The Pediatric Hypoplastic Thumb: Opponensplasty & MCP Joint UCL Reconstruction

Description

In this presentation led by Dr. Keith Diamond, we examine a case of a two-year-old male patient diagnosed with bilateral hypoplastic thumbs. The condition, characterized by reduced thumb size and various anatomical deficiencies, occurs approximately in 1 in 100,000 live births and is critical to assess for related health issues such as anemia and congenital anomalies.



The case details a comprehensive evaluation, including the overall health history of the patient, who was born prematurely via C-section but exhibited no complications postnatally. Notably, the patient demonstrated a preference for using his index and longer fingers in a scissor-like manner for grasping objects, indicating functional limitations due to thumb hypoplasia.



Clinical examination revealed significantly reduced thumb size, decreased thenar muscle bulk, and instability at the metacarpophalangeal joint. Imaging studies showed anatomical indicators of hypoplasia and a slight angular deformity, guiding the treatment strategy. Given the patient's challenges with thumb opposition and the presence of instability, a surgical approach involving opponensplasty and ulnar collateral ligament reconstruction was recommended.



Postoperative follow-up revealed marked improvements in thumb functionality, including the ability to perform thumb opposition and utilize the hand for common tasks like brushing teeth. The results highlight significant patient satisfaction and align with clinical literature advocating for similar surgical interventions in hypoplastic thumb cases.

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