Predictors of early and late complications after syndactyly release: A retrospective review of 684 cases

Journal of Hand Surgery (European Volume) · 2026-03-17

INTRODUCTION: This study aimed to identify predictors of early and late postoperative complications following syndactyly release. We analysed a series of 684 webspace releases at a paediatric tertiary care referral centre. We hypothesized that patient demographics and presentations would resemble the findings of previous reports. In addition, we hypothesized that complete or complex syndactyly would be predictive of early and late postoperative complications regardless of other demographic and presentation factors, as compared to simple or incomplete syndactyly. METHODS: Patients 0-17 years of age at presentation with congenital hand syndactyly who underwent surgical correction were included. Outcomes of interest included early (less than 30 days) postoperative complications and late (greater than 30 days) postoperative complications, including pathologic scar formation and/or web creep. RESULTS: In total, 684 web spaces from 318 patients were included. The average follow-up time was 2.2 years. The early 30 day complication rate was 12%, while the incidence of late postoperative complications was 26% with a web creep incidence of 8.8%. On regression analysis, complete syndactyly and bony involvement were predictors of early 30 day complications. Male sex and complete syndactyly were predictors of developing late postoperative complications. In a subgroup analysis of simple syndactyly cases, web creep and hypertrophic scarring were significantly higher in cases reconstructed with skin grafts compared to cases that utilized a graftless dorsal metacarpal VY island flap technique. CONCLUSIONS: While early postoperative complications are infrequent, one quarter of cases will develop a late postoperative complication. Complete syndactyly is a predictor of early and late postoperative complications. Reconstructing simple syndactyly with a graftless dorsal metacarpal VY island technique may lead to fewer postoperative complications. LEVEL OF EVIDENCE: IV.

Functional outcome measures for pediatric upper limb deficiencies with and without prostheses: A systematic review and appraisal

Prosthetics and Orthotics International · 2025-06-11

Effective orthopedic care/rehabilitation for pediatric upper limb deficiencies (ULDs) requires understanding how function and prosthetic control progress as the child develops. Psychometrically sound outcome measures are imperative. This systematic review critically appraised the instruments available for assessing upper limb function among children with ULDs. PubMed, Embase, CINAHL, and Scopus were searched. Eligible studies evaluated instruments' validity, reliability, and/or responsiveness and included children under 18 years. Following PRISMA guidelines, multiple reviewers independently screened studies, extracted data, assessed risk of bias, and rated psychometrics and evidence quality by the COnsensus-based Standards for selection of health Measurement INstruments methodology. Reviewers screened 2513 studies; 19 reports describing 4 performance-based tests and 6 patient-reported outcome measures were included. An ideal outcome measure for pediatric ULDs does not yet exist. For clinicians/researchers seeking a standardized observational assessment, the Assessment of Capacity for Myoelectric Control (valid only for myoelectric prostheses) and Assisting Hand Assessment are the most promising options, showing the best feasibility and psychometrics. A modified Assisting Hand Assessment is under development for ULDs with or without prosthesis use. For clinicians/researchers seeking a more practical questionnaire that they can implement beyond the clinic, all existing options would benefit from revision and simplification. We provisionally recommend the 10-min, parent-reported Child Amputee Prosthetics Project-Functional Status Inventory. However, the preschooler version needs construct revisions, and all versions need reliability studies. Two well-known pediatric instruments, the Patient-Reported Outcomes Measurement Information System and Pediatric Outcomes Data Collection Instrument, are invalid for assessing upper limb function among patients with ULDs.

Postoperative and Long-Term Patient-Reported Outcomes of Type A Ulnar Polydactyly

