Non-vascularized metatarsal transfer for thumb hypoplasia: a medium- to long-term retrospective study of 41 patients

We retrospectively reviewed 41 Manske type IIIB and IV hypoplastic thumbs reconstructed with non-vascularized fourth metatarsal transfers with a mean age of 3.1 years (range 2-7) at the time of operation. These patients were observed for at least 5 years postoperatively. Of the 41 hands, 13 developed complications: type IV patients had significantly more complications (p = 0.014) although using an additional cerclage wire for bony fixation significantly reduced the complication rate (p = 0.045). Of the 31 hands examined with regard to growth, eight exhibited early physeal arrest of bone graft within 5 years postoperatively. The growth rate of the reconstructed first metacarpal bone was significantly lower than that of the second metacarpal bone 10 years after surgery (p = 0.041). Transfer of the non-vascularized fourth metatarsal remains an alternative for type IIIB and IV hypoplastic thumbs if parents desire to keep a five-fingered hand.