Functional outcomes of children with index pollicizations for thumb deficiency.

PURPOSE: To gain a comprehensive perspective on outcomes by performing an array of tests on patients who had undergone index pollicization for isolated thumb aplasia or severe hypoplasia in the absence of clinical radial dysplasia; this led us to create a graphical snapshot for future comparison. Another purpose was to compare the function of the contralateral hand and to compare parent and patient perspectives. METHODS: We evaluated 22 hands (18 patients) by grip as well as lateral and tripod pinch strength tests; the pegboard Functional Dexterity Test (FDT); the Jebsen Hand Function Test (JHFT); and a parent/patient questionnaire. We compared operated hands with both contralateral nonoperated hands and nondominant hands in published normal data. We also compared contralateral nonoperated hands with dominant hands in published normal data, and FDT results and JHFT outcomes in children greater than 6 years old with published normal data. We evaluated questionnaire results. RESULTS: Mean grip as well as lateral and tripod pinch strength in operated hands were 3.4, 1.2, and 1.2 kg, and in normal nondominant hands were 11.7, 4.4, and 3.9 kg, respectively. Patients' contralateral nonoperated hands were weaker than normal dominant hands. Mean timed FDT results in operated hands was 127 seconds, compared with 44 seconds in published normal data. In 2 of 5 JHFT subtests administered, no difference existed between operated hands and published normal data. A graphical snapshot took various outcome measures into consideration and showed a global assessment. Mean parent and patient questionnaire scores were 10 and 22, respectively (best = 12; worst = 60). CONCLUSIONS: Comprehensive subjective and objective outcome testing suggested that an optimistic view of function after index pollicization is warranted. A graphical snapshot followed function over time. The contralateral hand fared worse than published normal data. Parent and patient perspectives were favorable. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

A 5-year interval evaluation of function after pollicization for congenital thumb aplasia using multiple outcome measures.

BACKGROUND: The authors aimed to determine the functional improvement rate over a 5-year interval among patients who had undergone index finger pollicization for isolated thumb absence compared with age-matched controls. They also investigated suggestions in previous reports that tissue remodeling in reconstructed thumbs causes improvements in function outpacing normal development. METHODS: Five patients (seven hands) evaluated 5 years earlier with grip, lateral pinch, and tripod pinch strength tests; the pegboard Functional Dexterity Test; the Jebsen Hand Function Test; standard radiographs; and parent questionnaires on appearance, social interactions, and functionality were reevaluated. Percentage changes were compared with expected changes from published norms. RESULTS: Regarding grip strength, patients showed a 148 percent increase compared with 102 percent in controls. Regarding lateral and tripod pinch, patients had 99 and 125 percent increases compared with 78 and 69 percent in controls, respectively; the differences were not significant between groups. Functional dexterity outcomes showed the same trend. Controls improved in the five administered subtests of the Jebsen tests. In three Jebsen subtests, patients accomplished the tasks in 40 to 45 percent less time than 5 years previously. Parent perspectives were comparable to 5 years previously. Previously, 60 percent of responses were in the best category and 4 percent were in the worst category. Those percentages were 58 and 6 percent, respectively, in this study. CONCLUSIONS: Although this was a small study group, it seems that children who have undergone index finger pollicization have changes in function comparable to normal development. Parents still have positive perspectives of the reconstructed thumb. There is no evidence that tissue remodeling causes improvement outpacing normal development.