The X-rays seem to be consistent with a type 3b thumb.
It sounds as though you have a good command of the issues here. Ask your questions without hesitation. Your questions here are great.
The paper you refer to was published in 1998. While commendable, this has not caught on as the latest and greatest for type 3b thumbs.
perhaps one reason is from the article itself in the discussion. Cultural motivation was high here and donor site issue should not be negated. With small numbers there is no real way to interpret the hand or occupation therapy data objectively.
This is one article. One article is an idea but it has not caught on as a new treatment widely.
from the discussion
Indications for operative treatment also are affected by cultural background. We prefer to treat a type-IIIB hypoplastic thumb with salvage and reconstruction because of the importance of the five-digit hand in Japanese culture. This consideration may be a factor in other cultures as well.
Reconstruction of the donor site has been a problem. Simply interposing free bone graft in the second toe will not maintain stability because the graft will not grow. Syndactyly between the second and third toes did not maintain the position of the second toe in the two patients who were so managed in the present study. The creation of a stable, artificial cutaneous syndactyly involving the great, second, and third toes may be more effective for maintaining the position of the second toe. Another alternative is to ablate the second toe primarily. None of our patients reported problems with weight-bearing or wanted the donor toe to be ablated.
In the present study, the number of patients in both groups was small and the groups were not comparable with regard to the ages of the patients or the types of deformities; therefore, any conclusions drawn from these data should be interpreted with caution. The transfer procedure showed promising results when compared with the pollicization procedure. In the present study, function of the hand was expressed as a percentage of normal (control) values6. We believe that this method of evaluation ensured that the difference between the groups with regard to age at the time of the operation had a negligible effect on the functional results.
In the intro the authors also note " Although the appearance of the thumb was closer to normal in the group that had had the pollicization procedure..." this is the thumb they talk about itself
The thumb will grow as is if left untouched, no sudden growth will occur.
Yes and no. Its not always Dad v Mom but you've hit the nail on the head with your questions
Remember what the abstract said regarding THUMB appearance .. and understand that is WHY.most casual observers DO NOT notice a 4 fingered pollicized hand. They do notice a thumb that is awkward...so are you really getting better cosmesis with a reconstruction.. and avoiding pollicization....arguably not
