated on 20 cases of syndactyly of different types-simple, compound, and complex-and 5 cases of symbrachydactyly. In all cases, the omega flap on the dorsum and anchor incision on the volar aspect of the finger forming 2 lateral palmar flaps were used. The release of syndactyly was satisfactory in all patients. There was no flap necrosis. None of these cases have required secondary surgery because the primary releases were adequate. Release of syndactyly had been a problem for centuries. Awareness of the disability was insufficient in earlier days; currently, they seek early medical care. The release should be complete. These children must be able to achieve the form and function of the hand, and additionally precision to work. We believe that the use of omega flap and anchor flap is a good procedure for syndactyly release.
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Affiliation(s)
- G. Balakrishnan
- The Tamil Nadu Dr. M.G.R. Medical University, Chennai, India
- Right Hospitals, Chennai, India
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Catena N, Baldrighi C, Jester A, Soldado F, Farr S. Microsurgery in pediatric upper limb reconstructions: An overview. J Child Orthop 2022; 16:241-255. [PMID: 35992521 PMCID: PMC9382710 DOI: 10.1177/18632521221106390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/13/2022] [Indexed: 02/03/2023] Open
Abstract
The use of microsurgery has spread during the last decades, making resolvable many complex defects considered hitherto inapproachable. Although the small vessel diameter in children was initially considered a technical limitation, the increase in microsurgical expertise over the past three decades allowed us to manage many pediatric conditions by means of free tissue transfers. Pediatric microsurgery has been shown to be feasible, gaining a prominent place in the treatment of children affected by limb malformations, tumors, nerve injuries, and post-traumatic defects. The aim of this current concepts review is to describe the more frequent pediatric upper limb conditions in which the use of microsurgical reconstructions should be considered in the range of treatment options.
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Affiliation(s)
- Nunzio Catena
- Reconstructive Surgery and Hand Surgery
Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy,Nunzio Catena, Reconstructive Surgery and
Hand Surgery Unit, IRCCS Istituto Giannina Gaslini, Largo G. Gaslini 5, 16121
Genova, Italy.
| | - Carla Baldrighi
- Children’s Hand and Upper Limb Service,
Department of Plastic Surgery, Birmingham Children’s Hospital NHS Foundation Trust,
Birmingham, UK
| | - Andrea Jester
- Children’s Hand and Upper Limb Service,
Department of Plastic Surgery, Birmingham Children’s Hospital NHS Foundation Trust,
Birmingham, UK
| | - Francisco Soldado
- Pediatric Hand, Nerve and Microsurgery
Institute, Vall d’Hebron Instituto de Oncologia, Barcelona, Spain
| | - Sebastian Farr
- Pediatric Orthopedics and Foot and
Ankle Surgery, Orthopedic Hospital Speising, Vienna, Austria
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Sabapathy SR, Mohan M, Shanmugakrishnan RR. Nonvascularized Free Toe Phalangeal Transfers in Congenital Hand Differences: Radiological, Functional, and Patient/Parent-Reported Outcomes. J Hand Surg Am 2021; 46:1124.e1-9. [PMID: 33966936 DOI: 10.1016/j.jhsa.2021.