Retrospective Study Of Surgical Treatment Of Thumb Duplication

Objective: To introduce the classification of congenital thumb duplication and discuss the appropriate surgical time and the causes of secondary deformities after first operation to facilitate the clinical treatment. Methods: Retrospective analysis was conducted on the data of operation of 153 cases of thumb duplication of our hospital, to investigate the clinical classification, the appropriate time of operation, the therapy methods and the causes of secondary deformities after primary repair. Results: According to Wassel classification, the most common type of thumb duplication in our hospital was typeâ…£, which accounted for 45.75%; typeâ…¡occupied 22.88% approximately; typeâ…¦maked up of 9.80% of total patients. All the patients accepted surgical treatments. 43 cases (51 sides) had been followed up from 6 months to 9 years. According to Kawabata's rating system, the operative results were as follows:excellent in 21 cases (26 sides), good in 19 cases (22 sides), poor in 3 cases (3 sides); 13 cases (14 sides) underwent operation treatment in 6 months to 1 year after birth were followed-up, excellent in 9 cases (10 sides), good in 2 cases (2 sides), poor in 2 cases (2 sides). 5 cases (6 sides) with the secondary deformities after primary repair underwent re-building surgery. Discussion: The clinical classification is very important to the effects of surgical treatment of thumb duplication,now there are many classifications such as Wassel (1969) divided congenital thumb duplication into seven categories. The appropriate opportunity of surgery of thumb duplication, evaluate the cases carefully before operation, operate carefully during the surgery and a long-term follow-up are very important to avoid the occurrence of secondary deformity. As for the appropriate opportunity of surgery there are many different attitudes. Someone think it should be among 2 to 6 years or 4 to 6 years, because the patients are a little more mature to identify the anatomic structures which make the operation easier relatively, and can judge their growth trend more accurately. From surgical treatment and follow-up results of our hospital we think that because the treatment not only has plastic effects, but also help to rebuild the function of the hand, therefore, it should be in the infant period to practise the surgery which is beneficial to rebuild hand anatomical structure and function, to the psychological development of children and reduce scar after surgery. So we think that the most fitting opportunity to carry out the operation should between 6 months to 3 years old. According to our clinical and follow-up outcomes the earlier curative effects are satisfactory, but with the development of children, secondary deformities are not uncommon. To ensure the effects of surgical treatment, we should: (1) carry out a detailed assessment of the state of the illness before operation, including X-ray, appearance and function value of thumb duplication, and chose the general thumb with these results correctly. (2) The general thumb can be chosen by X-ray, hand shape and the habit of using finger. Children's epiphyseal growth have not stopped, postoperative functional training easier than adults, therefore, we should select general thumb which position is better; adult's epiphyseal growth have ceased which make it more difficult to improve the smaller appearance than children, so we should choose the thumb which has been customarily use and has better function as the general thumb. (3) During the surgery we should handle correctly, implement long-term follow-up after operation to avoid the occurrence of secondary deformity. Along with the development of children secondary deformities are not uncommon. According to Kawabata's rating system, we can divide them into three groups. The main causes of secondary deformities we think including the time to implement the operation is not feasible, surgical plan is not correct and congenital abnormality of the thumb. Conclusions: 1. There are many classification of thumb duplication, because Wassel classification is on the basis of pathology, simple to understand and tally with anatomy, so we think when we classify thumb duplication Wassel classification should be the main evidence. 2. To improve surgical effects and rebuild the hand appearance and function the most appropriate time to carry out the operation should between 6 months to 3 years. 3. Choose surgical time falsely, examination carelessly before operation and surgery not subtly carried out are the main causes of secondary deformities. Therefore, to guarantee the effects of treatment we should asses correctly before surgery, carry out the surgery carefully and perform long-term follow-up after the primary operation.