title: Short-term and Long-term Clinical Results of the Surgical Correction of Thumb-in-Palm Deformity in Patients With Cerebral Palsy.
abstract: BACKGROUND
  Thumb-in-palm deformity disturbs a functional grip of the hand in patients with cerebral palsy. Reported recurrence rates after surgical correction are contradicting and earlier studies are limited to short-term follow-up. Therefore, the aim of this retrospective clinical outcome study is to evaluate the success rate of surgical correction of thumb-in-palm deformity around 1 year and at a minimum of 5 years follow-up. In addition, long-term patient satisfaction of the treatment is evaluated.
  
  
  METHODS
  Patients with cerebral palsy who underwent a surgical correction for their thumb-in-palm deformity between April 2003 and April 2008 at the Academic Medical Center in Amsterdam were included. All patients were classified into 4 categories according to the assessment system of the Committee on Spastic Hand Evaluation. The result of surgery was considered "short-term successful" and "long-term successful" when, respectively, short-term and long-term classification was better compared with preoperative. The association between the patient satisfaction outcomes and the long-term clinical outcomes were statistically analyzed.
  
  
  RESULTS
  Data were collected from 39 patients and their charts. The success rate was 87% at short-term follow-up, which in the long term decreased to 80%. Interestingly, thumb position deteriorated in 29% of the patients between short-term and long-term follow-up. In the long term, 74% of the patients were satisfied with the position of their thumb and 87% would undergo the surgery again. Both these outcomes were statistically significant associated with the long-term success rate (P<0.05).
  
  
  CONCLUSIONS
  The surgical correction of thumb-in-palm deformity has a high clinical success rate and patient satisfaction in the long term. However, it should be taken into account that the clinical result around 1 year postoperative cannot be considered final.
authors.affiliation: *Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Amsterdam †Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands.
authors.forename: Juul V
authors.initials: JV
authors.lastname: Alewijnse
authors.forename: Mark J C
authors.initials: MJ
authors.lastname: Smeulders
authors.forename: Mick
authors.initials: M
authors.lastname: Kreulen
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D005260:Female; D006227:Hand Deformities, Acquired / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D018737:Hand Strength; D006801:Humans; D000069451:Long Term Adverse Effects; D008297:Male; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000175:diagnosis; D012189:Retrospective Studies; D013933:Thumb / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome