Kim Sungmin, Kwak Woo Kyoung, Jung Sung Taek
Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea.
Front Pediatr. 2021 Jul 14;9:638059. doi: 10.3389/fped.2021.638059. eCollection 2021.
Congenital clasped thumb is a progressive flexion and adduction deformity presenting with heterogeneous congenital abnormalities and syndromes. This deformity is usually accompanied by first web space narrowing and metacarpophalangeal joint (MPJ) laxity. Understanding the various features of the clasped thumb and making an accurate diagnosis is essential for treatment. Depending on the classification, treatment can vary from conservative to surgical. We describe the case of a bilateral clasped thumb with various characteristics, which were treated differently according to the disease type. The deformity of the clasped thumb was bilateral, and the patient had MPJ flexion deformity, flexor pollicis longus shortening, first web space narrowing, and MPJ instability, which were confirmed through a stress test. The left thumb was a complex type and was surgically treated, whereas, the right thumb was a flexible type, which was treated with splinting; the treatment showed promising results at 2 years post surgery. Diagnosis of the clasped thumb through thorough history taking, physical examination and considering its characteristics, and appropriate classification of the disease is essential for treatment. Furthermore, a stress test can identify MPJ instability in the congenital clasped thumb.
先天性拇指内收畸形是一种进行性的屈曲和内收畸形，伴有多种先天性异常和综合征。这种畸形通常伴有第一掌指间隙变窄和掌指关节（MPJ）松弛。了解拇指内收畸形的各种特征并做出准确诊断对于治疗至关重要。根据分类不同，治疗方法可从保守治疗到手术治疗。我们描述了一例具有多种特征的双侧拇指内收畸形病例，根据疾病类型采用了不同的治疗方法。拇指内收畸形为双侧性，患者存在掌指关节屈曲畸形、拇长屈肌缩短、第一掌指间隙变窄以及掌指关节不稳定，通过应力试验得以证实。左手拇指为复合型，接受了手术治疗，而右手拇指为柔软型，采用夹板治疗；术后2年治疗效果良好。通过全面的病史采集、体格检查并考虑其特征对拇指内收畸形进行诊断，以及对疾病进行恰当分类对于治疗至关重要。此外，应力试验可识别先天性拇指内收畸形中的掌指关节不稳定。