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 01/07/2021] [Accepted: 03/10/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate radiologically, functionally and by patient-reported outcome measures, nonvascularized free toe phalangeal transfer (NVFTT) in the reconstruction of congenital short fingers with redundant soft tissue. METHODS Nineteen children who underwent NVFTT in 40 digits were studied. Of these, 13 patients with a mean follow-up of 5.2 years were assessed radiologically for epiphyseal patency, growth, growth rate, and length comparison with the contralateral toe. Eight children were available for an in-person follow-up. In these patients, we measured the pinch strength and range of motion. The Pediatric Outcomes Data Collection Instrument; the upper extremity, depression, anxiety, pain interference, and peer relationships domains of the Patient-Reported Outcomes Measurement Information Systems; and the aesthetic component of the Michigan Hand Questionnaire were used for the assessment of psychosocial impact. RESULTS An open epiphysis was found in 24 of 31 grafts. Among these, 20 of 21 grafts were in 9 children younger than 18 months and 4 of 10 grafts were in children older than 18 months at the time of operation. The mean growth was 3.4 mm. The mean growth rate was 1.3 mm/y. Length was 71.8% of the contralateral phalanx. The key pinch strength was 1.3 kg (2.6 kg on the normal side). The mean range of motion at the metacarpophalangeal joint was -4° to 65° flexion. Two proximal interphalangeal joints were stiff and 2 had range of motion of 0° to 30°. Children evaluated with Pediatric Outcomes Data Collection Instrument had high mean scores in all domains. The Patient-Reported Outcomes Measurement Information Systems scores were low for the upper-extremity domain. On the aesthetic component of the Michigan Hand Questionnaire, children gave higher scores than parents. Donor toes, though short, did not cause a functional disability. CONCLUSIONS NVFTT reliably provides length, stability, and movement in short fingers with redundant soft tissue. In addition to good radiological and clinical outcomes, the patient-reported outcome measures support performing NVFTT in children. Surgery before 18 months, extraperiosteal harvests of grafts, and avoidance of tight skin closures are important. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Peymani A, Lokhorst MM, Chen AD, van der Horst CMAM, Lee BT, Lin SJ, Strackee SD. #MadelungDeformity: Insights Into a Rare Congenital Difference Using Social Media. Hand (N Y) 2021; 18:24S-31S. [PMID: 34772284 PMCID: PMC10052623 DOI: 10.1177/15589447211054133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Madelung deformity is a rare congenital hand difference with little known regarding the patient perspective. In this cross-sectional survey study, we harnessed the global reach of social media to understand the clinical spectrum of Madelung deformity and its impact on physical, mental, and social health. METHODS A survey was developed based on a previously published protocol and multiple Patient-Reported Outcomes Measurement Information System (PROMIS) short forms. The survey was distributed on several Madelung deformity communities on Facebook and Instagram. T-scores were calculated, interpreted, and compared between patients who underwent surgery and those who did not. Correlations between scores were calculated using the Spearman rank correlation coefficient. RESULTS Mean PROMIS scores for adults were as follows: pain intensity, 4.9 ± 2.8; pain interference, 57.6 ± 10.0; upper extremity, 35.2 ± 8.1; depression, 53.8 ± 11.1; anxiety, 55.4 ± 11.4; and ability to participate in social roles and activities, 42.5 ± 7.7. Mean scores for children were as follows: pain intensity, 5.0 ± 2.8; pain interference, 55.7 ± 11.3; upper extremity function, 24.6 ± 10.4; depressive symptoms, 57.7 ± 11.3; anxiety, 57.3 ± 11.9; and peer relationships, 42.2 ± 10.3. CONCLUSIONS Madelung deformity has significant effects on patients' physical, mental, and social well-being, even after surgical treatment. Using social media, we were able to compensate for Madelung deformity's rarity by engaging an international audience, demonstrating the feasibility to conduct research through it, and providing a global perspective of the disease entity.
