The Oberg, Manske, and Tonkin Classification of Congenital Upper Limb Anomalies: A Consensus Decision-Making Study for Difficult or Unclassifiable Cases
An ideal classification system promotes communication and guides treatment for congenital upper limb differences (CULDs). The Oberg, Manske, and Tonkin (OMT) classification utilizes phenotypic presentation and knowledge of developmental biology for the classification of CULDs. In this consensus deci...
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creator | Wall, Lindley B. McCombe, David Goldfarb, Charles A. Lam, Wee Leon Wall, Lindley B. Van Heest, Ann James, Michelle Steinman, Suzanne Popp, Jim Ezaki, Marybeth Goldfarb, Charles A. McCombe, David Boyce, Dean Bourke, Grainne Coombs, Chris Tolerton, Sarah Lam, Wee Leon Horwitz, Maxim |
description | An ideal classification system promotes communication and guides treatment for congenital upper limb differences (CULDs). The Oberg, Manske, and Tonkin (OMT) classification utilizes phenotypic presentation and knowledge of developmental biology for the classification of CULDs. In this consensus decision-making study, we hypothesized that CULDs that are difficult to classify would be identically classified by a group of experienced pediatric hand surgeons.
An international consortium of 14 pediatric hand surgeons in 3 countries contributed a group of 72 difficult-to-classify CULD cases. These were identified from the clinical practices of the surgeons and from associated registries. Through a Delphi-type process, repeated efforts were made to obtain consensus for the correct OMT classification of each case utilizing clinical images and radiographs.
The first round of discussion yielded a universal consensus for 57 cases. The remaining 15 cases continued to be put through additional rounds of the Delphi-type process. The repeat classification and discussion resulted in a final yield of 93% complete consensus in classification by the OMT. The primary challenge in diagnosis was differentiating cleft hand from ulnar longitudinal deficiency, identified as group A. Five cases were in this group, yet 2 remained without a clear consensus. Another controversial group, group B, was termed “brachy-polydactyly” and consisted of 3 cases where diagnoses varied between sympolydactyly, symbrachydactyly, or complex syndactyly.
The Delphi-type process was feasible and effective and allowed a 93% consensus in the diagnosis of difficult-to-classify cases by the OMT Classification. There remain limitations and controversies with the OMT system, especially when classifying hands with less than 5 skeletal digits, syndactyly, and those with diagnostic overlap between ulnar longitudinal deficiency and cleft hand and those considered “brachypolydactyly.” An improved understanding of the underlying etiology may be needed to determine the final diagnosis in difficult-to-classify conditions.
A consensus-seeking approach is effective and feasible in addressing difficult-to-classify CULDs. |
doi_str_mv | 10.1016/j.jhsa.2022.07.007 |
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An international consortium of 14 pediatric hand surgeons in 3 countries contributed a group of 72 difficult-to-classify CULD cases. These were identified from the clinical practices of the surgeons and from associated registries. Through a Delphi-type process, repeated efforts were made to obtain consensus for the correct OMT classification of each case utilizing clinical images and radiographs.
The first round of discussion yielded a universal consensus for 57 cases. The remaining 15 cases continued to be put through additional rounds of the Delphi-type process. The repeat classification and discussion resulted in a final yield of 93% complete consensus in classification by the OMT. The primary challenge in diagnosis was differentiating cleft hand from ulnar longitudinal deficiency, identified as group A. Five cases were in this group, yet 2 remained without a clear consensus. Another controversial group, group B, was termed “brachy-polydactyly” and consisted of 3 cases where diagnoses varied between sympolydactyly, symbrachydactyly, or complex syndactyly.
The Delphi-type process was feasible and effective and allowed a 93% consensus in the diagnosis of difficult-to-classify cases by the OMT Classification. There remain limitations and controversies with the OMT system, especially when classifying hands with less than 5 skeletal digits, syndactyly, and those with diagnostic overlap between ulnar longitudinal deficiency and cleft hand and those considered “brachypolydactyly.” An improved understanding of the underlying etiology may be needed to determine the final diagnosis in difficult-to-classify conditions.
