Mateusz Gładysz FESSH prep

FESSH prep Congenital hand Shared features of Blauth types II and IIIA, Manske subdivision of type III and choice of reconstruction or pollicisation, strength after pollicisation, effect of radial longitudinal deficiency, patient and parent satisfaction

Thumb hypoplasia: classification, reconstruction and pollicisation

Last reviewed v1.0

FESSH-068Congenital hand●●● advanced

Regarding congenital thumb hypoplasia and its surgical treatment:

  1. 1.Blauth type II and type IIIA hypoplastic thumbs share a narrowed first web space, hypoplastic or absent thenar muscles and metacarpophalangeal joint instability.

  2. 2.In Manske's subdivision of Blauth type III, the presence of a first carpometacarpal joint (type IIIA) favours reconstruction, whereas type IIIB, with aplasia of the metacarpal base, has traditionally been treated by pollicisation.

  3. 3.After index pollicisation for thumb hypoplasia or aplasia, grip and pinch strength usually reach normal values.

  4. 4.The functional outcome of index pollicisation is not influenced by an associated radial longitudinal deficiency.

  5. 5.Patient and parent satisfaction with the function and appearance of a pollicised thumb is generally high.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-068
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. Blauth type II and type IIIA hypoplastic thumbs share a narrowed first web space, hypoplastic or absent thenar muscles and metacarpophalangeal joint instability.

    True

    Reconstruction therefore addresses each component: widening of the first web space, an opposition transfer and stabilisation of the metacarpophalangeal joint. In Christen's technique the ring-finger flexor digitorum superficialis provides the opposition transfer and is also used to stabilise the metacarpophalangeal joint.

    • Christen T, Dautel G. Type II and IIIA thumb hypoplasia reconstruction. J Hand Surg Am. 2013;38(10):2009-15. PMID 24021736

  2. 2. In Manske's subdivision of Blauth type III, the presence of a first carpometacarpal joint (type IIIA) favours reconstruction, whereas type IIIB, with aplasia of the metacarpal base, has traditionally been treated by pollicisation.

    True

    Manske promoted reconstruction rather than pollicisation for type IIIA, in which a carpometacarpal joint is present. In Foucher's series, staged reconstruction of type III thumbs gave results inferior to pollicisation in both function and appearance; some groups now reconstruct selected type IIIB thumbs when parents decline pollicisation.

    • Foucher G, Gazarian A, Pajardi G. [Reconstructive surgery of Blauth type III hypoplasia of the thumb]. Chir Main. 1999;18(3):191-6. PMID 10855319
    • Balakrishnan G, Vijayaragavan S, Somesh B. Restoration of Five Digit Hand in Type III B & C Thumb Hypoplasia-A Game Changer in Surgical Management. Indian J Plast Surg. 2020;53(3):349-356. PMID 33402764

  3. 3. After index pollicisation for thumb hypoplasia or aplasia, grip and pinch strength usually reach normal values.

    False

    In Netscher's series of isolated thumb aplasia or severe hypoplasia, mean grip and lateral pinch strength of the operated hands were 3.4 kg and 1.2 kg, against 11.7 kg and 4.4 kg in normal non-dominant hands. De Kraker likewise found range of motion and strength after pollicisation significantly below normative data.

    • Netscher DT, Aliu O, Sandvall BK, Staines KG, Hamilton KL, Salazar-Reyes H, et al.. Functional outcomes of children with index pollicizations for thumb deficiency. J Hand Surg Am. 2013;38(2):250-7. PMID 23290464
    • de Kraker M, Selles RW, van Vooren J, Stam HJ, Hovius SE. Outcome after pollicization: comparison of patients with mild and severe longitudinal radial deficiency. Plast Reconstr Surg. 2013;131(4):544e-551e. PMID 23542272

  4. 4. The functional outcome of index pollicisation is not influenced by an associated radial longitudinal deficiency.

    False

    De Kraker found that all strength measurements after pollicisation were significantly more affected in severe than in mild longitudinal radial deficiency. In Ceulemans's series, function and subjective evaluation were significantly worse when the thumb deficiency was associated with a radial club hand, whereas syndromic and isolated cases did not differ.

    • de Kraker M, Selles RW, van Vooren J, Stam HJ, Hovius SE. Outcome after pollicization: comparison of patients with mild and severe longitudinal radial deficiency. Plast Reconstr Surg. 2013;131(4):544e-551e. PMID 23542272
    • Ceulemans L, Degreef I, Debeer P, De Smet L. Outcome of index finger pollicisation. J Hand Microsurg. 2010;2(1):13-7. PMID 23129947

  5. 5. Patient and parent satisfaction with the function and appearance of a pollicised thumb is generally high.

    True

    In de Kraker's long-term study, a median of 9.4 years after pollicisation, patients and parents were very satisfied with the function and appearance of the new thumb although strength and motion were below normative data. Netscher also reported favourable parent and patient perspectives.

    • de Kraker M, Selles RW, van Vooren J, Stam HJ, Hovius SE. Outcome after pollicization: comparison of patients with mild and severe longitudinal radial deficiency. Plast Reconstr Surg. 2013;131(4):544e-551e. PMID 23542272
    • Netscher DT, Aliu O, Sandvall BK, Staines KG, Hamilton KL, Salazar-Reyes H, et al.. Functional outcomes of children with index pollicizations for thumb deficiency. J Hand Surg Am. 2013;38(2):250-7. PMID 23290464