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Affiliation(s)
- Abbas Peymani
- University of Amsterdam, The Netherlands.,Harvard Medical School, Boston, MA, USA
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Hu CH, Thompson ER, Agel J, Bauer AS, Moeller AT, Novotny SA, Van Heest AE, Bohn DC. A Comparative Analysis of 150 Thumb Polydactyly Cases from the CoULD Registry Using the Wassel-Flatt, Rotterdam, and Chung Classifications. J Hand Surg Am 2021; 46:17-26. [PMID: 32873448 DOI: 10.1016/j.jhsa.2020.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 05/07/2020] [Accepted: 06/16/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Three commonly used classifications for thumb polydactyly are the Wassel-Flatt, Rotterdam, and Chung. The ideal classification system would have high validity and reliability and be descriptive of the thumb anomaly. The purposes of this investigation were to (1) compare the inter- and intrarater reliability of these 3 classifications when applied to a large sample of patients enrolled in the Congenital Upper Limb Differences (CoULD) Registry and (2) determine the prevalence of radial polydactyly types when using the various classifications in a North American population. METHODS Inter- and intrarater reliability were determined using 150 cases of radial polydactyly presented in a Web-based format to 7 raters in 3 rounds, a preliminary training round and 2 observation rounds. Raters classified each case according to the Wassel-Flatt, Rotterdam, and Chung classifications. Inter- and intrarater reliability were evaluated with the intraclass correlation coefficient (ICC) calculated using 2-way random measures with perfect agreement. RESULTS For Wassel-Flatt, both the interrater (ICC, 0.93) and the intrarater reliability (ICC, 0.91) were excellent. The Rotterdam classification had excellent reliability for both interrater reliability (ICC, 0.98) and intrarater reliability (ICC, 0.94), when considering type alone. Interrater analysis of the additional subtypes demonstrated a wide range of reliabilities. The Chung classification had good interrater (ICC, 0.88) and intrarater reliability (ICC, 0.77). Within the Wassel-Flatt classification, the most frequent unclassifiable thumb was a type IV hypoplastic thumb as classified by the Rotterdam classification. CONCLUSIONS The Wassel-Flatt and Rotterdam classifications for radial polydactyly have excellent inter- and intrarater reliability. Despite its simplicity, the Chung classification was less reliable in comparison. The Chung and Rotterdam classification systems capture the hypoplastic subtypes that are unclassifiable in the Wassel-Flatt system. Addition of the hypoplastic subtype to the Wassel-Flatt classification (eg, Wassel-Flatt type IVh) would maintain the highest reliability and classify over 90% of thumbs deemed unclassifiable in the Wassel-Flatt system. CLINICAL RELEVANCE The Wassel-Flatt and Rotterdam classifications have excellent inter-and intrarater reliability for the hand surgeon treating thumb polydactyly. Addition of a hypoplastic subtype to the Wassel-Flatt (Type 4h) allows classification of most previously unclassifiable thumbs.
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Affiliation(s)
- Caroline H Hu
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| | - Eliza R Thompson
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO; Gillette Children's Specialty Healthcare, St. Paul, MN
| | - Julie Agel
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| | - Andrea S Bauer
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - Amy T Moeller
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN; Twin Cities Orthopaedics, Burnsville, MN
| | | | - Ann E Van Heest
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN; Gillette Children's Specialty Healthcare, St. Paul, MN.
| | - Deborah C Bohn
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN; Gillette Children's Specialty Healthcare, St. Paul, MN
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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.
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Abstract
Background: Madelung deformity is a congenital wrist condition characterized by volar subluxation of the wrist caused by premature growth arrest of the distal radius. Progressive symptoms can necessitate surgical intervention, yet optimal treatment strategy remains unknown. The aim of this study is to determine treatment options, surgical indications, and operative outcomes for Madelung deformity. Methods: This study adhered to the Meta-Analyses of Observational Studies in Epidemiology (MOOSE) guidelines. A comprehensive systematic review was performed to identify all studies describing surgical interventions for Madelung deformity. All studies were evaluated by level of evidence and a self-developed quality assessment tool. Results: Twenty-five studies met inclusion criteria; all case series with type IV level of evidence. Studies assessed pain, range of motion, aesthetic deformity, and grip strength. The primary indication for surgery was the presence of wrist pain. Various surgical procedures exist and could be categorized as radial lengthening, ulnar shortening, or a combination of both. All studies report postoperative pain reduction and most studies report an improved range of motion. Conclusions: A variety of surgical procedures reportedly have satisfactory outcomes. However, outcomes are reported in an inconsistent manner, prohibiting pooling of studies and comparisons of surgical procedures and their outcomes. We propose several methodological changes for implementation in future studies, increasing the quality of evidence to compensate for small patient numbers.
