Congenital thumb differences- current concepts

Abstract

Anomalies of the thumb development are not uncommon and may be associated with a number of syndromes also. These anomalies range from total absence to duplication. Reconstructive surgery for the creation of an opposable thumb is the most rewarding aspect of Hand Surgery and also the most challenging. Classification systems have been modified for better description. A number of procedures have been introduced to improve the functionality of the hand in anomalies and age old concepts are undergoing a metamorphosis to further this. A brief description of the common conditions and their treatment are discussed here and highlighted by selected clinical cases.

Pollicization of index Fingers For Bilateral Hypoplastic Thumbs of Twin Babies: Case Series At Cure Children’s Hospital of Ethiopia

“…Although chromosome testing was not available in our setup, the results of other ancillary diagnostic workups were unremarkable for associated anomalies. 13 …”

“…Although chromosome testing was not available in our setup, the results of other ancillary diagnostic workups were unremarkable for associated anomalies. 13 Therefore, according to the modified Blauth classification, pollicization is a good option for types IIIB, IV, and V. 5 Most medical journals have reported pollicization of different digits, such as the index finger, middle finger, and ring finger. 2,3 Different authors consider index finger pollicization to be the most suitable technique to restore thumb function in the hand impaired by thumb hypoplasia and an unstable CMC joint.…”

Applications of Artificial Intelligence (AI) for cardiology during COVID-19 pandemic

“…This technology's typical applications are applied to predict outcomes like transcatheter aortic valve implantation and coronary artery stenosis. It can make predictions from lesser assumptions [34] , [35] , [36] , [37] , [38] . Table 1 discusses the significant applications of AI in cardiology during COVID-19 pandemic.…”

Pulgar en gatillo, pulgar en resorte, o tenosinovitis estenosante del pulgar pediátrico

“…1,2,5 El tratamiento está determinado por la edad; entre 10-30% de los pacientes menores de 2 años puede curarse de forma espontánea, 15,16,2 incluso aumenta este valor a 60% si realizan ejercicios de extensión pasiva por los padres y la colocación de férulas en extensión. 6 En pacien-tes mayores de 2 años o con contractura fija en flexión se prefiere el tratamiento quirúrgico, pues ha demostrado excelentes resultados y pocas complicaciones, entre las que destacan la lesión del nervio digital y las infecciones. 8 La cirugía consiste en realizar un acceso transverso de 1 cm sobre el pliegue palmar de la articulación metacarpofalángica y un corte longitudinal en la polea A1; no es recomendable efectuar liberaciones percutáneas, porque se asocian con índice de falla de 30% al no liberar por completo la polea y lesión parcial del tendón en 80% de los casos.…”

“…La flexión del pulgar depende del correcto deslizamiento del flexor largo del pulgar a través de un sistema de poleas (A1, polea oblicua y A2); en esta alteración el tendón se encuentra engrosado proximal a la polea A1, generando una discrepancia de tamaño, que impide el deslizamiento del tendón a través de la polea; 5 de forma característica, el engrosamiento del tendón forma el llamado nódulo de Notta. 6,7,3…”