Long-Term Outcomes of Huber Opposition Transfer for Augmenting Hypoplastic Thumb Function

Abstract

Purpose This study was conducted to report the functional outcomes of the Huber opposition transfer (abductor digiti minimi muscle) in type II and IIIA hypoplastic thumbs. Methods Patients who had undergone a Huber opposition transfer with at least 5 years of follow-up were included in this study. There were 21 thumbs included; 12 returned for a detailed evaluation and 9 were included with a medical record review. Outcome measures included range of motion and pinch strength; PODCI and PROMIS scores were collected on those who could return. There were 15 type II and 6 IIIA thumbs. Results Range of motion was significantly less than normal for both the interphalangeal (IP) and metacarpophalangeal (MCP) joints. For the returning cohort, key and tripod pinch were 44% and 65% of normal. The median Kapandji score was 9 (range 6–10). PODCI scores were high for global, upper extremity function, happiness, and pain. PROMIS scores were similar to normal, except for parent reports of physical function. For all included patients, there was a revision surgery rate of 22%, primarily related to persistent instability. Conclusions The Huber opposition transfer for type II and IIIA thumbs was shown to provide good subjective outcomes, despite limited range of motion and strength, at a minimum 5-year follow-up. Type of study/level of evidence Therapeutic level IV.

A detailed analysis of long-term outcomes following reconstruction for congenital thumb hypoplasia

“…Although VAS scores for function and appearance of the reconstructed thumbs in this study were significantly lower than that of contralateral thumbs, a vast majority of manual activities of daily life could be performed without difficulty and help, as measured with the ABILHAND-Kids questionnaire, the same conclusion reached by Vuillermin et al (2016) and Wall et al (2017) using different questionnaires. When comparing the two techniques for opposition transfer, the VAS scale for function was superior for patients with an ADM transfer.…”

Performance of Pediatric PROMIS CATs in Children With Upper Extremity Fractures

“…2,23 However, in the pediatric orthopedic population, PROMs such as the PODCI are routinely used and PROMIS CATs are slowly being incorporated alongside them. 18,25 Few studies have evaluated pediatric PROMIS assessments in the orthopedic population. Wall et al reported on the long-term outcomes of Huber Opposition Transfer for augmenting hypoplastic thumb.…”

“…Wall et al reported on the long-term outcomes of Huber Opposition Transfer for augmenting hypoplastic thumb. 25 In that study, PODCI and PROMIS scores were collected. Wall et al utilized PROMIS CATs to evaluate a specific pediatric orthopedic population similar to how our group analyzed pediatric orthopedic patients presenting with an UE fracture.…”

A Case of a 5-Year-Old Boy with a Blauth Type IIIB Hypoplastic Thumb Reconstructed with a Nonvascularized, Hemilongitudinal Metatarsal Transfer

“…As a common treatment option, type I follow-up is performed. Meanwhile, for types II and IIIA, opponensplasty is performed, such as the Huber opposition or flexor digitorum superficialis tendon transfers [4, 5]. Finally, for types IV and V, pollicization is performed [4, 6, 7].…”