Plastic & Reconstructive Surgery · 2025-02-24

BACKGROUND: Type A ulnar or postaxial polydactyly describes a well-developed supernumerary small finger, which may have self-image and functional sequelae even after reconstructive surgery. The authors aimed to characterize postoperative outcomes and substantiate the clinical relevance of the Congenital Upper Limb Differences Ulnar Polydactyly (CUP) Classification. METHODS: All cases at 2 major pediatric hospitals from 2012 through 2022 were reviewed. Surgeons classified preoperative radiographs using the CUP Classification. Complication rates were compared using chi-square or Fisher exact tests. Patient-reported outcomes included the Patient and Observer Scar Assessment Scale, Australian Hand Difference Register aesthetics scale, and Patient-Reported Outcomes Measurement Information System (PROMIS); descriptive analyses considered minimum clinically important differences. RESULTS: Sixty-four hands of 42 patients underwent surgery (mean age, 15.1 ± 12.2 months). Operative techniques aligned with the CUP reconstructive pathway. Late complications varied significantly by CUP subtype ( P < 0.001), occurring most commonly in A3 (divergent metacarpophalangeal) and A5 (duplicated metacarpal) cases. Differences centered on functional complications, including subjective functional concerns, flexion contractures, and limited flexion (each P ≤ 0.02). Nineteen patients or caregivers completed questionnaires on average 5.9 years postoperatively. Most agreed that surgery improved their hand appearance (median 5 of 5) and endorsed happiness with their hand appearance (median 4 of 5). Approximately half believed that their hands could look better. Patients or caregivers reported good scar quality. Regarding function, mean PROMIS Upper Extremity scores fell more than a minimum clinically important difference below pediatric norms, especially for older children or adolescents (ages 8 to 18 years). Self-reported PROMIS Peer Relationships scores were within normal limits. CONCLUSIONS: Most patients were pleased with postoperative results, but many reported room for aesthetic and functional improvement. This study corroborated the clinical relevance of the CUP Classification. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Morel-Lavallée Lesions in the Pediatric Patient: An Evaluation of Treatment With Interdisciplinary Clinical Management

Journal of the Pediatric Orthopaedic Society of North America · 2025-12-16

Introduction: Morel-Lavallée lesions (MLLs) are internal degloving injuries from traumatic shearing forces. Multiple pathways exist for treating MLLs, including surgery, percutaneous aspiration, sclerodesis, and conservative methods. These lesions differ between pediatric and adult patients in cause and location. There currently is limited data specific to treating pediatric and adolescent MLLs. Our goal was to review our recent experience with patient population, management strategy and patient outcomes for pediatric patients diagnosed with MLLs. Materials and methods: A retrospective review was conducted on patients ages 8-25 with documentation of an MLL in the electronic medical record between 2018 and 2024, with at least three months of available follow-up. Demographic information, lesion size and location, injury details, including injury-to-diagnosis time intervals, treatmzent across specialties, and patient outcomes, including documented resolution, were collected. Results: Eighty-three patients, with 87 total lesions (four with two lesions each), and a mean age 14.4 years (range 8-20 years), met study criteria. Seventy-four were trauma-induced MLLs (89.2%), consisting of sports injuries (n = 52, 70.3%), motor vehicle collisions and other trauma. Nine (10.8%) had no documented or identifiable traumatic mechanism. Forty-nine lesions were at the knee (56.3%). Seventy-two of 83patients (86.7%) were seen by an orthopedist during their treatment course, with the most common treatment being conservative management (n = 50, 69.4%). Of these, 7 patients (14%) required further treatment via interventional radiology (IR) or plastic/general surgery. Other orthopaedic treatments included conservative care with drainage and/or sclerotherapy (n = 11, 15.3%), surgery (n = 4, 5.6%), or no orthopaedic intervention (n = 7, 9.7%). Eleven patients (13.3%) were initially seen by IR or surgery and not orthopaedics. Only 15 patients (18.1%) had sufficient clinical/radiographic documentation to confirm lesion resolution, but of those, all demonstrated full resolution of their MLL. Discussion: Sports trauma was the most common cause of pediatric/adolescent MLLs, most often involving the knee. Most patients treated conservatively did not require further intervention. A multidisciplinary approach ensures appropriate care escalation. Improved follow-up could enhance both clinical outcomes and patient satisfaction. Understanding lesion factors' influence on treatment success can help guide future protocols. Key Concepts: (1)Morel-Lavallée lesions in pediatric and adolescent patients most commonly occur due to sports injuries and most commonly involve the knee.(2)Conservative treatment including targeted compression was effective in the majority of cases and often avoided the need for invasive intervention.(3)Lesion recurrence and treatment escalation were uncommon when early conservative management was used.(4)A multidisciplinary treatment approach comprised of orthopaedics, interventional radiology, and plastic surgery can allow for individualized care.(5)Standardized follow-up and documentation are important for assessing long-term resolution and improving patient outcomes. Level of Evidence: Level IV (Case series).

