PubMed · 3420124
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E J Bell. 1988. A splint in time.. https://pubmed.ncbi.nlm.nih.gov/3420124/
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Thumb hypoplasia is part of a spectrum of radial longitudinal deficiencies involving the upper limb. Systemic involvement of other organ systems is not uncommon, thus requiring a team approach to management. Because of the variety of anatomic abnormalities associated with thumb hypoplasia, clinical and intraoperative evaluation of the thumb must be precise. Effective management of thumb hypoplasia requires an understanding of the embryology, epidemiology, classification, presentation, and management options. Management, which is primarily determined by the grade of thumb hypoplasia, may include nonsurgical techniques, reconstruction, pollicization, and, recently, microsurgical procedures.
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If a classically hypoplastic thumb, type IIIA, presenting with a first carpometacarpal joint, is amenable to reconstruction, a type IIIB case without the basal joint, is classically treated by pollicization. The authors concur with this opinion, but found two circumstances in which reconstruction is an option in a type IIIB thumb, either when an adolescent asks for improvement of an unstable but utilized thumb, or when a parent definitely refuses pollicization. In such cases, a free, vascularized metatarsophalangeal joint is the first step of the reconstruction, followed by classic non-microsurgical steps. The authors reviewed five cases, with a mean follow-up of 7.8 years. Hypoplasia of the reconstructed thumb, and a limited pinch, allow this option only with restricted indications.