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Affiliation(s)
- Abbas Peymani
- University of Amsterdam, The
Netherlands,Harvard Medical School, Boston, MA,
USA,Abbas Peymani, Department of Plastic,
Reconstructive and Hand Surgery, Academic Medical Center, University of
Amsterdam, Room G4-226, Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam, The
Netherlands.
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Pons-Riverola A, Camprubi-Garcia E, Barrera-Ochoa S, Bergua-Domingo JM, Knorr J, Soldado F. On-Top-Plasty for Atypical Thumb Duplication: A Case Report With 10 Year Follow-up. Hand (N Y) 2018; 13:NP17-NP19. [PMID: 29682986 PMCID: PMC6081786 DOI: 10.1177/1558944718770770] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A very uncommon pattern of thumb duplication consists of an ulnar-side floating thumb and a radial-side distally hypoplastic thumb. METHODS We report the case of a 15-month-old child with this type of thumb duplication on his right hand treated with an on-top-plasty technique. The ulnar-side segment was pedicled and transferred to the lateral thumb, which was distally resected. RESULTS A well-aligned and widely mobile thumb with a wide first web and an excellent cosmetic appearance was exhibited 10 years after surgery. CONCLUSIONS On-top-plasty technique might be amenable to reconstruct certain atypical thumb duplications.
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Affiliation(s)
| | | | | | | | | | - Francisco Soldado
- Universitat de Barcelona, Barcelona,
Spain,Francisco Soldado, Pediatric Hand Surgery
and Microsurgery, Hospital Sant Joan de Déu, Universitat de Barcelona, Passeig
Sant Joan de Déu, 2, 08950 Esplugues (Barcelona), Spain.
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13
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Tian X, Xiao J, Li T, Chen W, Lin Q, Chim H. Single-Stage Separation of 3- and 4-Finger Incomplete Simple Syndactyly With Contiguous Gull Wing Flaps: A Technique to Minimize or Avoid Skin Grafting. J Hand Surg Am 2017; 42:257-64. [PMID: 28372639 DOI: 10.1016/j.jhsa.2017.01.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 11/17/2016] [Accepted: 01/19/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Staged separation of 3- and 4-finger syndactyly is commonly performed owing to concerns about vascular supply to the central digit and availability of flap skin. We performed single-stage separation of patients with incomplete syndactyly of multiple digits with adjacent contiguous dorsal gullwing flaps and avoided skin grafts in the majority of cases. METHODS Seventy-four webs of 31 patients with more than 2-finger incomplete syndactyly were included. Median age at surgical separation was 12 months (range, 5-123 months). All cases were incomplete syndactyly that did not extend to the fingernail level, with no bony involvement. A dorsal gullwing flap was used for all cases, which reconstructed the interdigital webs and partly covered the lateral side of the proximal phalanx. The technique relies on perfusion of the flap through the dorsal metacarpal artery perforator to aid flap mobility and double radial and ulnar z-plasties on each side of the flap to aid flap advancement. Skin grafts were needed if there were any remaining skin defects. RESULTS In 30 of 31 cases, a single-stage procedure was accomplished. One case was staged owing to abnormal digital arterial anatomy found on exploration. No skin graft was required in 21 out of 31 patients (67.7%). Median postoperative follow-up was 12 months (range, 6-36 months). All finger web depths were normal or slightly deepened. CONCLUSIONS One-stage separation for 3- and 4-finger syndactyly with a dorsal gullwing flap is feasible and safe as long as at least 1 proper digital artery is preserved in each finger. The need for skin grafting is minimized. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Abstract
Background: Poland anomaly is a sporadic, phenotypically variable congenital condition usually characterized by unilateral pectoral muscle agenesis and ipsilateral hand deformity. Methods: A comprehensive review of the medical literature on Poland anomaly was performed using a Medline search. Results: Poland anomaly is a sporadic, phenotypically variable congenital condition usually characterized by unilateral, simple syndactyly with ipsilateral limb hypoplasia and pectoralis muscle agenesis. Operative management of syndactyly in Poland anomaly is determined by the severity of hand involvement and the resulting anatomical dysfunction. Syndactyly reconstruction is recommended in all but the mildest cases because most patients with Poland anomaly have notable brachydactyly, and digital separation can improve functional length. Conclusions: Improved understanding the etiology and presentation of Poland anomaly can improve clinician recognition and management of this rare congenital condition.
