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Opponensplasty With Abductor Pollicis Brevis Rerouting for Types II and IIIA Hypoplastic Thumbs.

Sakura Yamaguchi¹, Takehiko Takagi¹, Atsuhito Seki¹

¹Division of Orthopaedic Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan.

The Journal of Hand Surgery

|April 7, 2024

Summary

Abductor pollicis brevis rerouting effectively improved thumb alignment and strength in children with hypoplastic thumbs. This surgical technique enhanced functional outcomes, offering joint stability and improved thumb opposition.

Keywords:

Abductor pollicis brevis hypoplastic thumb opponensplasty rerouting

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Area of Science:

Hand surgery
Pediatric orthopedics
Reconstructive surgery

Background:

Hypoplastic thumbs, particularly types II and IIIA, present significant functional deficits.
Opponensplasty aims to restore thumb function and improve hand dexterity.
Abductor pollicis brevis (APB) rerouting is a surgical technique for thumb reconstruction.

Purpose of the Study:

To evaluate the functional outcomes of APB rerouting in patients with type II and IIIA hypoplastic thumbs.
To assess improvements in thumb alignment and strength following the procedure.

Main Methods:

A cohort of nine children with eleven type II and IIIA hypoplastic thumbs underwent APB rerouting.
Follow-up averaged 70 months.
Preoperative and postoperative measurements included metacarpal and phalangeal angles, grip, and pinch strength.

Main Results:

Significant improvement in the first-second metacarpal axis angle (mean 64°) and reduction in the first metacarpal-proximal phalanx angle (mean 8°).
Postoperative grip strength averaged 77% and pinch strength 72% of the unaffected side.
The procedure yielded substantial gains in thumb alignment and strength.

Conclusions:

APB rerouting is a viable surgical option for type II and IIIA hypoplastic thumbs.
The technique effectively restores opponens function, enhances joint stability, and provides a strong pronation effect.
This method significantly improves functional thumb capabilities in pediatric patients.