| Objective:To report the short-term surgical results of polydactyly and to investigate the relationship between postoperative complications of polydactyly and parent’s subjective evaluation and Chung classification.Methods:From January 2019 to January 2021,children with polydactyly treated in our hospital were retrospectively analyzed.We excluded 3 cases with other hand deformities and syndromes,4 bilateral cases and 31 cases who failed to obtain follow-up and failed to complete the questionnaire were also excluded.All of the 33 cases had unilateral disease,includes 17 boys and 16 girls.The operation age ranged from 6 months to 2 years and 3 months,with an average of 13.3 months.Wassel-Flatt classification and Chung classification based on preoperative X-ray and intraoperative exploration.According to Wassel-Flatt classification,type I was partial bifurcation of the distal phalanx,no type I in this study;type II was complete bifurcation of the distal phalanx in 1 case;type III was partial bifurcation of the proximal phalanx in 3 cases;Type IV was complete bifurcation of proximal phalanx in 10 cases;type V was partial bifurcation of metacarpal bones in 6 cases,type VI was complete bifurcation of metacarpal bones in 4 cases,type VII was triphalangeal thumb in 3 cases.In addition,extra digit and main digit are connected by a boneless joint,which cannot be included in the Wassel-Flatt classification in 6 cases.According to Chung classification,type I is the joint type,with a total of 17 cases;type II is a single epiphyseal type,with a total of 4 cases;type III is an osteochondroma-like type,with a total of 6 cases;type IV is a hypoplastic type,with a total of 6cases.Preoperative surgical plan was designed according to Chung classification.Chung type I surgery included radial thumb resection,trimming of proximally enlarged metacarpal head or proximal phalangeal head to match the articular surface,reconstruct of the radial articular ligament and/ Or reconstruct the thenar muscle.If the deviation of the finger is obvious,a closed osteotomy should be added to correct the deviation,or the flexor and extensor tendon of the extra digit will be transferred and sutured to the ulnar side of the base of the distal end of the main thumb,and the tendon will be rebalanced to correct the deviation.If the deviation is mild,release the joint capsule of the interphalangeal joint,and for the stenosis of the first web space,simultaneously perform five-valvuloplasty to enlarge the first web space..Chung type II surgery included resection of the extra digit and reconstruction of the main digit in 4 cases,and modified B-C surgery was performed for the crab claw like deformity.In Chung III type,the radial secondary thumb was excised,and the insertion point of the abductor pollicis brevis muscle of the extra digit was reconstructed to the the main digit.Closed metacarpal osteotomy was performed to correct the deviation if necessary.In type IV,the radial thumb was simply removed.All children were sutured subcutaneous tissue and skin with 5-0 Vicryl suture,and then applied mupirocin ointment on the incision surface,covered with oil gauze and sterile dressing in turn,and wrapped with sterile bandage to fix the thumb in the abducted position.The electronic version of Questionnaire Star was used to send through We Chat to conduct postoperative follow-up surveys on the parents.The postoperative function and appearance of the thumb were scored using the Visual Analogue Scale(VAS)(0-100),and it was required to fill in the dissatisfaction with the appearance or function of the thumb after surgery,including finger deviation,tiny thumb,scar,limited thumb flexion,decreased strength.Intention to reoperation was also included as a separate survey item.In order to understand the influence of thumb on children’s daily life after operation.Items such as grasping large objects with the affected hand and pinching small objects with the thumb and index finger were designed to evaluate the thumb function.Some items of the Universal Core Scale for Children’s Quality of Life(Peds QL4.0)were used to evaluate the children’s interaction and activity participation with children of the same age(Table 3.1).ANOVA was used to compare the functional and appearance scores of children with various types of Chung classification,and to compare the effects of finger deviation,thumb size,scar,limited thumb flexion and extension,and weakened strength on the VAS score.Other measurement data were tested by t test,when P<0.05 was considered statistically significant.Results:The follow-up period was from 15 months to 42 months(22.2 months on average).The parents of the children were highly satisfied with the postoperative results,with an average overall appearance VAS score of 86.73 and an overall functional VAS score of 87.03.Chung type IV had the highest appearance and functional scores.The overall functional VAS score of Chung classification was not statistically significant(P=0.247,Table 4.1),but the overall appearance VAS score was statistically significant(<0.001,Table4.1),and the appearance score of type II was significantly lower than that of type I,type III and IV(P=0.001,P=0.001,P<0.001).In this group,6%(2/33)of the parents had the intention of reoperation,61%(20/33)of the parents indicated that they had no intention of reoperation in the short term,and 33%(11/33)indicated that they would make a decision based on the development of the thumb.Parents’ dissatisfaction with appearance includes thumb deviation,thumb thickness difference,scars,etc.As for the functional and appearance problems after operation,9 parents believed that there was a certain degree of deviation after operation,including 7 type I and 2 type II.7 thumbs were different in size with normal thumbs,including 3 type I,1 type II,and 3 type III.5 cases of thumb scars were more prominent.Other appearance problems included differences in thumb length,nail deformity,prominence.Functional dissatisfaction includes reduced thumb mobility and weak thumb strength.The flexion and extension range of thumb was poor in 9cases,including 8 type I and 1 type II.7 cases of thumb strength were weaker than normal thumb,including 5 type I and 2 type III.When thumb deviation,obvious scar,and weakened thumb strength occurred after surgery,the parents’ scores for appearance or function were significantly lower.Most of the children had good results on daily life and social assessments.Conclusions:The overall postoperative satisfaction of parents with function and appearance is high,and thumb deviation is the main factor affecting the postoperative results and satisfaction,and these results are related to Chung classification. |
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