Department of Pediatric Orthopaedics, Guangdong Provincial Clinical Research Center for Child Health, GuangZhou Women and Children's Medical Center, GuangZhou Medical University, 9th JinSui Road, GuangZhou, 510623, China.
Department of Pediatric Orthopedic, ChenZhou No.1 People's Hospital, ChenZhou, China.
BMC Musculoskelet Disord. 2024 Oct 11;25(1):802. doi: 10.1186/s12891-024-07916-x.
Wu et al. introduced a modified radiographic system that allows classification of all forms of CTD with excellent interobserver and intraobserver reliability. No study to date has evaluated the radiographic characteristics of Wu et al. type C3 CTD with osseous attachment at the level of the metacarpal.
This study aimed to evaluate the radiographic features of type C3 CTD according to the system of Wu et al., to describe the different anatomical subtypes of the duplication, and to propose a categorization approach to distinguish diverse surgical strategies based on the radiographic anatomy of this specific subtype of duplication.
We performed a retrospective analysis of 215 patients (221 thumbs) diagnosed with Wu et al. type C3 CTD at our Institution between 2015 and 2021. We evaluated all CTDs by examining the alignment of the interphalangeal (IP) and metacarpophalangeal (MP) joints and by assessing the presence of abnormal hypertrophic epiphysis of the primary thumb on posteroanterior (PA) radiographs. The proposed classification system has four types: Type I with good alignment of both MP and IP joints, Type II with ulnar deviation of the MP joint, Type III with radial deviation in the MP joint and Type IV with abnormal hypertrophic epiphysis of the distal phalanx of the main thumb with ulnar deviation of the IP joint with or without ulnar deviation of the MP joint.
There were 140 male and 75 female patients with CTD (221 thumbs). There were 65 left, 144 right and 6 bilateral forms. The right-to-left, male-to-female and unilateral-to-bilateral ratios were 2.2:1, 1.9:1 and 35.8:1 respectively. The mean age at surgery was 22.3 ± 11.8 months (range, 8-80). The proposed classification system allowed the classification of all CTDs (n = 221). Specifically, 53 fingers were classified as Type I (24%), 136 as Type II (61.5%), 21 as Type III (9.5%), and 11 as Type IV (5%).
The proposed system is based on radiographic pathoanatomy and complements that of Wu et al. by identifying four distinct subtypes of deformity. It has the potential to improve inter-professional communication and guide surgery in patients with Wu et al. type C3 CTD. However, our results are preliminary and further research is needed to validate them.
III.
Wu 等人引入了一种改良的影像学系统，可对所有类型的 CTD 进行分类，具有出色的观察者间和观察者内可靠性。迄今为止，尚无研究评估 Wu 等人的 CTD 类型 C3 中伴有掌骨水平骨附着的影像学特征。
本研究旨在根据 Wu 等人的系统评估 CTD 类型 C3 的影像学特征，描述该畸形的不同解剖亚型，并提出一种分类方法，根据该特定亚型的影像学解剖结构来区分不同的手术策略。
我们对 2015 年至 2021 年间在我院诊断为 Wu 等人的 CTD 类型 C3 的 215 例患者（221 个拇指）进行了回顾性分析。我们通过检查指间（IP）和掌指（MP）关节的对线以及评估掌骨原发性拇指的异常肥大骨骺的存在情况，对所有 CTD 进行评估。提出的分类系统有四种类型：I 型，MP 和 IP 关节对线良好；II 型，MP 关节尺侧偏斜；III 型，MP 关节桡侧偏斜；IV 型，主拇指远节指骨异常肥大骨骺，IP 关节尺侧偏斜伴或不伴 MP 关节尺侧偏斜。
有 140 名男性和 75 名女性患者（221 个拇指）患有 CTD。有 65 个左侧、144 个右侧和 6 个双侧。右-左、男-女和单侧-双侧的比值分别为 2.2:1、1.9:1 和 35.8:1。手术时的平均年龄为 22.3±11.8 个月（范围 8-80）。所提出的分类系统可以对所有 CTD（n=221）进行分类。具体而言，53 个手指被分类为 I 型（24%），136 个为 II 型（61.5%），21 个为 III 型（9.5%），11 个为 IV 型（5%）。
该系统基于影像学病理解剖结构，通过识别四种不同的畸形亚型来补充 Wu 等人的系统。它有可能改善专业间的沟通，并指导 Wu 等人的 CTD 类型 C3 患者的手术。然而，我们的结果是初步的，需要进一步的研究来验证。
III。
