Growth chart patterns and clinical implications in thumb hypoplasia

Introduction: Thumb hypoplasia is a rare congenital condition that may occur in isolation or as part of multisystem syndromes. Although its anatomical and surgical management are well described, data on long-term postnatal growth patterns remain limited. Methods: This was a retrospective review of children diagnosed with thumb hypoplasia from 2003 to 2025. Data collected included demographics, Manske classification, syndromic status, surgical management and longitudinal growth measurements. Weight-, height-, and body mass index for age z -scores were calculated using World Health Organization standards, and small for gestational age status was assessed using INTERGROWTH-21st standards. Growth outcomes were compared across syndromic status, anatomical severity and surgical categories with longitudinal changes analysed from baseline to latest follow-up (median follow-up approximately 4 years). Results: A total of 291 patients were included. Growth impairment in at least one anthropometric index was observed in 47% of patients. Syndromic patients had significantly lower growth z -scores than non-syndromic patients and increasing Manske severity was associated with poorer growth indices. Birth weight and gestational age showed modest associations with postnatal growth. Surgical status and surgical type were not associated with significant differences in longitudinal growth changes. Conclusion: Children with thumb hypoplasia have impaired growth, particularly those with associated syndromes and higher severity of anomaly. Growth patterns appear to be driven primarily by systemic and biological factors rather than surgical intervention. These findings support the importance of multidisciplinary assessment and long-term growth monitoring, with growth impairment serving as a potential indicator of broader developmental or genetic pathology. Level of evidence: III