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Affiliation(s)
| | - Apurva S. Shah
- Division of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, PA, USA,Apurva S. Shah, Division of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, Second Floor Wood Building, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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15
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Abstract
Background: Symbrachydactyly is a unilateral congenital hand malformation characterized by failure of formation of fingers and the presence of rudimentary digit nubbins. The management is variable and are investigated in this review. Methods: A detailed review of the literature was compiled into succinct clinically relevant categories. Results: Etiology, classification, non-surgical management, surgical intervention, and patient oriented outcomes are discussed. Conclusions: All interventions should prioritize realistic, evidence-supported appearance and functional gains. Studies of the baseline function and quality of life of children with symbrachydactyly would allow surgeons to better understand functional changes associated with various interventions and would help surgeons and parents to make the best treatment decisions.
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Affiliation(s)
| | - Andrea S. Bauer
- Shriners Hospital for Children Northern California, Sacramento, USA,Andrea S. Bauer, Boston Children’s Hospital 300 Longwood Avenue, HUN 213 Boston, MA 02115, USA.
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16
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Nikkhah D, Martin N, Pickford M. Paediatric toe-to-hand transfer: an assessment of outcomes from a single unit. J Hand Surg Eur Vol 2016; 41:281-94. [PMID: 26179866 DOI: 10.1177/1753193415594480] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 04/16/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED Toe-to-hand transfer is an acceptable treatment option for children born with absent digits. Toe transfer can provide functionally useful digits and may enhance patient wellbeing. A total of 19 children had 31 free second-toe-to-hand microsurgical transfers between 1998 and 2012. The mean age of these children at the time of the first operation was 45 months. All transferred toes survived. The donor site was satisfactory in all 19 patients. Twelve children (19 toes) attended a special review clinic; all children could grasp large objects (Duplo bricks) after toe transfer. The total passive range of motion was greater than total active range of motion by an average of 54 degrees. Static 2-point discrimination was generally excellent (mean = 5 mm). Eleven out of 12 children strongly agreed that their toe transfer had improved hand function. Microsurgical toe-to-hand transfer is a safe and reliable technique that can provide useful function for children with congenital differences. Our series compares favourably with the published literature. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- D Nikkhah
- Queen Victoria Hospital, East Grinstead,UK
| | - N Martin
- Queen Victoria Hospital, East Grinstead,UK
| | - M Pickford
- Queen Victoria Hospital, East Grinstead,UK
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17
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Abstract
This study was designed to investigate the prevalence of dorsal dimelia in a series of 160 consecutive patients with congenital anomalies of the hands and feet, and to investigate the distribution of dorsal dimelia and the concurrent anomalies. Five cases (3.1%) showed evidence of dorsal dimelia and the distribution of dorsal dimelia was similar to the distribution of concurrent anomalies in all five cases. Another 11 cases of concurrent dorsal dimelia with other congenital anomalies have been reported previously with a positive match in the distributions in all cases. This similarity in the distribution in all 16 reported cases (including the five cases in the current study) is statistically significant. It is concluded that dorsal dimelia in humans is not as rare as it is generally thought to be, and that it may be viewed as an error of dorso-ventral patterning, which occurs in the same distribution as other concurrent anomalies.
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Affiliation(s)
- M M Al-Qattan
- Division of Plastic Surgery, King Saud University, Riyadh, Saudi Arabia
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