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.

Extensor pollicis longus rerouting is a common procedure to improve thumb abduction in thumb-in-palm deformity seen with spastic cerebral palsy. In 1985, Manske redirected the extensor pollicis longus tendon in this procedure through the first extensor compartment. They also proposed an alternative subcutaneous route around the extensor pollicis brevis and abductor pollicis longus tendons proximal to the extensor compartment. In this study, we performed a three-dimensional analysis of thumb motion on 11 cadaver arms with the subcutaneous route and the first extensor compartment route. We found that with the two different routing methods, the mean difference in thumb radial abduction and retropulsion (0° or 6°, respectively) was very small. Such differences are unlikely to have clinical relevance. We were unable to find significant differences in the motion range of the thumb after these rerouting techniques or sites of insertion. Our biomechanical data support the simpler subcutaneous route.

Objective: Determine healthcare costs of upper-extremity surgical correction in children with spastic cerebral palsy (CP). Method: This cohort study included 39 children with spastic CP who had surgery for their upper extremity at a Dutch hospital. A retrospective cost analysis was performed including both hospital and rehabilitation costs. Hospital costs were determined using microcosting methodology. Rehabilitation costs were estimated using reference prices. Results: Hospital costs averaged €6813 per child. Labor (50%), overheads (29%), and medical aids (15%) were important cost drivers. Rehabilitation costs were estimated at €3599 per child. Conclusions: Surgery of the upper extremity is an important contributor to the healthcare costs of children with CP. Our study shows that labor is the most important cost driver for hospital costs, owing to the multidisciplinary approach and patient-specific treatment plan. A remarkable finding was the substantial amount of rehabilitation costs. ARTICLE HISTORY