Congenital anomalies are the main cause of thumb deficiencies in children. These congenital thumb anomalies include hypoplasia and aplasia, constriction ring syndrome, brachydactyly, and true transverse absence. Thumb hypoplasia is found in longitudinal deficiencies or in underdevelopment of the preaxial ray. Hypoplasia is encountered in cases of thumb duplication in which the tissue that is supposed to form a single thumb is divided into two small thumbs that share the tendons, intrinsic muscles, and ligaments. When treating children with thumb deficiencies, the surgeon needs to be proficient in all the different techniques to restore function to the affected hand, from the different ways to correct the unstable type II of Blauth classification to the more sophisticated pollicization technique that will provide the child not only with a functional but also with a cosmetically pleasant thumb.
In this chapter, we discuss our experience with the different ways we treat the hypoplastic thumb from observation to the type I of Blauth, the three possible opponensplasty for type II, and pollicization for types III to V.
Preaxial underdevelopment Radial longitudinal deficiencies Thumb stabilization Pollicization
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