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Long-Term Hand Function after Pollicization for Congenital Thumb Hypoplasia using Validated Patient-Reported Outcome Measures
John R Vaile, BS
1,2; Holly Cordray, BS
3; Sarah L. Struble, MD
4; Vinay Rao, MD, MPH
4; Meagan Pehnke, MS, OTR/L, CHT, CLT
4; John A. Tipps, BA
4; Apurva S Shah, MD MBA
2,3; Benjamin Chang, MD
4; Shaun D Mendenhall, MD
51Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; 2The Children's Hospital of Philadelphia, Philadelphia, PA; 3Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; 4Children's Hospital of Philadelphia, Philadelphia, PA; 5University of Utah, Salt Lake City, UT
Introduction: Pollicization aims to improve prehension and activities of daily living (ADL) in children with hypoplastic or absent thumbs.
However, validated patient-reported outcome measures (PROMs) that assess manual ability of children after pollicization are lacking, with commonly used instruments being inappropriate for children with congenital hand differences. We hypothesized that validated PROMs focusing on pinch, fine-motor dexterity, and graded force will demonstrate satisfactory functional outcomes after pollicization.
Materials and Methods: After IRB approval, children who underwent pollicization for congenital thumb hypoplasia between 2007 and 2023 were queried. All patients were consented by phone, and surveys containing the Children's Hand-Skills Ability Questionnaire (CHSQ) and QuickDASH Sports/Performing Arts were distributed via REDCap. Descriptive statistics were performed.
Results: Characteristics. 12 patients (8 male, 4 female) who underwent pollicization for congenital thumb hypoplasia completed the survey. Mean age at surgery was 1.7 (SD 1.6) years. 1 patient had Blauth grade IIIA, 2 patients had Blauth grade IIIB, 5 patients had Blauth grade IV, and 4 patients had Blauth grade V. Mean follow-up time was 8.6 (SD 3.2) years.
Children's Hand-Skills Ability Questionnaire (CHSQ). CHSQ contains 21 items and spans 3 domains: leisure/play (9 items), school/education (6 items), and activities of daily living (6 items) (
Table 1). This instrument focuses on pinch, fine-motor dexterity, and graded force. Individual responses are reported as "extremely difficult” (1 point), "difficult” (2 points), "not difficult” (3 points), and "not applicable” (0 points). Mean CHSQ scores were 2.77 (SD 0.51), 2.73 (SD 0.54), and 2.62 (SD 0.67) for play/leisure, school/education, and ADL domains, respectively.
QuickDASH Sports/Performing Arts. This 4-item instrument relates to the impact of the arm, shoulder, or hand problem on playing a sport or musical instrument that is most important to the child. 33.3% of children indicated no participation in sports or performing arts, and 66.6% indicated participation in either basketball, football, guitar, or drumming. For those participating in sports or performing arts, mean QuickDASH score was 6.25 (SD 8.84).
Conclusions: - This study is the first to utilize validated patient-reported outcome measures focusing on pinch, fine-motor dexterity, and graded force among children who underwent pollicization for congenital thumb hypoplasia.
- A pollicized hand is capable of completing a variety of tasks spanning play/leisure, school/education, and ADL domains; however, there is particular difficulty with fastening and unzipping zippers/snaps/buttons.
- Two-thirds of children who underwent pollicization participated in sports or performing arts, and on average, reported low QuickDASH scores for these activities.
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