Outcomes of the toe PIP joint transfer for IIIB hypoplastic thumb: Is it justified when pollicization is denied?

Amputation followed by index finger pollicization is the gold-standard treatment for type III B thumb hypoplasia. However, despite its high success rate, some parents decline this procedure because it results in a four-finger hand.

To evaluate the outcomes of reconstructive surgery in eight patients with type III B thumb hypoplasia, stabilized using a non-vascularized proximal interphalangeal (PIP) joint harvested from the foot when parental consent for pollicization was not granted.

The study cohort comprised 8 postoperative patients (mean follow-up: 7 years) who underwent reconstructive stabilization of a hypoplastic thumb using a PIP joint from the foot. Hand function was evaluated by measuring range of motion (ROM), thumb stability and length, grip strength, and performance on a manual manipulation test. Donor-site morbidity was assessed via foot examination following PIP joint harvest. Functional outcomes were further analyzed using specialized patient-reported questionnaires.

Most patients achieved good thumb stability and a functional passive range of motion. Reconstructed thumbs averaged approx. 75% of the length of a normal thumb, and grip strength measured about 50% of that in the contralateral hand. Donor-site assessment revealed toe shortening in the majority of cases but no deficits in ambulation or weight-bearing. The overall complication rate was 25%, and most patients and their parents reported satisfaction with the treatment.

Thumb reconstruction with a non-vascularized PIP joint yields enhanced stability and reduced hypermobility, with outcomes comparable to those reported for similar techniques. This approach represents a viable alternative for patients whose parents decline pollicization.