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Bilateral Digital Extensor Hypoplasia Correction: A Case Report and Systematic Review.

Marudeen Aivaz1, Esperanza Mantilla-Rivas1, Ashleigh Brennan1

  • 1Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia.

Archives of Plastic Surgery
|March 31, 2023
PubMed
Summary

Digital extensor hypoplasia (DEH) is a rare condition affecting finger extension. Successful surgical tendon transfers significantly improved a child's finger extension and function, restoring full activity.

Keywords:
congenital hypoplasiaextensor retinaculumextensor tendon transferextensors tendons

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Area of Science:

  • Hand Surgery
  • Pediatric Orthopedics
  • Congenital Malformations

Background:

  • Digital extensor hypoplasia (DEH) is a rare congenital malformation characterized by the loss of active finger extension at the metacarpophalangeal joints.
  • Optimal treatment strategies and outcomes for DEH are not well-documented in medical literature.

Purpose of the Study:

  • To describe the successful surgical management and outcomes of a pediatric patient with severe digital extensor hypoplasia.
  • To highlight the efficacy of tendon transfer surgery in restoring finger extension and function in DEH.

Main Methods:

  • Case report of a 5-year-old male with congenital DEH and severe bilateral finger extension limitation.
  • Diagnostic workup included magnetic resonance imaging (MRI) to confirm extensor tendon hypoplasia/aplasia.
  • Surgical intervention involved tendon transfers using the extensor carpi radialis longus to the common extensor tendons, with tenolysis on one hand.

Main Results:

  • The patient demonstrated marked improvement in metacarpophalangeal joint position and active finger extension 2 years postoperatively.
  • Restoration of functional grip strength and ability to grip objects without limitation was achieved.
  • The patient returned to full unrestricted activity.

Conclusions:

  • Tendon transfer surgery, potentially combined with tenolysis, is an effective treatment for digital extensor hypoplasia.
  • Operative intervention can significantly restore finger extension, improve hand function, and enhance quality of life in affected children.