The spectrum of radial longitudinal deficiency: a modified classification.
ABSTRACT The records of 119 patients with 196 extremities with radial longitudinal deficiency seen between 1923 and 1996 were reviewed. We propose a global classification system that includes the spectrum of pathology affecting the radial side of the extremity, including deficiency of the radius, carpal abnormalities, and hypoplastic thumbs. Radial deficiency could be classified for 181 extremities of 104 patients using this classification system. Type N has a normal length radius and a normal carpus with thumb hypoplasia, type O has a normal length radius and radial side carpal abnormalities, type 1 has more than 2 mm shortening of the radius, type 2 has a hypoplastic radius, type 3 has a partial radius with absence of the distal physis, and type 4 has complete absence of the radius. All patients had thumb hypoplasia. Eighty-two percent of extremities with thumb hypoplasia but no deficiency of the radius that were available for carpal bone classification had carpal anomalies, including absence, hypoplasia, and coalitions. All the extremities with type 1 radial deficiency had carpal anomalies. Carpal abnormalities could not be determined for types 2, 3, and 4 deficiency because most had a prior centralization. Proximal radioulnar synostosis or congenital dislocation of the radial head was seen in 44% of extremities with type 1 radial deficiency. This classification includes carpal anomalies and thereby links isolated thumb hypoplasia and deficiency of the radius into one system.
- Plastic and Reconstructive Surgery - PLAST RECONSTR SURG. 01/1982; 69(3):560-561.
Article: Type III-A hypoplastic thumb.[show abstract] [hide abstract]
ABSTRACT: Thirteen type III-A hypoplastic thumbs were reviewed. The abnormalities included those found in type II hypoplasia (narrow thumb-index web space, hypoplastic thenar muscles, unstable metacarpophalangeal joint, as well as extrinsic tendon abnormalities); all had stable carpometacarpal joints. They are differentiated from type III-B hypoplastic thumbs, which have an unstable carpometacarpal joint due to a deficient base of the metacarpal. The extrinsic tendon abnormalities included absent extensor pollicis longus tendon, absent or aberrant flexor pollicis longus tendon, and a tendon interconnection between the flexor pollicis longus and extensor aponeurosis. Twelve of the thumbs had surgical reconstruction. None was treated with ablation and index pollicization.The Journal Of Hand Surgery 04/1995; 20(2):246-53. · 1.57 Impact Factor
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ABSTRACT: The records of 98 patients with 160 hypoplastic thumbs seen between 1923 and 1993 were reviewed to determine the salient characteristics of this population. Physical findings, photographs, and x-ray films were studied. Sixty-three percent of patients were male, and 63% had bilateral thumb hypoplasia, 59% had radial dysplasia, and 86% had other anomalies. An associated syndrome, most commonly the vertebral, anal, tracheosophageal, renal, and radial limb anomalies association or Holt-Oram syndrome, was present in 44%. Patients with spine, genitourinary, or gastrointestinal anomalies were most likely to have the vertebral, anal, tracheosophageal, renal, and radial limb anomalies association, those with cardiac anomalies were most likely to have Holt-Oram syndrome, and those with lower extremity anomalies were most likely to have a different syndrome. One hundred thirty-nine thumbs were classifiable, using a modification of Blauth's classification; 19% were types 1 and 2, 23% were type 3, and 58% were types 4 and 5. One hundred seven operations were performed on 63 upper limbs, including 24 thumb reconstructions and 35 pollicizations. These patients must be carefully examined for bilaterality, other anomalies, and syndromes. Classification using a modification of Blauth's criteria is useful and helps the surgeon determine a treatment plan.The Journal Of Hand Surgery 02/1996; 21(1):104-13. · 1.57 Impact Factor