Index finger pollicization for treating a congenitally nonfunctioning thumb in patients with radial longitudinal deficiency

Radial longitudinal deficiency (radial club hand) is a congenital deformity in the upper extremity that can present with a range of thumb deficiencies. A variety of surgical procedures to correct for absence of a thumb have been described, such as pollicization, osteoplastic reconstruction, toe to hand transfer, and extension with distraction. We have reviewed 8 index finger pollicizations in 6 patients after correction of the radial club hand deformity through wrist centralization. Four hands used were the dominant hand. Buck-Gramcko’s technique was used with a mean age of 4.6 (range from 2 to 14) years. The mean follow-up time was 6 (range from 2 to 10) years. The mean active range of motion at the pollicized digit was 121.4 (range from 83 to 150) degrees. The result was considered excellent in 5 cases (62.5%), good in 2 cases (25%), and fair in 1 case (12.5%) in accordance with Percival’s scoring system; none of the outcomes were poor. The younger patients adapted easier. Index finger pollicization is a method that provides dramatic improvement to hand function in thumb aplasia or severe hypoplasia, which may be preferred in treatment. The operations improved hand cosmetic appearance and functional ability.