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Congenital abnormalities of the thumb
399
ABSTRACTS
ABNORMALITIES
CONGENITAL THUMB.
D.
Matthews.
Med. 62:53-55,
Proc.
OF
Roy.
THE
Sot.
1969.
At Great Ormond Street, 135 cases of trigger thumb have presented in the last 10 years. Results following simple incision of the tendon sheath over the nodule in the tendon have been excellent. A bifid thumb may present as no more than a splaying and longitudinal furrowing of the thumb nail or it may appear clinically and radiologically almost as a supernumerary digit. Most commonly there is duplication of the terminal phalanx, there being a common synovial cavity and a broadened head to the proximal phalanx. Assessment of function determines which portion to preserve although this does not necessarily give the best cosmetic result. After excision of the supernumerary phalanx, together with its portion of the head of the proximal phalanx, careful closure of the synovial cavity is important, and afterwards prolonged and careful splintage of the thumb to bring it into the straightest possible line. The author uses daytime lateral splint allowing flexion and extension for many months and a full encircling splint at night for many years. The treatment of a small markedly hypoplastic thumb consisting of soft tissues only should be excision. This should also apply to the larger but equally useless hypoplastic thumb, but because it looks more normal in the baby parental permission may be difficult to obtain. Excision should be recommended on the grounds that the digit is quite functionless, is abnormally situated on the hand, will not grow as the child grows and will interfere with normal function of the rest of the hand. The importance of not repositioning such a thumb is emphasised since by so doing any chance of carrying out pollicization of the index finger later will be destroyed. As regards the management of a child with an absent thumb or thumbs, if the condition is bilateral pollicization of the index should be carried out on one side at least. In a unilateral case all factors must be considered seriously since the child may scarcely be functionally disabled at all. Pollicization, which the author carries out at two and a half years of age, has proved very successful as long as the index finger itself is in all respects normal. In
congenital cases, since there is often no trapezium, it is suggested that the distal three-quarters of the index proximal phalanx become the thumb metacarpal, the distal half of the index metacarpal and the metacarpophalangeal joint are removed, and the metacarpal is used to peg the remnant of the index metacarpal to the new thumb metacarpal. The author finds that it is not necessary to shorten the tendons in any way and that it is important not to rotate the new thumb too much preventing opposition with all three of the remaining fingers. Pollicization in radial club hand is not recommended until after the age of twelve years when a preliminary wrist fusion may be performed.-Margaret J. Mayell EWING’S SARCOMA IN CHILDREN. S. K. Mor-
gan
and
W. G.
37 (January),
Thurman.
Clin. Ped 9:
1970.
This is a case presentation of four cases (eight to 19 years of age), with one cure. Ewing’s Sarcoma is the second most common childhood malignant tumor of bone. It occurs most often in the first three decades of life. The tumor may arise in any bone, however the shaft of long tubular bone, or pelvic bones are the most common sites. Pain and tenderness over the involved area may be associated with fever and leukocytosis. Metastases appear in other bones, in the lungs and in other viscera. In the experience of the authors, ablative surgery for primary disease involving only the extremities is not superior to isolation-perfusion, systemic chemotherapy and irradiation. With aggressive treatment overall five-year survival rates are 9-12 per cent.-Michel Gilbert PSEUDOHYPERTROPHIC PHY
AND
ITS
MUSCULAR
SURGICAL
DYSTRO-
MANAGEMENT:
REVIEW OF THIRTY PATIENTS. L. Roy
Canad. 1970.
D. A. Gibson.
(January),
and
J. Surg. 13: 13-20
A followup study was made of 105 patients seen in the muscular dystrophy clinic of the Hospital for Sick Children in Toronto during the years 1960 to 1968. In 30 patients a variety of surgical procedures were performed and by this means these children were kept walking for an average of 25 additional months, about 10 per cent of their expected lifespan.
ABSTRACTS
ABNORMALITIES
CONGENITAL THUMB.
D.
Matthews.
Med. 62:53-55,
Proc.
OF
Roy.
THE
Sot.
1969.
At Great Ormond Street, 135 cases of trigger thumb have presented in the last 10 years. Results following simple incision of the tendon sheath over the nodule in the tendon have been excellent. A bifid thumb may present as no more than a splaying and longitudinal furrowing of the thumb nail or it may appear clinically and radiologically almost as a supernumerary digit. Most commonly there is duplication of the terminal phalanx, there being a common synovial cavity and a broadened head to the proximal phalanx. Assessment of function determines which portion to preserve although this does not necessarily give the best cosmetic result. After excision of the supernumerary phalanx, together with its portion of the head of the proximal phalanx, careful closure of the synovial cavity is important, and afterwards prolonged and careful splintage of the thumb to bring it into the straightest possible line. The author uses daytime lateral splint allowing flexion and extension for many months and a full encircling splint at night for many years. The treatment of a small markedly hypoplastic thumb consisting of soft tissues only should be excision. This should also apply to the larger but equally useless hypoplastic thumb, but because it looks more normal in the baby parental permission may be difficult to obtain. Excision should be recommended on the grounds that the digit is quite functionless, is abnormally situated on the hand, will not grow as the child grows and will interfere with normal function of the rest of the hand. The importance of not repositioning such a thumb is emphasised since by so doing any chance of carrying out pollicization of the index finger later will be destroyed. As regards the management of a child with an absent thumb or thumbs, if the condition is bilateral pollicization of the index should be carried out on one side at least. In a unilateral case all factors must be considered seriously since the child may scarcely be functionally disabled at all. Pollicization, which the author carries out at two and a half years of age, has proved very successful as long as the index finger itself is in all respects normal. In
congenital cases, since there is often no trapezium, it is suggested that the distal three-quarters of the index proximal phalanx become the thumb metacarpal, the distal half of the index metacarpal and the metacarpophalangeal joint are removed, and the metacarpal is used to peg the remnant of the index metacarpal to the new thumb metacarpal. The author finds that it is not necessary to shorten the tendons in any way and that it is important not to rotate the new thumb too much preventing opposition with all three of the remaining fingers. Pollicization in radial club hand is not recommended until after the age of twelve years when a preliminary wrist fusion may be performed.-Margaret J. Mayell EWING’S SARCOMA IN CHILDREN. S. K. Mor-
gan
and
W. G.
37 (January),
Thurman.
Clin. Ped 9:
1970.
This is a case presentation of four cases (eight to 19 years of age), with one cure. Ewing’s Sarcoma is the second most common childhood malignant tumor of bone. It occurs most often in the first three decades of life. The tumor may arise in any bone, however the shaft of long tubular bone, or pelvic bones are the most common sites. Pain and tenderness over the involved area may be associated with fever and leukocytosis. Metastases appear in other bones, in the lungs and in other viscera. In the experience of the authors, ablative surgery for primary disease involving only the extremities is not superior to isolation-perfusion, systemic chemotherapy and irradiation. With aggressive treatment overall five-year survival rates are 9-12 per cent.-Michel Gilbert PSEUDOHYPERTROPHIC PHY
AND
ITS
MUSCULAR
SURGICAL
DYSTRO-
MANAGEMENT:
REVIEW OF THIRTY PATIENTS. L. Roy
Canad. 1970.
D. A. Gibson.
(January),
and
J. Surg. 13: 13-20
A followup study was made of 105 patients seen in the muscular dystrophy clinic of the Hospital for Sick Children in Toronto during the years 1960 to 1968. In 30 patients a variety of surgical procedures were performed and by this means these children were kept walking for an average of 25 additional months, about 10 per cent of their expected lifespan.