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Radial Longitudinal Deficiency: Congenital Thumb Hypoplasia

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Congenital Anomalies of the Upper Extremity

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Abstract

Congenital thumb hypoplasia is a congenital malformation involving failure of formation and/or differentiation in the radial-ulnar axis of the limb. A modification of Blauth’s classification maintains the integrity of Müller’s concept of a teratogenic sequence of increasing severity of thumb hypoplasia and the original Blauth distinction between Grades 2 and 3 according to the presence or absence of the proximal metacarpal. Sub-division within Grades 2 and 3 allows for more precise grouping and therefore comparison of like thumbs depending on the degree of hypoplasia of all thumb components.

Surgical techniques of thumb reconstruction and pollicization need to address all anatomical anomalies. Careful pre- and intraoperative assessment is necessary to choose the appropriate methods of reconstruction. Grade 2 thumbs respond well to surgical reconstruction. Grade 3, 4 and 5 thumbs may best be treated with pollicization for optimal functional results. However, reconstruction in higher grades allows retention of five digits, and alternative methods of reconstruction of a carpometacarpal joint and metacarpal through transfer of vascularized and non-vascularized joints and bone may be considered if the demand for a five-fingered hand is paramount.

Assessment of surgical outcomes is difficult because of the wide spectrum of anomalies in hypoplastic thumbs. Assessment of surgical results – comparing pre- and postoperative state, comparison of outcomes from different studies and comparison of outcomes of reconstruction of higher degrees of hypoplasia with results obtained from pollicization – might be facilitated by a proposed specific thumb hypoplasia score which is based on Blauth’s classification and applicable to all age groups.

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Authors and Affiliations

  1. University Hospital Basel, Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Basel, Switzerland

    Konrad Mende

  2. Department of Hand Surgery and Peripheral Nerve Surgery, Royal North Shore Hospital, The Children’s Hospital at Westmead, University of Sydney, Sydney, NSW, Australia

    Richard Lawson

  3. University of Sydney Medical School, Royal North Shore Hospital, The Children’s Hospital at Westmead, Department of Hand Surgery and Peripheral Nerve Surgery, Sydney, NSW, Australia

    Michael A. Tonkin

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  1. Konrad Mende
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  1. Colchester, VT, USA

    Donald R. Laub Jr.

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Mende, K., Lawson, R., Tonkin, M.A. (2021). Radial Longitudinal Deficiency: Congenital Thumb Hypoplasia. In: Laub Jr., D.R. (eds) Congenital Anomalies of the Upper Extremity. Springer, Cham. https://doi.org/10.1007/978-3-030-64159-7_9

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  • DOI: https://doi.org/10.1007/978-3-030-64159-7_9

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