A consensus-seeking approach is effective and feasible in addressing difficult-to-classify CULDs.</description><identifier>ISSN: 0363-5023</identifier><identifier>EISSN: 1531-6564</identifier><identifier>DOI: 10.1016/j.jhsa.2022.07.007</identifier><identifier>PMID: 36089550</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Anomalies ; Child ; congenital ; Consensus ; Delphi ; Hand Deformities, Congenital ; Humans ; Syndactyly ; Syndrome ; Upper Extremity ; Upper Extremity Deformities, Congenital - diagnosis ; upper limb</subject><ispartof>The Journal of hand surgery (American ed.), 2024-04, Vol.49 (4), p.379.e1-379.e7</ispartof><rights>2024 American Society for Surgery of the Hand</rights><rights>Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-1db50712cbe306ddb8ab376647dc7574c1df4d0c7a794b6fe9db945c938bf3543</citedby><cites>FETCH-LOGICAL-c356t-1db50712cbe306ddb8ab376647dc7574c1df4d0c7a794b6fe9db945c938bf3543</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jhsa.2022.07.007$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36089550$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wall, Lindley B.</creatorcontrib><creatorcontrib>McCombe, David</creatorcontrib><creatorcontrib>Goldfarb, Charles A.</creatorcontrib><creatorcontrib>Lam, Wee Leon</creatorcontrib><creatorcontrib>Wall, Lindley B.</creatorcontrib><creatorcontrib>Van Heest, Ann</creatorcontrib><creatorcontrib>James, Michelle</creatorcontrib><creatorcontrib>Steinman, Suzanne</creatorcontrib><creatorcontrib>Popp, Jim</creatorcontrib><creatorcontrib>Ezaki, Marybeth</creatorcontrib><creatorcontrib>Goldfarb, Charles A.</creatorcontrib><creatorcontrib>McCombe, David</creatorcontrib><creatorcontrib>Boyce, Dean</creatorcontrib><creatorcontrib>Bourke, Grainne</creatorcontrib><creatorcontrib>Coombs, Chris</creatorcontrib><creatorcontrib>Tolerton, Sarah</creatorcontrib><creatorcontrib>Lam, Wee Leon</creatorcontrib><creatorcontrib>Horwitz, Maxim</creatorcontrib><creatorcontrib>ICHAD study group</creatorcontrib><title>The Oberg, Manske, and Tonkin Classification of Congenital Upper Limb Anomalies: A Consensus Decision-Making Study for Difficult or Unclassifiable Cases</title><title>The Journal of hand surgery (American ed.)</title><addtitle>J Hand Surg Am</addtitle><description>An ideal classification system promotes communication and guides treatment for congenital upper limb differences (CULDs). The Oberg, Manske, and Tonkin (OMT) classification utilizes phenotypic presentation and knowledge of developmental biology for the classification of CULDs. In this consensus decision-making study, we hypothesized that CULDs that are difficult to classify would be identically classified by a group of experienced pediatric hand surgeons.
An international consortium of 14 pediatric hand surgeons in 3 countries contributed a group of 72 difficult-to-classify CULD cases. These were identified from the clinical practices of the surgeons and from associated registries. Through a Delphi-type process, repeated efforts were made to obtain consensus for the correct OMT classification of each case utilizing clinical images and radiographs.
The first round of discussion yielded a universal consensus for 57 cases. The remaining 15 cases continued to be put through additional rounds of the Delphi-type process. The repeat classification and discussion resulted in a final yield of 93% complete consensus in classification by the OMT. The primary challenge in diagnosis was differentiating cleft hand from ulnar longitudinal deficiency, identified as group A. Five cases were in this group, yet 2 remained without a clear consensus. Another controversial group, group B, was termed “brachy-polydactyly” and consisted of 3 cases where diagnoses varied between sympolydactyly, symbrachydactyly, or complex syndactyly.
The Delphi-type process was feasible and effective and allowed a 93% consensus in the diagnosis of difficult-to-classify cases by the OMT Classification. There remain limitations and controversies with the OMT system, especially when classifying hands with less than 5 skeletal digits, syndactyly, and those with diagnostic overlap between ulnar longitudinal deficiency and cleft hand and those considered “brachypolydactyly.” An improved understanding of the underlying etiology may be needed to determine the final diagnosis in difficult-to-classify conditions.
