title: Functional outcome for children with thumb aplasia undergoing pollicization.
abstract: BACKGROUND
  Hand function is difficult to evaluate in young patients. It is helpful to assess young children after surgery for trauma or congenital anomaly to see how they cope as they progress through their developmental milestones.
  
  
  METHODS
  Functional outcome in 10 children (12 upper extremities) who had previous pollicization for a congenitally absent or severely hypoplastic thumb were evaluated by standard radiographs, thumb total active range of motion, grip and pinch strength, parent questionnaire, modified Jebsen functional testing, and a pegboard Functional Dexterity Test.
  
  
  RESULTS
  Grip strength was significantly less (p = 0.008) in the hands that had been operated on (mean, 2 kg) compared with the hands that had not been operated on (mean, 5.6 kg). Pinch strength was also significantly less (p = 0.008) in the hands that had been operated on (mean, 1.0 kg) compared with those that had not been operated on (mean, 2.1 kg). In most, hands that had been operated on and those that had not been operated on tested outside the 2-SD range of age-matched normals for pinch and grip strength and also for the Functional Dexterity Test. In contrast, total Jebsen Hand Function Test time was not significantly different from hands that had not been operated on, except that some subtests were significantly different, such as checker stacking (p = 0.016; mean difference, 7.2 seconds) and page turning (p = 0.031; mean difference, -10 seconds). The total active range of motion in hands that had been operated on and those that had not been operated on was also not significantly different. All children used their reconstructed thumbs in a normal pattern. Parent questionnaires revealed satisfaction with appearance and good social interactions. Functional activities showed greatest difficulty handling small objects, especially when simultaneous pinch strength was required, such as fastening buttons and small snaps.
  
  
  CONCLUSIONS
  This study demonstrates the importance of evaluating multiple aspects of functional outcome for congenital hand problems and of using comparative age-appropriate validated norms. Pollicization is a rewarding procedure for children with thumb aplasia.
authors.affiliation: HealthSouth, Baylor College of Medicine, St. Luke's Episcopal Hospital, Houston, Texas, USA.
authors.forename: Kimberly Goldie
authors.initials: KG
authors.lastname: Staines
authors.forename: Ramsey
authors.initials: R
authors.lastname: Majzoub
authors.forename: John
authors.initials: J
authors.lastname: Thornby
authors.forename: David T
authors.initials: DT
authors.lastname: Netscher
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005385:Fingers; D018737:Hand Strength; D006801:Humans; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D013933:Thumb / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014182:Transplantation, Autologous; D016896:Treatment Outcome