The Windblown Hand: Correction of the Complex Clasped Thumb Deformity

Hr, McCarroll; Pr, Manske

doi:10.1016/s0749-0712(21)00699-5

Cited by 24 publications

(4 citation statements)

References 23 publications

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“…Abdel-Ghani et al had reported a similar 68% and 77.5% incidence, respectively, in their case series [1,4]. We used the Tsuyuguchi classification as suggested by Abdel-Ghani et al and we agree with their opinion of no difference between type II and type III clasped thumb with respect to severity, operative findings, treatment protocol, procedures performed, and the operative results and, hence, their suggestion of grouping the condition into supple and complex variants [1,2,3,4,6]. The classical approach to management is to treat the supple type with splinting and perform tendon transfers if it failed, while the complex type was treated by surgical correction of the contractures [ stability [4].…”

Section: Discussionmentioning

confidence: 57%

Clinical Profile of Congenital Clasped thumb: A case series

Kumar¹,

Acharya²,

Prasad³

et al. 2022

Jcorth

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Purpose: :Congenital clasped thumb is a rare deformity and not much has been described in literature about it. The aim of this study was to evaluate clinical profile of congenital clasped thumb, examine peroperative pathoanatomy, and evaluate the results of the treatment of such cases. Methods: A prospective study on 57 patients [106 hands] was done and their data recorded from the medical case records. A thorough clinical and radiological assessment was performed. Patients were classified using the Tsuyuguchi classification. Splinting program was initially started and patients not responding to it and those older than 10 years underwent contracture release, joint stabilization, and local flap cover with or without tendon transfers. All patients were assessed by Gilbert’s grading after 1 year. Results: There were 43 males and 14 females. The average age was 33 months [range 0–21 years]. At presentation, 51% [54/106] of hands were classified as severe with syndromic pattern [Type III]. About 61% [35/57] of the patients presented at the age <5 years and 21% after 10 years including three adults. About 41% of these patients [23/57] had a history of consanguinity and 27% [15/57] had a family history of a similar or associated congenital deformity. Splinting program showed excellent results in type I. An a-la-Carté release of soft tissues, joint stabilization with K-wire, and ligament reconstruction with local flap cover gave good to excellent results in 73% of our patients. Nine patients had features of web creep at first web space. Conclusion: Congenital clasp thumb showed a strong genetic predisposition. There was no difference between type II and type III variants with respect to the pathoanatomy, treatment protocol, operative procedures, and results. Splinting program in mild deformity and surgical correction with reconstruction in more severe cases gave satisfactory results.

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Section: Discussionmentioning

confidence: 57%

Clinical Profile of Congenital Clasped thumb: A case series

Kumar¹,

Acharya²,

Prasad³

et al. 2022

Jcorth

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“…1,[18][19][20] This may be associated with a "windblown hand," resulting in an adducted first metacarpal, first webspace contracture, and ulnar deviation of the digits. 1,4 In addition, there may be flexion deformities of the digits and varying degrees of clasped thumb. Some authors believe that in patients with arthrogryposis, deficient thumb extensors are not the primary cause of the clasped thumb abnormality.…”

Section: Discussionmentioning

confidence: 99%

“…Congenital clasped thumb causes a flexion and adduction deformity that is typically diagnosed when a flexion posture of the thumb persists beyond 4 to 6 months of age. [1][2][3][4] Clasped thumb is most often bilateral, occurs more commonly in men, has a variable presentation, and may occur within the spectrum of distal arthrogryposis. [1][2][3] As with many congenital differences, reconstruction of clasped thumb depends on which structures are hypoplastic or abnormal.…”

Section: Introductionmentioning

confidence: 99%

Abductor Pollicis Longus Tendon Abnormalities and Release in Children With Congenital Clasped Thumb

Israel

Jeardeau

Tomhave

et al. 2022

Hand (New York, N,Y.)

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Background: Congenital clasped thumb is associated with deficient thumb extensor tendons. Reconstruction includes tendon transfer. Here, we describe a variant of the abductor pollicis longus (APL) tendon, not previously reported, contributing to the flexion deformity. The purpose of this study is to report examples of and offer surgical repair techniques for APL variants identified in patients with clasped thumb. Methods: We reviewed records of 11 consecutive patients undergoing reconstruction for clasped thumb. Surgical anatomy of the APL tendon was evaluated in all patients, followed by release of aberrant APL attachments. Participants were invited to return for an in-person assessment with a certified hand therapist. Data were collected regarding intraoperative findings, surgical techniques for reconstruction, postoperative thumb motion, and patient and caregiver satisfaction. Results: Eleven children (12 thumbs) underwent aberrant APL release and rerouting between 2019 and 2021. Preoperatively, all thumbs were passively correctible to 0° of extension. In all patients, the APL was found to terminate palmar to the metacarpophalangeal (MCP) joint, creating an MCP flexion moment when tensioned. The average age at surgery was 7 years (range: 1-15 years), and the average follow-up was 14.2 months (range: 1-21 months). The mean postoperative thumb radial abduction was 55° (range: 20°-75°). Conclusions: When reconstructing clasped thumbs, surgeons should explore the presence of APL abnormalities. Release and centralization of the APL can improve thumb position and function. This technique may avoid the need for extra-anatomical tendon transfer in patients with clasped thumb.

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“…Nonsurgical management in the form of splinting and surgical techniques, including soft tissue procedures and bony correction, have been reported. A number of surgical techniques, ranging from contracture release, excision of abnormal bands of tissues, tendon transfers and osteotomies, have been described in the literature based on a few reported cases [7][8][9]. The efficacy of splinting, the effectiveness of surgery, the incidence of relapse following nonsurgical and surgical management and the appropriate timing of surgery are still a matter of debate.…”

Section: Introductionmentioning

confidence: 99%

Surgical management of windblown hand: Results and literature review

Gavaskar

Chowdary

2009

Journal of Children's Orthopaedics

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Purpose Windblown hand is a congenital anomaly characterized by multiple hand deformities. The condition is extremely rare as shown by the paucity of cases reported in the literature. The deformities, which can result in a cosmetically unsatisfactory appearance and, if left untreated, maladaptive behavior, are progressive in nature. Consequently early treatment is necessary. Methods We operated upon 23 hands in 18 patients (age range at surgery 6 months to 16 years) at a tertiary care center over a period of 7 years. The patients were followed for an average period of 7 years. The surgical approach was chosen based on the severity of the condition according to Zancolli and Zancolli's classification [Hand Clin 1:443-456 (1985)]. Results According to the criteria of Wood and Biondi [J Hand Surg 15A:431-438 (1990)], of the 23 hands operated upon, 17 had excellent cosmetic results, and 15 had excellent functional results. The results were better in patients undergoing early surgery-before the age of 2 years. Relapse of the deformity to a lesser extent than the original condition was seen in two hands at the last follow up. Conclusion Definitive conclusions on this condition cannot be drawn due to limited experience in the surgical management of this rare condition. We believe that early surgical management is probably the best option available for the patient based on the results obtained. Early surgery and good post-operative compliance from patients can facilitate successful management of this rare condition with predictable results.

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The Windblown Hand: Correction of the Complex Clasped Thumb Deformity

Cited by 24 publications

References 23 publications

Clinical Profile of Congenital Clasped thumb: A case series

Clinical Profile of Congenital Clasped thumb: A case series

Abductor Pollicis Longus Tendon Abnormalities and Release in Children With Congenital Clasped Thumb

Surgical management of windblown hand: Results and literature review

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