A consensus-seeking approach is effective and feasible in addressing difficult-to-classify CULDs.</description><subject>Anomalies</subject><subject>Child</subject><subject>congenital</subject><subject>Consensus</subject><subject>Delphi</subject><subject>Hand Deformities, Congenital</subject><subject>Humans</subject><subject>Syndactyly</subject><subject>Syndrome</subject><subject>Upper Extremity</subject><subject>Upper Extremity Deformities, Congenital - diagnosis</subject><subject>upper limb</subject><issn>0363-5023</issn><issn>1531-6564</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcuO0zAYRi0EYsrAC7BAXrKYBDuO7RaxqTLcpI5mQbu2fPnTcSexi50gzZvwuLhqYcnKsnS-Y1kHobeU1JRQ8eFQHx6yrhvSNDWRNSHyGVpQzmgluGifowVhglWcNOwKvcr5QEhZMf4SXTFBlivOyQL93j4AvjeQ9jf4Tof8CDdYB4e3MTz6gLtB5-x7b_XkY8Cxx10Mewh-0gPeHY-Q8MaPBq9DHPXgIX_E6xOSIeQ541uwPpdhdaeLbY9_TLN7wn1M-Nb3xToPEy6XXbCXd7QZAHc6Q36NXvR6yPDmcl6j3ZfP2-5btbn_-r1bbyrLuJgq6gwnkjbWACPCObPUhkkhWums5LK11PWtI1ZquWqN6GHlzKrldsWWpme8Zdfo_dl7TPHnDHlSo88WhkEHiHNWjaSsmAXnBW3OqE0x5wS9OiY_6vSkKFGnIuqgTkXUqYgiUpUiZfTu4p_NCO7f5G-CAnw6A1B--ctDUtl6CBacT2An5aL_n_8Pk_SeKQ</recordid><startdate>202404</startdate><enddate>202404</enddate><creator>Wall, Lindley B.</creator><creator>McCombe, David</creator><creator>Goldfarb, Charles A.</creator><creator>Lam, Wee Leon</creator><creator>Wall, Lindley B.</creator><creator>Van Heest, Ann</creator><creator>James, Michelle</creator><creator>Steinman, Suzanne</creator><creator>Popp, Jim</creator><creator>Ezaki, Marybeth</creator><creator>Goldfarb, Charles A.</creator><creator>McCombe, David</creator><creator>Boyce, Dean</creator><creator>Bourke, Grainne</creator><creator>Coombs, Chris</creator><creator>Tolerton, Sarah</creator><creator>Lam, Wee Leon</creator><creator>Horwitz, Maxim</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202404</creationdate><title>The Oberg, Manske, and Tonkin Classification of Congenital Upper Limb Anomalies: A Consensus Decision-Making Study for Difficult or Unclassifiable Cases</title><author>Wall, Lindley B. ; 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The Oberg, Manske, and Tonkin (OMT) classification utilizes phenotypic presentation and knowledge of developmental biology for the classification of CULDs. In this consensus decision-making study, we hypothesized that CULDs that are difficult to classify would be identically classified by a group of experienced pediatric hand surgeons.
An international consortium of 14 pediatric hand surgeons in 3 countries contributed a group of 72 difficult-to-classify CULD cases. These were identified from the clinical practices of the surgeons and from associated registries. Through a Delphi-type process, repeated efforts were made to obtain consensus for the correct OMT classification of each case utilizing clinical images and radiographs.
The first round of discussion yielded a universal consensus for 57 cases. The remaining 15 cases continued to be put through additional rounds of the Delphi-type process. The repeat classification and discussion resulted in a final yield of 93% complete consensus in classification by the OMT. The primary challenge in diagnosis was differentiating cleft hand from ulnar longitudinal deficiency, identified as group A. Five cases were in this group, yet 2 remained without a clear consensus. Another controversial group, group B, was termed “brachy-polydactyly” and consisted of 3 cases where diagnoses varied between sympolydactyly, symbrachydactyly, or complex syndactyly.
The Delphi-type process was feasible and effective and allowed a 93% consensus in the diagnosis of difficult-to-classify cases by the OMT Classification. There remain limitations and controversies with the OMT system, especially when classifying hands with less than 5 skeletal digits, syndactyly, and those with diagnostic overlap between ulnar longitudinal deficiency and cleft hand and those considered “brachypolydactyly.” An improved understanding of the underlying etiology may be needed to determine the final diagnosis in difficult-to-classify conditions.
A consensus-seeking approach is effective and feasible in addressing difficult-to-classify CULDs.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>36089550</pmid><doi>10.1016/j.jhsa.2022.07.007</doi></addata></record> |
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subjects | Anomalies Child congenital Consensus Delphi Hand Deformities, Congenital Humans Syndactyly Syndrome Upper Extremity Upper Extremity Deformities, Congenital - diagnosis upper limb |
title | The Oberg, Manske, and Tonkin Classification of Congenital Upper Limb Anomalies: A Consensus Decision-Making Study for Difficult or Unclassifiable Cases |
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