Goldfarb Charles A, Chia Ben, Manske Paul R
Department of Orthopaedic Surgery, Washington University School of Medicine at Barnes Jewish Hospitals, St. Louis, MO, USA.
J Hand Surg Am. 2008 Nov;33(9):1579-88. doi: 10.1016/j.jhsa.2008.05.010.
To assess the long-term subjective and objective outcome of cleft reconstruction in patients with central ray deficiency.
Twelve patients with 16 central ray deficiency hands were included. Each hand had been treated with cleft reconstruction using soft tissue and/or bony procedures. A surgeon and parent assessed the subjective outcome using a visual analog scale to compare preoperative and postoperative appearance. Objective outcome was assessed with a clinical examination for digital range of motion and with a radiographic examination for preoperative and postoperative divergence angles of the index finger and ring finger metacarpals and phalanges.
The surgeon's visual analog scale score significantly increased from 4 to 7. Nine parents were very satisfied, 4 were satisfied, and 3 were somewhat satisfied with hand appearance. A ring finger proximal interphalangeal joint flexion contracture averaging 31 degrees was the most notable clinical finding. The metacarpal divergence angle significantly improved from 33 degrees to 12 degrees , and the phalangeal divergence angle significantly improved from 38 degrees to 12 degrees .
Cleft reconstruction improves hand appearance in patients with central deficiency. A new technique of quantifying the radiographic divergence of the border rays of the cleft demonstrates improved alignment at long-term follow-up.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
