The Journal of Hand Surgery - European Volume - April 2018 - 8

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recommended conservative therapy but most did so
for a short period of time (6-12 months) with shorter
periods in older patients.
The literature (USA and Korea) suggests that 80%
of PTT cases will improve to grade 0 with up to 60
months of conservative management. We believe a
pragmatic trial of conservative management for
paediatric trigger thumb is feasible to establish the
duration and outcome of conservative management
in the UK and the development of suitable information for parents.

Apert's Hand Revisited: A New Classification
System
Mr Hazem Alfeky and Professor Paul McArthur
Alder Hey Children's Hospital
Time in programme: Friday 4th May 2018 08:51

Aim: Acrocephalosyndactyly or Apert's hand is a rare
syndrome occurring once in every 45000 live births. It
has been well described and classified by Upton into
3 types based on the configuration of the first web
space with type 3 as the most severe form. The challenge in Acrocephalosyndactyly is often more than a
first web space issue. The pattern of the proximal and
distal synostosis is one of the key factors that determines the management and outcome.
Patients and methods: 42 Apert's hands have been
assessed and managed within MDT setting. All hand
procedures were performed by a single surgeon over
a period of 10 years. A new proposed classification
system is presented. Follow up period ranged
between 4 and 13 years. Outcomes were assessed
by the hand therapy team as well as patient and
family satisfaction.
Results: The difficulty in operating on Apert's hand,
and consequently the predicted outcomes, relates
more to the degree and level of the synostosis,
status of MCPs and absence or coalescence of the
osseous elements of the hand more than the status
of the first web space.
A new classification system, based on clinical and
the x ray findings, is proposed to help planning and
predicting the outcomes of the surgery in Apert's
hand, in particular a realistic prediction of number
of digits achievable.

Journal of Hand Surgery (Eur) 43(Supplement 1)
A Palmar Bilobed Flap for the Correction of Radial
Dysplasia
Ms Ciara Deall, Professor Henk Giele and Ms Roisin Dolan
John Radcliffe Hospital
Time in programme: Friday 4th May 2018 08:55

Aims: The correction of radial dysplasia can be performed using a palmar bilobed flap that leaves less
visible scar than a dorsal approach.
Methods: This novel modification of the David Evans
dorsal bilobed approach is presented, demonstrating
the excellent access, re-distribution of the ulnar skin,
and reduced scar visibility. A review of 20 cases performed through the palmar bilobed approach is presented. The aesthetic visibility of the palmar
approach scar was compared to the scar in 20 previous cases performed through the dorsal bilobed or
dorsal curved incision by collating interobserver
scores in blinded post-operative photos of the cases.
Results: Successful completion of all radial dysplasia
corrections either radialization or centralizations,
with successful healing of all bilobed flaps. Two
cases out of twenty palmar bilobed flaps had tip
necrosis of one of the flaps requiring dressings
until healed, but no operative intervention was
required. All observers noted the lack of visible scarring on dorsal views of the wrist in the palmar
bilobed approach compared to the visible scars with
the other approaches.
Conclusion: We describe a novel modification of the
Evans dorsal bilobed incision for radial dysplasia correction that reduces the visible scarring and
improves the palmar access.

Poor Surgical Outcomes in Camptodactyly Using
Total Anterior Teno-Arthrolysis or Osteotomies
Miss Michelle Baker, Miss Roisin Dolan and
Mr Henk Giele
John Radcliffe Hospital
Time in programme: Friday 4th May 2018 08:59

Objectives: The surgical management of camptodactyly is poorly described with little data to support a
variety of surgical techniques. The aim of this study is
to correlate functional results of total anterior tenoarthrolysis (TATA) or osteotomies for camptodactyly
correction.
Methods: We performed a retrospective review of all
patients presenting consecutively to a tertiary centre
for paediatric hand surgery for the surgical managment of camptodactyly. All patients were assessed by

Table of Contents for the Digital Edition of The Journal of Hand Surgery - European Volume - April 2018