Surgical Treatment of Congenital Hypoplasia of the Thumb

Jong Seo Lee; Tae Young Ahn; Tae Hoon Lee; Hui Taek Kim

doi:10.4055/jkoa.2013.48.6.464

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Lee, Ahn, Lee, and Kim: Surgical Treatment of Congenital Hypoplasia of the Thumb

Original Article

Journal of the Korean Orthopaedic Association 2013; 48(6): 464-470.

Published online: 26 December 2013

DOI: https://doi.org/10.4055/jkoa.2013.48.6.464

Surgical Treatment of Congenital Hypoplasia of the Thumb

Jong Seo Lee, M.D., Tae Young Ahn, M.D., Tae Hoon Lee, M.D., Hui Taek Kim, M.D.

Department of Orthopedic Surgery, Pusan National University Hospital, Busan, Korea.

Correspondence to: Hui Taek Kim, M.D. Department of Orthopedic Surgery, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 602-739, Korea. TEL: +82-51-240-7248, FAX: +82-51-247-8395, kimht@pusan.ac.kr

Received 10 April 2013 Revised 19 June 2013 Accepted 6 September 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We evaluated the results and complications of surgical treatment for congenital thumb abnormalities.

Materials and Methods

Between 2002 and 2011, nine thumbs were surgically treated (Pusan National University Hospital, Busan, Korea). There were five males and four females. The mean age of patients at the time of operation was 4.7 years (seven patients were under five years old and two patients were over 10). Five cases of Blauth type V hypoplasia (aplasia) were treated by pollicization (using the Buck-Gramcko technique). Four cases of type I or II hypoplasia were treated by opponensplasty and tendon transfer (for extensor and abductor augmentation). The Mehta scoring system was used for analysis of outcomes.

Results

Among nine cases, outcomes were good in five cases, fair in three cases, and poor in one case. Second operations were required due to muscle weakness and metacarpo-phalangeal joint subluxation in three cases of aplasia and one case of hypoplasia. In all cases, the range of active abduction of the thumb was more than 40° and pinch power was at least 40% of that on the normal side at the latest follow up.

Conclusion

Surgical reconstruction using pollicization and opponensplasty for congenital thumb aplasia and hypoplasia, with additional surgery for muscle weakness, provided good results both functionally and cosmetically.

Keywords: thumb, aplasia, hypoplasia, pollicization, opponensplasty

Figures and Tables

Figure 1

A 2-year-old girl (Case 4) had right thumb agenesis (A). She underwent pollicization using the Buck-Gramcko technique (B).

Figure 2

A 2-year-old boy (Case 9) had left thumb hypoplasia (A). He underwent opponensplasty using the flexor digitorum sublimus of the fourth finger along with abduction and extension augmentation using the palmaris longus and flexor carpi ulnaris. Two years after surgery, his pinch power had improved (B).

Figure 3

Thumb pinch lifting strength was measured by comparison of counterweights lifted on the affected and normal sides.

Table 1

Case Summary

F/U, follow-up; F, female; M, male; ECR, extensor carpi radialis; BR, brachioradialis; FCR, flexor carpi radialis; EPL, extensor pollicis longus; APL, abductor pollicis longus; PL, palmaris longus; FDS, flexor digitorum superficialis; MP, metacarpophalangeal; EIP, extensor indicis proprius. ^*Blauth and Buck-Gramcko classification.

Table 2

Scoring System of Mehta

Notes

This work was supported by a 2-Year Research Grant of Pusan National University.

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