Huber Opponensplasty Offers Benefit in Reconstruction of Blauth Type III Hypoplastic Thumbs
Conner J Paez, MD1, Joseph P Scollan, MD2, Lauren Grobaty, MD1 and William H Seitz Jr, MD3, (1)Cleveland Clinic Foundation, Cleveland, OH, (2)Cleveland Clinic, Cleveland, OH, (3)Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
Objective: To demonstrate that the routine use of Huber Oppenensplasty for reconstruction of Blauth II-IIIc thumbs can avoid amputation and pollicization for these patients and allows for good hand function.
Methods: A single surgeon’s patient records were reviewed retrospectively for patients with Blauth II-IIIc thumbs who underwent Huber oppenesplasty as part of a reconstructive effort. 37 cases in 35 patients were identified. Patient age at time of the opponensplasty, indications for surgery, associated procedures, and complications were documented. Primary outcome measurements were range of motion, ability to pinch, grip strength, and patient or family satisfaction with the surgery.
Results: Average age of patients at time of thumb reconstruction was 2.6-years-old. 31 of the 37 (83.8%) thumbs were noted to have full active range of motion at final follow up. 24 (64.9%) actively use the thumb to pinch during play, and 26 (70.3%) had full grip strength. 4 patients, of whom 3 were 6 months from surgery at latest follow up, continued to show thumb stiffness, and 9 had residual weakness, but incorporated the thumb in all prehensile activities. 10 minor complications included 2 local wound infections and 8 cases of webspace contracture; these were successfully managed with soft tissue surgeries. There were 3 major complications of recurrent thumb MCPJ instability, and 3 patients required revision tendon transfer procedures to improve opposition strength. All families were satisfied with final outcomes.
Conclusions: The utilization of a Huber opponensplasty in conjunction with skeletal augmentation and flexor/extensor tendon transfer when indicated provides thumb reconstruction as a viable, effective alternative to amputation and pollicization for congenital Blauth Type III hypoplasia of the thumb.
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