Podetti HC, Arroyo CR, Ramírez RT, Estrada R

Language: Spanish
References: 18
Page: 559-566
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Inborn defects affect between 1-2% of newborns and approximately 10% of this group represents deformities of the upper limb. Specifically, preaxial duplications of the thumbs occur in 8 out of 100.000 births. We should take huge interest in this digit, because of its function; being the most important unit in the hand, it takes care of more than half of the actions of our hands. This deformity also carries an emotional burden for our patients and their parents, and this matter should not be forgotten. The classification used worldwide is Wassel´s. It was introduced in 1969 and posteriorly modified by Wood and Miura to incorporate types IV and VII of duplications, being the most common type IV deformity, both worldwide and in Costa Rica. Surgery is the elected treatment, and its complexity is based on Wassel´s degree of injury. It should be planned thoroughly, having as a maximum goal achieving the most functionality out of the hand. Clearing all doubts from the patients and parents, and warning the need of future procedures is of outmost importance. Doctor-patient relationship is extremely important in this case. The recommended age for surgery is between 6 months and the age of 3. Between these ages there is a gained balance between bone formation and social maturity. In the case of deformities types I-III, Bilhaut- Cloquet technique´s is advised, and for types IV-VI the elected technique is more emphatic in reconstruction of pulleys, ligaments and tendons. Type VII deformity is rare and literature reports are minimal. Despite of being a severe malformation, results get better as an adequate surgical technique is utilized. This article intends to analyze the most frequent types of thumb duplication in the National Children's Hospital in Costa Rica, during a period of 8 years and correlate the clinical result with the chosen surgical procedure for each type of deformity.

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