Long term functional outcomes after early childhood pollicization

Nina Lightdale-Miric; Nicole M Mueske; Emily L Lawrence; Jennifer Loiselle; Jamie Berggren; Sudarshan Dayanidhi; Milan Stevanovic; Francisco J Valero-Cuevas; Tishya A L Wren

doi:10.1016/j.jht.2014.11.003

Long term functional outcomes after early childhood pollicization

J Hand Ther. 2015 Apr-Jun;28(2):158-65; quiz 166. doi: 10.1016/j.jht.2014.11.003. Epub 2014 Dec 4.

Authors

Nina Lightdale-Miric¹, Nicole M Mueske², Emily L Lawrence³, Jennifer Loiselle⁴, Jamie Berggren⁴, Sudarshan Dayanidhi⁵, Milan Stevanovic², Francisco J Valero-Cuevas⁶, Tishya A L Wren⁷

Affiliations

¹ Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA; Orthopaedic Surgery Department, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
² Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA.
³ Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA.
⁴ Division of Rehabilitation Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA.
⁵ Muscle Physiology Laboratory, Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, USA.
⁶ Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
⁷ Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA; Orthopaedic Surgery Department, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA. Electronic address: twren@chla.usc.edu.

Abstract

Study design: Retrospective Cohort

Introduction: Important outcomes of polliciation to treat thumb hypoplasia/aplasia include strength, function, dexterity, and quality of life.

Purpose of the study: To evaluate outcomes and examine predictors of outcome after early childhood pollicization.

Methods: 8 children (10 hands) were evaluated 3-15 years after surgery. Physical examination, questionnaires, grip and pinch strength, Box and Blocks, 9-hole pegboard, and strength-dexterity (S-D) tests were performed.

Results: Pollicized hands had poor strength and performance on functional tests. Six of 10 pollicized hands had normal dexterity scores but less stability in maintaining a steady-state force. Predictors of poorer outcomes included older age at surgery, reduced metacarpophalangeal and interphalangeal range of motion, and radial absence.

Discussion: Pollicization resulted in poor strength and overall function, but normal dexterity was often achieved using altered control strategies.

Conclusions: Most children should obtain adequate dexterity despite weakness after pollicization except older or severely involved children.

Level of evidence: IV.

Keywords: Dexterity; Functional outcome; Pollicization; Surgical outcome; Thumb.

Publication types

Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Adolescent
Child
Child, Preschool
Female
Fingers / transplantation*
Functional Laterality / physiology*
Hand Deformities / physiopathology
Hand Deformities / surgery*
Hand Strength / physiology*
Humans
Male
Motor Skills / physiology*
Outcome Assessment, Health Care
Quality of Life*
Retrospective Studies
Surveys and Questionnaires
Task Performance and Analysis
Thumb / abnormalities*
Thumb / physiopathology
Thumb / surgery
Time Factors

Supplementary concepts

Thumb deformity

Abstract

Publication types

MeSH terms

Supplementary concepts

Grants and funding