On the classification of congenital thumb hypoplasia

Abstract

In 1937, Müller introduced the concept of a teratological sequence of thumb hypoplasia with increasing severity from mild deficiency, through severe deficiency, to thumb absence. Blauth subsequently detailed five specific grades. In 1992, Manske and McCarroll altered Blauth's classification such that Grade 3 was sub-divided into Grades 3A and 3B, according to a presence or absence of the proximal metacarpal. Buck-Gramcko added a Grade 3C in which there was only a remnant metacarpal head. This article investigates their publications and those of others to identify 'who said what' and clarify the definitions of grades of thumb hypoplasia. A modification of Blauth's classification is proposed, which retains the integrity of the concept of Müller and the skeletal and soft tissue grading of Blauth, but which also incorporates the disparate anomalies that may present in Grades 2 and 3 hypoplastic thumbs.

Reversed vascularized second metatarsal flap for reconstruction of Manske type IIIB and IV thumb hypoplasia with reduced donor site morbidity

“…Thumb hypoplasia refers to a spectrum of clinical abnormalities ranging from a slightly small digit to complete absence of the thumb unit. [9] The goal of treating such abnormality is to provide the child with a stable and functional thumb unit, as well as to improve cosmesis. [10] In spite of multiple studies have suggested better functional outcome of pollicization than what various bone flap based reconstructions could achieve, [11,12] parents’ objections to amputation are strong in China, as finger mutilation is associated with criminality in the afterlife by the social perceptions.…”

Methods for Congenital Thumb Hypoplasia Reconstruction. A Review of the Outcomes for Ten Years of Surgical Treatment

“…The modern classification was developed by Blauth in 1967 and consists of five grades. This classification was updated several times, first by Manske in 1992 involving a division into grade IIIa and IIIb, by Buck-Gramcko in 2002 who added grade IIIc, and finally by Tonkin in 2013 (Figure 1) who added subgrades such as IIc [12,13,14].…”

Revisiting the management of Manske Type 3B and 4 thumb hypoplasia

“…Buck-Gramcko added Grade 3C, in which only the distal one-third of the metacarpal is present. Tonkin (2014) reviewed the different modifications and proposed a unified classification from which surgical indications may be established. Despite this, there remains a degree of confusion about the different subtypes.…”