Single-stage Radialization and Pollicization for Radial Longitudinal Deficiency With Thumb Hypoplasia

Typically, multistage surgeries are usually required for reconstruction of radial longitudinal deficiency with thumb hypoplasia. In this study, we propose single-stage radialization and pollicization for the radial longitudinal deficiency with thumb hypoplasia. The advantages of this technique are to reduce the number of surgical operations, the amount of anesthesia required, and to reduce the cost of multiple follow-ups for patients and family. This technique is noteworthy for the following reasons: (1) use of dorsal vertical midline incision benefit radialization proximal extension for ulnar osteotomy and has less interference with pollicization incision; (2) ulnar shortening osteotomy should be done in case of difficulty in reposition carpus over distal ulnar, overlapping bone, or wrist flexion deformity after complete soft tissue released; (3) recommended fixation technique including predrill and retrograde Kirchner insertion makes for easy osteotomy fixation; (4) exit point of Kirchner wire at the palmar site of the base index metacarpal bone was less interfered with pollicization procedure; and (5) preserved dorso-radial skin bridge between pollicization incision and radialization incision allows for adequate venous draining and prevents postoperative swelling. This technique was carried out on 2 children (4-year-old girl and 2-year-old boy) who presented with type IV radial longitudinal deficiency with unreconstructable hypoplastic thumb. This procedure was successful without any postoperative complications. At 1-year follow-up, the appearance of the wrist was corrected from 90-degree radial angulation to neutral position and from 95-degree to 15-degree radial angulation respectively. For both pollicized thumbs, adequate first web space with proper opposition thumb position was achieved. Thumb tendons started to function at 3 months after surgery. Both patients were able to use their hands to grip light objects with stable carpometacarpal joint and without any pain.