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Functional Testing and Outcome Measures in Children with Isolated Thumb Aplasia Treated by Pollicization
David T. Netscher, MD1; Oluseyi Aliu, MD1; Brinkley Sandvall, MD1; Kimberly Staines, OTR, CHT2; John Thornby, PhD3
1Department of Orthopedic Surgery and Division of Plastic Surgery, Baylor College of Medicine, Houston, TX; 2Physical Medicine, VA Medical Center, Houston, TX; 3Internal Medicine, VA Medical Center, Houston, TX

Purpose: Our purpose was fourfold:  First to gain a comprehensive perspective on outcomes by performing an array of tests on patients who had undergone index pollicization for isolated thumb aplasia in the absence of clinical forearm radial dysplasia; second to create a graphical “fingerprint” for future comparisons; third, to assess function of the seemingly “normal” contralateral hand; finally, to compare parent and patient perspectives.

Methods: Evaluate 22 hands by grip, lateral, and tripod pinch strength tests, pegboard Functional Dexterity Test (FDT), Jebsen Hand Function Test (JHFT) and parent/patient questionnaire.  We compared operated hands with both contralateral non-operated hands and with published pediatric age-matched normals.  We also compared the contralateral non-operated hands with published normals.

Results: Grip, lateral key pinch and tripod pinch on operated hands were 60%, 44%, 47% of contralateral hands and 29%, 27%, 31% of normal.  Contralateral non-operated hands were 50%, 58%, 62% for each of these measures compared with age-matched published normals.

For FDT affected operated hands fared worse than published normals.  In JHFT, a more realistic evaluation of ability to perform ADLs, our patients fared better.  They performed as well as controls in two subtests (page turning and checker stacking).  Both parent and patient assessments showed a positive outlook regarding appearance, function, and social ramifications of a pollicized finger.  Mean parent and patient questionnaire scores were 18.8 and 21.6 respectively (best = 12, worst = 60).

A graphical “fingerprint” could be created by taking all outcome measures into consideration and thus show a global assessment.

Figure 1.jpg

Furthermore, comparisons over time in an individual patient can be done as is shown for grip, key pinch and tripod pinch strength:

Figure 2 (2).jpg

Conclusions: While individual tests may sometimes give pessimistic outcomes, a global assessment enables a more optimistic view after index pollicization.  We excluded patients who had any clinical or radiographic evidence of forearm radial dysplasia and so feel that this study reflects as closely as possible the effects of pollicization alone.  A graphical “fingerprint” can be used to follow function over time.  The seemingly “normal” contralateral hand fared worse than published normal data.  Parent and patient perspectives were favorable.  While no outcome measures are necessarily perfect, our study gives impetus for pediatric outcome study groups to determine the most suitable outcome measures that can be followed as the child develops through puberty and on into adulthood so that we can assess the value of our treatments.

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