Surgical Approaches and Outcomes for 69 First Web Space Congenital Syndactyly Cases of the Hand

Journal of Hand Surgery Global Online · 2025-09-17 · 1 citations

Purpose: First web space syndactyly presents a considerable reconstructive challenge, and because of the rarity and complexity of the condition, there is no consensus on the optimal approach to its reconstruction. This study therefore describes our experience with congenital first web space syndactyly, providing an overview of reconstructive techniques and outcomes. Methods: Sixty-nine cases (55 simple and 14 complex/complicated), from 2007 to 2022, were analyzed with descriptive statistics. Results: Dorsal commissural flaps were the initial operative approach in 100% of the complex/complicated cases, whereas Z-plasties were used in 64% of the simple cases. Full-thickness skin grafts were required in 12 (86%) of the complex/complicated cases and in 14 (26%) of the simple cases. Additional procedures such as amputation or osteotomy were performed in five complex/complicated (36%) and five simple (9.1%) cases. Range-of-motion deficits were the most common complication (26%), and 20 (29%) cases required revision surgery. Conclusions: Patients with first web syndactyly often require multiple operations and concurrent procedures on the index finger and thumb to optimize hand function. Reconstruction should be personalized to each patient's unique clinical presentation. Type of study/level of evidence: Prognosis IIb.

Gamified assessments of pediatric upper extremity function: A systematic review and appraisal

Journal of Hand Therapy · 2025-03-17 · 1 citations

32. Outcomes of Hyperselective Neurectomy for Pediatric Upper and Lower Extremity Spasticity

Plastic & Reconstructive Surgery Global Open · 2025-04-24

PURPOSE: Hyperselective neurectomy (HSN), the selective and partial sectioning of motor nerve fascicles near motor endplates, is a promising surgical treatment for extremity spasticity, but its application in children has not been well studied. We hypothesized that hyperselective neurectomy would yield significant improvements in spasticity and function with minimal complications in pediatric patients. METHODS: After IRB approval, we retrospectively reviewed the records of all pediatric patients with upper and lower extremity spasticity who underwent HSN by the senior author from 2021 to 2024. We collected demographic information, surgical details, complications, preoperative and postoperative Modified Ashworth scale (MAS), spontaneous posture, passive range-of-motion (pROM), and muscle strength (0-5). MAS scores were adjusted to a 6-point scale (0-5) for analysis. A paired t-test was used to compare preoperative and postoperative data for cases with complete datasets, with a p-value<0.05 indicating statistical significance. RESULTS: Twenty-five patients (56% male) underwent 59 upper and/or lower extremity HSN procedures at an average age of 11.5 years (range 6-23 years). Etiologies of spasticity included cerebral palsy (n=16, 64%), stroke (n=5, 20%), Leigh syndrome (n=2, 8%), intracranial hemorrhage (n=1, 4%) and traumatic brain injury (n=1, 4%). HSN was performed on 24 upper extremities (8 median, 8 musculocutaneous, 4 radial, 4 ulnar) and 35 lower extremities (21 obturator, 8 sciatic, 6 tibial). Most cases (81.4%) involved concurrent orthopedic procedures (tendon/muscle lengthening, tendon transfers, fusions). Average length of follow up was 6 months (range 1-18 months). MAS scores reduced significantly postoperatively (p<0.01) for both upper and lower extremity cases. Patients were also able to achieve more relaxed spontaneous postures and better pROM, while strength remained relatively stable. Complications included a bilateral lower extremity surgical site infection in one patient and hypertrophic scarring in another patient. There were no cases of recurrent spasticity requiring reoperation. CONCLUSION: Hyperselective neurectomy is a safe and effective treatment that improves pediatric extremity spasticity and enhances function without negatively affecting strength.

