Opponensplasty for Nerve Palsy: A Systematic Review

Area of Science:

• Hand surgery
• Reconstructive surgery
• Orthopedics

Background:

• Thumb opposition is crucial for hand function, and its loss leads to significant disability.
• Congenital and acquired conditions can impair thumb opposition, necessitating reconstructive procedures.
• Opponensplasty aims to restore thumb function through various surgical transfer techniques.

Approach:

• A systematic review adhering to PRISMA guidelines was performed.
• Searched PubMed, Embase, Medline, and Web of Science for studies on opponensplasty techniques.
• Included 42 studies (873 patients) published before April 2021 focusing on neurologic dysfunction.

Key Points:

• Palmaris longus (PL), extensor indicis proprius (EIP), and flexor digitorum superficialis (FDS) are common tendon transfers for opponensplasty.
• All techniques improved range of motion, pinch strength, and Kapandji scores.
• FDS and EIP transfers yielded better functional results but had higher complication rates (19% and 12%, respectively) mainly from donor sites. PL transfers had a 6% complication rate, often due to bowstringing.

Conclusions:

• Significant heterogeneity exists in opponensplasty literature, limiting direct statistical comparison.
• FDS and EIP transfers offer superior functional outcomes for thumb opposition restoration.
• Higher complication rates associated with FDS and EIP necessitate careful patient counseling regarding technique-specific risks and benefits. Further comparative studies are recommended.