Good long-term results seen for radial polydactyly reconstruction, with need for revision increasing with time

BOSTON — A minimum 10-year follow-up of pediatric patients who underwent radial polydactyly reconstruction shows good functional and subjective outcomes and an 18% revision rate.

“Long-term results following thumb polydactyly reconstruction is good as measured by DASH, Peds QL and grip and pinch strength,” Chris Stutz, MD, said at the American Society for Surgery of the Hand Annual Meeting, here. “The need for revision surgery tends to increase over time. The average time to revision surgery in our series was 8 years, with pain and functional issues driving the desire for revision surgery. Alternative or additional procedures to stabilize the IP joint at the index procedure may decrease the need for revision surgery.”

The study included 41 patients (43 thumbs) who had undergone a surgical reconstruction of type I through type VI radial polydactyly at a single institution and had at least 10 years of follow-up from their index procedure. The average patient age at primary surgery 1.1 years. Stutz said 58% of the operations were performed on the dominant extremity and there were no early postsurgical complications. Patients had an average follow-up of 16.8 years.

During follow-up, Stutz found 10 late secondary procedures or revision operations in eight patients, leading to an 18.6% revision rate. The average time to revision was 8 years following the index procedure.

“With regards to the revision operations, we had five interphalangeal joint fusions for pain, one CMC joint ligament reconstruction for an atypical instability at the CMC joint in a type III [deformity], three extrinsic tendon realignments with osteotomy for angular deformity and functional improvement, and one opposition transfer with a first web-space deepening,” Stutz said.

The average Tada score was 4.1 points, with 79% of patients having good results and 29% with fair results. Patients had an average DASH score of 4.5 and the average Peds QL score was 87. – by Gina Brockenbrough, MA

Reference:

Stutz C. Paper #26. Presented at: American Society for Surgery of the Hand Annual Meeting; Sept. 18-20, 2014; Boston.

Disclosure: Stutz has no relevant financial disclosures.