Infantile Fibrosarcoma of the Hand: Limb-Sparing Treatment With Modern Targeted Oral Chemotherapy and Conservative Surgical Resection

Journal of Hand Surgery Global Online · 2025-12-05

fusion oncogenes have been used to decrease the extent of surgical resection. However, the management of morphologically similar infantile fibrosarcoma-like tumors has not been well characterized. We report a case of an anaplastic lymphoma kinase-driven infantile fibrosarcoma-like neoplasm of the hand that was managed using a multimodal, limb-sparing approach. A 35-week gestation neonate presented with a vascular mass on the volar aspect of his left hand. Neoadjuvant treatment with the anaplastic lymphoma kinase inhibitor lorlatinib led to considerable tumor regression, which enabled conservative surgical resection and preservation of the hand. At 2 years of follow-up, the patient remains on lorlatinib therapy without recurrence and demonstrates excellent hand function despite moderate scar contractures. This case highlights the efficacy of neoadjuvant therapy combined with resection in managing infantile fibrosarcoma-like tumors.

Aggressive Digital Papillary Adenocarcinoma: A Meta-Analysis of the Presentation, Treatment, and Outcomes of a Rare Hand Tumor

Hand · 2025-01-10 · 1 citations

Background: Aggressive digital papillary adenocarcinoma (ADPA) is a rare skin adnexal tumor with a predilection for the hand. The presentation, treatment, and outcomes of ADPA remain poorly defined due to the scarcity of reports and low-level evidence of published findings. Methods: We performed a meta-analysis following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines with the intent to provide hand surgeons a better understanding of the diagnosis and treatment of the disease. Three additional cases of ADPA from our institution were combined with the results from the systematic review. Results: A total of 238 cases were included in the meta-analysis. Most ADPAs were painful, evolving, and less than 2 cm in size. Regional sentinel lymph node biopsies were performed in 55 patients, of which 25.5% were positive. Overall cohort recurrence and distant metastasis rates were 24.3% and 18.1%, respectively. Patients who obtained clear margins within 6 months of diagnosis had significantly lower rates of recurrence, metastasis, and mortality ( P &lt; .001, P = .04, P = .003, respectively). There were no differences in recurrence or metastasis rates in those who obtained clear margins by excision or amputation ( P = .27 and P = .07, respectively). In patients who died from disease (6.0%), 5.0 years was the average time to death. Conclusions: Aggressive digital papillary adenocarcinoma should be included in the differential diagnosis of hand lesions with unusual presentations or lack of response to other therapies. Clear margins should be obtained within 6 months of diagnosis, and routine surveillance should be provided by an oncologic physician familiar with ADPA as these tumors have high recurrence rates.

Selecting Patient-Reported Outcome Measures for Pediatric Upper Extremity Function

Journal of Pediatric Orthopaedics · 2025-04-30 · 1 citations

BACKGROUND: Patient-reported outcome measures (PROMs) are important in understanding pediatric upper extremity outcomes. Little guidance is available to help clinicians select appropriate PROMs, which are often used beyond their scope of validation. This systematic review analyzed the content, readability, and psychometrics of existing PROMs of pediatric upper extremity function. METHODS: PubMed, Embase, CINAHL, and Scopus were searched. Eligible studies evaluated psychometrics of global upper extremity function PROMs in pediatric patients. Following PRISMA guidelines, 2 reviewers screened studies, extracted data, assessed risk of bias, and rated psychometrics using the COnsensus-based Standards for selection of health Measurement INstruments (COSMIN). Content was analyzed using the Occupational Therapy Practice Framework and well-established readability indices. RESULTS: Reviewers screened 2513 studies; 44 reports on 9 PROMs were included. The Pediatric Outcomes Data Collection Instrument (PODCI) showed strong evidence of validity and responsiveness for the widest range of conditions, covered all upper extremity functional categories and occupational domains, and easily achieved the American Medical Association's readability standards. The Upper-Extremity Cerebral Palsy Profile of Health and Function Computerized Adaptive Test (UE-CP-PRO) showed stronger psychometrics for cerebral palsy and brachial plexus birth injury. The Infant Motor Activity Log (IMAL) is the strongest option for infants under 2 years old. The Patient-Reported Outcomes Measurement Information System Upper Extremity Module (PROMIS-UE) has strong potential but requires more diagnosis-specific validation. CONCLUSIONS: We recommend the PODCI, UE-CP-PRO, and IMAL as outlined. We also urge further validation of the PROMIS-UE computerized adaptive test and short form as shorter, more customizable alternatives to the PODCI. LEVEL OF EVIDENCE: Level II-systematic review of level I and level II studies.