Triphalangeal Thumbs in the Pediatric Population: Long Term Outcomes Following Surgical Intervention

This study is ongoing, but not recruiting participants.
Sponsor:
Information provided by (Responsible Party):
Angela Wang, University of Utah
ClinicalTrials.gov Identifier:
NCT01409980
First received: August 2, 2011
Last updated: December 3, 2013
Last verified: December 2013
  Purpose

A triphalangeal thumb is a thumb with three phalanges. The thumb often appears long and fingerlike, and can sometimes be in the same plane as the other fingers. Anatomically, the extra phalanx can have different shapes. Several classification systems have been used, but the simplest and most often used is the Wood (1976) classification by the shape of the extra phalanx. If the extra phalanx is triangularly shaped it is classified as a type I. Type II has a rectangular shaped extra phalanx but it has not developed as a full phalanx. Type III is a full extra phalanx.


Condition
Phalanx of Supernumerary Digit of Hand

Study Type: Observational
Study Design: Observational Model: Cohort
Official Title: Triphalangeal Thumbs in the Pediatric Population: Long Term Outcomes Following Surgical Intervention

Resource links provided by NLM:


Further study details as provided by University of Utah:

Primary Outcome Measures:
  • evaluate the long-term outcomes of surgical treatment for children treated at Primary Children's Medical Center and Shriners Hospital with a delta phalanx. [ Time Frame: 1 year ] [ Designated as safety issue: No ]
    Outcomes being measured include objective measurements (stability of IP and MCP joints, ROM of IP and MCP joints, grip strength and key pinch) and subjective measurements (VAS for functionality, pain and appearance, and DASH).


Estimated Enrollment: 50
Study Start Date: July 2011
Estimated Study Completion Date: July 2014
Estimated Primary Completion Date: July 2014 (Final data collection date for primary outcome measure)
Groups/Cohorts
Triphalangeal Thumb
A search will be performed using CPT code 26587 (reconstruction of a supernumerary digit) at both Primary Children's Hospital and Shriners to identify all patients who Dr. Wang and Hutchinson operated on with a delta phalanx.

Detailed Description:

A triphalangeal thumb is a thumb with three phalanges. The thumb often appears long and fingerlike, and can sometimes be in the same plane as the other fingers. Anatomically, the extra phalanx can have different shapes. Several classification systems have been used, but the simplest and most often used is the Wood (1976) classification by the shape of the extra phalanx. If the extra phalanx is triangularly shaped it is classified as a type I. Type II has a rectangular shaped extra phalanx but it has not developed as a full phalanx. Type III is a full extra phalanx.

Different treatment strategies have been developed based on the type of triphalangeal thumb. This project looks specifically at type I, or a delta phalanx. The goals of surgery in any type are to reconstruct the anatomic deformity with a stable, functional thumb while providing an acceptable appearance.

There is no consensus on how triphalangeal thumbs with a delta phalanx should be treated. Bunnell and Campbell in the 1940s advocated doing no surgery at all. Milch advocated excising the abnormal phalanx in the pediatric population but supporting non-operative treatment for the adult population. A potential unwanted result of excision has been an angulated joint. Buck-Gramcko proposed that excision of the delta phalanx combined with ligament reconstruction could give a better result than with excision alone.

Hovius recommended different treatment based on the age of presentation. For patients less than 6 years, he advocated excision of a transverse oval piece of skin, resection of the extra phalanx with reconstruction of the radial collateral ligament at the new IP joint, and lengthening of the ulnar collateral ligament. For patients older than 6 years, he advocates partial resection of the extra phalanx with correction of the angle and arthrodesis of the DIP joint. Usually, collateral ligament reconstruction is not necessary in these cases.

Horii et al reviewed 13 type I delta triphalangeal thumbs with no associated hand abnormalities. Surgical treatment for these patients consisted of excision of an accessory phalanx and the repair of the collateral ligament. The IP joint was temporarily fixed with Kirschner wires for 4-6 weeks. Mean follow-up was 8.9 years. All patients were satisfied with the improvement in appearance. The mean IP joint motion was 54 degrees. No patients complained of instability or pain in the IP joint. Only one patient had ten degrees of lateral bending. They recommend operating on these patients between ages 1-2 years, when the phalangeal epiphyses becomes clear. They felt that earlier excision allows for better joint adaptation. The children also will learn how to use their hands correctly.

Recently it has been debated that it is beneficial to wait to operate on these children until they are older, and their bones and joints have matured. At that point, an osteotomy could be performed. Although these results have not been published yet, several well-respected hand surgeons have concluded that their outcomes have been better on patients who have had delayed surgery.

In our institutions, children generally have their thumb reconstructed using a delta phalanx excision with repair of the ligament around 1 to 2 years.

  Eligibility

Ages Eligible for Study:   1 Year to 18 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population

A search will be performed using CPT code 26587 (reconstruction of a supernumerary digit) at both Primary Children's Hospital and Shriners to identify all patients who Dr. Wang and Hutchinson operated on with a delta phalanx.

Criteria

Inclusion Criteria:

  • Patients under age 18 with a delta, or type I, phalanx
  • Surgical intervention at Primary Children's Hospital or Shriners Hospital by Dr. Angela Wang or Dr. Douglas Hutchinson consisting of delta phalanx excision and ligament reconstruction

Exclusion Criteria:

  • Patients with type II or III triphalangeal thumb
  • Patients undergoing a secondary or revision surgery as their first surgery at our institutions
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT01409980

Sponsors and Collaborators
University of Utah
Investigators
Principal Investigator: Angela Wang, M.D. University of Utah Orthopedic Center
  More Information

No publications provided

Responsible Party: Angela Wang, M.D., University of Utah
ClinicalTrials.gov Identifier: NCT01409980     History of Changes
Other Study ID Numbers: 49246
Study First Received: August 2, 2011
Last Updated: December 3, 2013
Health Authority: United States: Institutional Review Board

Keywords provided by University of Utah:
delta phalanx
thumb reconstructed
triphalangeal thumbs

Additional relevant MeSH terms:
Polydactyly
Limb Deformities, Congenital
Musculoskeletal Abnormalities
Musculoskeletal Diseases
Congenital Abnormalities

ClinicalTrials.gov processed this record on April 16, 2014