RESUMO
PURPOSE: The Thumb Grasp and Pinch Assessment (T-GAP) is a new instrument for evaluating thumb use in children with congenital hypoplastic thumbs. The assessors video-record the children while they perform nine specific activities and score their grasp types using T-GAP. A high T-GAP score indicates more mature grasp patterns. The developers reported the instrument's validity and reliability for index finger pollicization. This study investigated T-GAP's validity and reliability in children with reconstructed hypoplastic thumbs. METHODS: Four hand surgeons and two hand therapists from two hospitals rated video clips of 20 Manske type II and IIIa hands twice in 17 patients who performed the T-GAP at least 1 year after opposition transfer and thumb ligament reconstruction. To investigate the validity, we calculated correlation coefficients for T-GAP scores and clinical outcomes, including thumb ROM, grip and pinch strength, and visual analog assessments of thumb function and appearance. To estimate T-GAP's inter- and intrarater reliability, we calculated intraclass correlation coefficients and their 95% confidence intervals (CIs). RESULTS: Thumb Grasp and Pinch Assessment score showed a strong linear correlation (r = 0.815-0.944) and a moderate to strong nonlinear correlation (ρ = 0.527-0.744) with visual analog scale assessments of thumb function and appearance, respectively; a moderate nonlinear correlation (ρ = 0.464) with grip strength; and a moderate nonlinear correlation (ρ = 0.541) with thumb MCP joint range of motion. The intraclass correlation coefficient for the interrater reliability was 0.892 (95% CI, 0.768-0.954) in round 1 and 0.898 (95% CI, 0.754-0.959) in round 2, and for intrarater reliability, the mean was 0.882 (95% CI, 0.785-0.980). CONCLUSIONS: Thumb Grasp and Pinch Assessment score had a moderate to strong construct validity and a moderate concurrent validity. Both inter- and intrarater reliability was strong. CLINICAL RELEVANCE: This study supports the T-GAP instrument's validity and reliability for assessing functional outcomes in congenital hypoplastic thumb reconstruction.
RESUMO
This study evaluates the long-term donor site outcomes after second toe transfers for congenital hand differences performed during childhood. In total, 25 toe transfers in 18 patients were followed up for a mean period of 17.4 years. We examined the patients clinically, radiologically and with a gait analysis system. Patient-reported outcome measures were collected. The patients were asymptomatic and there were no problematic clinical or radiological findings. Patients expressed high levels of satisfaction. The results were consistent, regardless of the resection level in the toe transfer or whether the operation was unilateral or bilateral. No postoperative complications or late reoperations on the foot were observed.Level of evidence IV.
RESUMO
This study evaluates the long-term results of pollicization for a congenitally absent or severely hypoplastic thumb. Twenty-nine patients with 34 pollicizations were divided to two groups: those with simple thumb hypoplasia (22 pollicizations) and those with radial longitudinal dysplasia (12 pollicizations). The patients were followed from 1.3 to 32 years, with a mean follow-up time of 11 years. The patients were examined clinically and radiologically, and they completed a questionnaire concerning satisfaction with appearance, function, and social interaction. The Percival score was also calculated. In both groups, grip and pinch strengths of the operated hands were inferior to the normative age-related values. Radiologically, flattening of the original metacarpal head was found in 20 out of the 34 operated hands. We found better patient satisfaction in the simple hypoplasia group than in the radial longitudinal dysplasia group. The functional outcomes and patients' satisfaction did not correlate with the age of patients at operation. Level of evidence: IV.