수부 다지증 환자에서 Modified Wassel- Flatt 분류의 결과

Abstract

Purpose Radial polydactyly is a common congenital hand anomaly. Traditionally, the Wassel-Flatt classification has been used to categorize radial polydactyly based on radiographic skeletal duplication. However, its limitations in guiding effective surgical interventions and predicting outcomes have led to proposals for a modified Wassel-Flatt classification. This study aimed to evaluate our modified Wassel-Flatt classification in terms of surgical planning and clinical outcome and to compare hypoplastic and non- hypoplastic types. Methods This retrospective study was conducted at a single center and reviewed medical records of 211 patients with 223 thumbs treated for radial polydactyly between October 2017 and November 2022. Demographics, surgical procedures, and clinical outcomes such as JSSH score and caregiver’s satisfaction score were reviewed. Patients were classified using the modified Wassel-Flatt classification. Comparisons were made between the hypoplastic and non-hypoplastic types (type II-VII), within hypoplastic category between hypoplastic proximal (HP) type and hypoplastic distal (HD) type, and among the non-hypoplastic types. Results Simple excision was feasible only for the HP type, whereas the HD type required procedures related to nail issues, and the non-hypoplastic types necessitated complex procedures. Generally, the hypoplastic types were associated with better outcomes than the non-hypoplastic types. Within the hypoplastic category, the HP type achieved better appearance scores than the HD type. Among the non-hypoplastic types, comparisons revealed no significant differences; however, caregiver’s satisfaction with function was significantly lower for type III compared to type II and IV. Conclusion The hypoplastic type not only differed in surgical methods, but also showed varied overall outcomes, especially in terms of functional scores. Distinguishing between the HP and HD type within the hypoplastic category further revealed differences in surgical approaches and cosmetic results. Using the modified Wassel-Flatt classification, appears to enhance surgical planning and effectively predict clinical outcomes.