| المستخلص: |
Syndactyly is the second most common congenital deformity in the upper limb with an estimated incidence of 1 per 2000–3000 births. One of the challenges of syndactyly release is the construction of a new web space. ‘Web creep’ is a distal migration of the web following syndactyly release. It is one of the most common post-operative complications causing return to theatre and rendering furtherrisk forthe patient and cost tothe health system. In the literature the incidence rate ofweb creep is estimated to be 2% to 60%.In recent years many studies have used the incidence of post-operativeweb creep to compare the outcome of different surgical techniques. However, many of these studies do not have an objective measurement of web position and therefore cannot make an objective evaluation of web creep. The aim of this study is, first, to review all previous methods used to measure normal web position and web creep following syndactyly release in the literature; and,second, to introduce two new techniques to measure web position and to test their applicability to a small number of adult hands. First, a literature review was conducted to assess all previous measurement methods (clinical and radiological) used to measure normal web position and web creep in syndactyly. Second, two new measurement methods (dorsal and palmar) weredesigned and applied to 20 normal hands: 5 female and 5 male participants (total webs= 60). Our literature review revealed multiple methods, inconsistent and variable. Most were not tested for reliability and reproducibility and some involved radiological and radiation exposure. Results of the pilot study confirmed applicability of both proposed methods. The study indicated that the results of dorsal and palmar measurement methods are consistent with each other. The mean maximum unforced passive abduction angle for the dorsal method for the secondweb= 44.75°, for the thirdweb=40°, and for the fourthweb = 51.25°. The meanmaximum unforced passive abduction angle for the palmar method forthe secondweb= 49°, for the thirdweb=48°, and for the fourthweb=56°.The maximum unforcedpassive abduction angle was consistently smaller in thethirdweb and higher in thefourthweb underboth methods. The meandorsal method web index for the secondweb= 0.40, for the thirdweb=0.45, and for the fourthweb=0.38.The mean palmar method web index for thesecondweb=1.13, for the thirdweb=1.07, and for the fourthweb=1.17.For the dorsal method, the higher the index the more distal the web position is. For the palmar method, the lower the index, the more distal the web position is. A decreased unforcedpassive abduction angle equates with a more distal web. Both methods indicate that the thirdweb position extends further distallythan do thesecondandfourthwebs. This pilot study justifiescarrying outa further study to establish the inter-observer and intra-observer error and assess the accuracy and reproducibility of the two proposed methods. These measurement techniques can be thenadopted for use with children undergoing syndactyly surgery.
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