Current strategies in the management of hypoplastic thumb: surgical techniques and functional outcomes

Abstract References Abstract Introduction. Thumb hypoplasia is a spectrum of abnormalities of the first ray that profoundly impacts hand function and development. Surgical intervention aims to improve functionality and grip by addressing abnormalities of the thumb’s structures. The most commonly used classification for this condition is the Blauth classification, with modifications by Manske guiding treatment decisions. Methods. This manuscript reviews the spectrum of thumb hypoplasia, from Type I to Type V, and their respective surgical options. Techniques range from simple soft-tissue procedures, ligament reconstructions, and tendon transfers in less severe cases, to pollicization or toe phalange, metatarsophalangeal, or proximal interphalangeal joint from the foot transfer in more advanced abnormalities. Surgical decisions are influenced by abnormalities of the first carpometacarpal joint, extrinsic and intrinsic muscles, and by cosmetic and ethical considerations, which are increasingly influential in parental decision-making. Results. Functional outcomes after reconstruction are predominantly influenced by the stability of the carpometacarpal joint and the adequacy of opposition and grip. Surgical techniques – whether oppo­sitionplasty, ligament reconstruction, pollicization, or phalange/joint transfer – aim to maximize thumb mobility and stability while improving grip and pinch. Pollicization typically results in 50% of normal grip and pinch strength and a Kapandji score of 5.5–8, depending on severity. Furthermore, non-vascularized joint and phalange transfer techniques, although less frequently used, can produce reasonable stability and functionality when pollicization is declined. Conclusion. Surgery for thumb hypoplasia must be individualized based on the morphology and functionality of the thumb. Preservation and reconstruction techniques can be viable in milder cases, while pollicization is recommended in more severe abnormalities. Although outcomes can be lower than in a normal thumb, these procedures enable children to perform daily tasks more effectively and integrate the thumb into grip and pinch patterns. The decision should be made in collaboration with the patient’s family, taking into account both functional and aesthetic preferences.