The authors present their 13 year experience with index finger pollicization for congenitally deficient thumbs and follow the functional and aesthetic progress of their patients as hand function matures with an average follow-up of 9 years. Patients varied from Blauth type V, IV, and IIIB patients with one type IIIA patient. Overall, 21 pollicizations were performed in 18 patients with an average age at operation of 3.5 years. Seven patients had radial club hands with pollicazation performed 6-12 months after hand centralization. Results demonstrated total active motion of 145 degrees for those with isolated thumb deficiency and 96 degrees for those with additional radial deficiency. Sensation was normal when compared with other digits. Grip strength was 76% of the contralateral hand in isolated thumb hypoplasia/aplasia but 40% in those with additional radial deficiency. Lateral pinch averaged 60% of the contralateral normal and tip pinch was 56% with lower strengths for those with further radial deficiency. Those operated on at younger ages (prior to age 2) tended to perform hand activities faster at final follow-up than those with surgery at later ages. Those with further radial deficiency demonstrated more difficulty with thumb function in later follow-up.
This study demonstrates results consistent with other reported ranges of results for motion and strength albeit at the upper range of desired motion and strength. The authors noted that patients with isolated thumb aplasia/hypoplasia universally did better than those with concomitant radial deficiency involving the carpus or forearm. The authors recommend performing the procedure as early as possible and only delaying the operation till older ages in those syndromes (such as Fanconi or Holt-Oram syndrome), or in those with radial deficiency which require procedures to centralize the hand prior to pollicization.