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Trends in Bunnell and Huber Abductorplasty are Driven by Differences in Geographical Region and Surgical Training
Alejandro J. Friedman, MA, Janet Hsu, BS; Steven M. Koehler, M.D.
Montefiore Medical Center, Bronx, NY
Introduction: Thumb hypoplasia causes suboptimal prehension and manipulative grip. The Bunnell (flexor digitorum superficialis) tendon transfer and the Huber (abductor digiti minimi) muscle transfer may reconstruct abduction of hypoplastic thumbs in pediatric patients. Huber transfers provide a superior line of pull, increased strength, and more favorable hand aesthetics but are regarded as a more technically challenging procedure. We hypothesized that less Huber transfers are performed in the United States, potentially due to surgeon training pedigree. We describe trends in utilization of each over time, as well as factors that influence these trends.
Materials & Methods: The Pediatric Health Information System (PHIS) database was queried. 513 patients were identified using CPT codes for Bunnell and Huber procedures between 2004 and 2024. The presence of CPT codes was the primary outcome. Trends were described using Cochran-Armitage tests, and relationships between procedure choice and other variables were investigated using chi-square analyses and multivariate regression.
Results: 349 Bunnell procedures (68%) and 164 Huber procedures (32%) were observed. There was a strong trend towards Bunnell transfers (Z = -6.4, p < 0.001). Census region (p < 0.001), race (p = 0.002) and ethnicity (p=0.049) were associated with procedure choice. High volume hospitals (HVH) were identified as hospitals at which more than 15 procedures occurred. Surgical institution was significantly associated with procedure choice (p < 0.001). In multivariate models, the likelihood of receiving a Bunnell transfer increased 10.6% (p < 0.001) year-over-year and 11.6% (p = 0.005) year-over-year at HVHs. Patients in the Midwest were over four times more likely to receive a Bunnell, OR 4.09 (1.94-9.32), p < 0.001. At HVHs, orthopedists were over twice as likely to perform Bunnell procedures, OR 2.60 (1.16-5.84), p = 0.020.
Conclusion: The choice between a Bunnell (FDS) and Huber (ADM) tendon transfer is driven by factors including geographical location, hospital choice and surgeon subspecialty. Hospital and regional preference may be the result of pediatric hand fellowship training differences.
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