Journal of Clinical Orthopaedics | Vol 7 | Issue 2 | Jul-Dec 2022 | page: 43-51 | Bhaskaranand Kumar, Ashwath M Acharya, Himanshu R Prasad, S M Venugopal
Author: Bhaskaranand Kumar , Ashwath M Acharya , Himanshu R Prasad , S M Venugopal 
 Department of Orthopaedics, Balaji Institute of Surgery, Research and Rehabilitation for the Disabled, Tirupati, Andhra Pradesh, India,
 Department of Hand Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India,
 Department of Orthopaedic Surgeon, Sunshine Hospital, Hyderabad, Telangana, India.
Address of Correspondence
Dr. Ashwath M Acharya,
Department of Hand Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal – 576 104, Karnataka, India.
Purpose: :Congenital clasped thumb is a rare deformity and not much has been described in literature about it. The aim of this study was to evaluate clinical profile of congenital clasped thumb, examine peroperative pathoanatomy, and evaluate the results of the treatment of such cases.
Methods: A prospective study on 57 patients [106 hands] was done and their data recorded from the medical case records. A thorough clinical and radiological assessment was performed. Patients were classified using the Tsuyuguchi classification. Splinting program was initially started and patients not responding to it and those older than 10 years underwent contracture release, joint stabilization, and local flap cover with or without tendon transfers. All patients were assessed by Gilbert’s grading after 1 year.
Results: There were 43 males and 14 females. The average age was 33 months [range 0–21 years]. At presentation, 51% [54/106] of hands were classified as severe with syndromic pattern [Type III]. About 61% [35/57] of the patients presented at the age <5 years and 21% after 10 years including three adults. About 41% of these patients [23/57] had a history of consanguinity and 27% [15/57] had a family history of a similar or associated congenital deformity. Splinting program showed excellent results in type I. An a-la-Carté release of soft tissues, joint stabilization with K-wire, and ligament reconstruction with local flap cover gave good to excellent results in 73% of our patients. Nine patients had features of web creep at first web space.
Conclusion: Congenital clasp thumb showed a strong genetic predisposition. There was no difference between type II and type III variants with respect to the pathoanatomy, treatment protocol, operative procedures, and results. Splinting program in mild deformity and surgical correction with reconstruction in more severe cases gave satisfactory results.
Keywords: Congenital adducted thumb, congenital clasped thumb, first web space contracture.
- Abdel-Ghani H, El-Naggar A, Hegazy A, Hanna A, Tarraf Y, Temtamy S. Characteristics of patients with congenital clasped thumb: A prospective study of 40 patients with the results of treatment. J Child Orthop 2007;1:313-22.
- Kozin S. Deformities of the thumb. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, Cohen MS editors. Green’s Operative Hand Surgery. 7th ed. 7th ed. Philadelphia, PA: Elsevier; 2017. p. 1289-337.
- Tsuyuguchi Y, Masda K, Kawabata H, Kawai H, Ono K. Congenital clasped thumb: A review of forty-three cases. J Hand Surg Am 1985;10:613-8.
- Abdel-Ghani H, Mahmoud M, Shaheen A, Abdel-Wahed M. Treatment of congenital clasped thumb in arthrogryposis. J Hand Surg Eur 2017;42:794-8.
- Verhagen JM, Schrander-Stumpel CT, Blezer MM, Weber JW, Schrander JJ, Rubio-Gozalbo ME, et al. Adducted thumbs: A clinical clue to genetic diagnosis. Eur J Med Genet 2013;56:153-8.
- McCarroll HR, Manske PR. The windblown hand: Correction of the complex clasped thumb deformity. Hand Clin 1992;8:147-59.
- Lin SC, Hung TH, Hsu HY, Lin CG, Chiu HY. A simple splinting method for correction of supple congenital clasped thumbs in infants. J Hand Surg Br 1999;24:612-4.
- Zlotolow DA, Tiedeken NC. Reorientation osteotomy for the atypical clasp thumb in children with arthrogryposis. Tech Hand Up Extrem Surg 2014;18:165-9.
- Mahmoud M, Abdel-Ghani H, Elfar JC. New flap for widening of the web space and correction of palmar contracture in complex clasped thumb. J Hand Surg Am 2013;38:2251-6.
- Wood VE, Biondi J. Treatment of the windblown hand. J Hand Surg Am 1990;15A:431-8.
- Caroli A, Zanasi S. First web-space reconstruction by Caroli’s technique in congenital hand. deformities with severe thumb ray adduction. Br J Plast Surg 1989;42:653-9.
- Brand PW. The hand. In: Campbell’s Operative Orthopaedics. 4th ed. St Louis: CV Mosby Co.
- Buck-Gramcko D. Congenital Malformations of the Hand and Forearm. Vol. 141. London: Churchill Livingstone; 1998.
- Ezaki M, Oishi SN. Index rotation flap for palmar thumb release in arthrogryposis. Tech Hand Up Extrem Surg 2010;14:38-40.
|How to Cite this article: Kumar B, Acharya AM, Prasad HR, Venugopal SM. Clinical Profile of Congenital Clasped Thumb: A Case Series. Journal of Clinical Orthopaedics Jul-Dec 2022;7(2):43-51.|