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Hand and Upper Extremity Program
Finger or Thumb Hypoplasia and Aplasia
Kids aren’t just mini adults. In fact, they’re incredibly different. That’s why they need incredibly different care.
What is finger or thumb hypoplasia and finger or thumb aplasia?
Finger hypoplasia or thumb hypoplasia is when a baby is born with a finger or thumb that is not fully developed and is smaller in size. Finger aplasia or thumb aplasia is when a baby is born without a finger or thumb, and the digit is completely missing. These conditions may or may not affect all structures of the finger or thumb such as bones, tendons, ligaments, muscles, joints and nerves.
Who gets finger or thumb hypoplasia or aplasia?
Doctors do not know why hypoplasia or aplasia occurs, but they do know that it is often associated with specific syndromes and other hand differences.
Some medical conditions associated with finger or thumb hypoplasia and aplasia include:
- Apert syndrome
- Amniotic band syndrome
- Fanconi's anemia (a bone marrow failure syndrome)
- Holt-Oram syndrome
- Radial dysplasia (radial longitudinal deficiency)
- Rubinstein-Taybi syndrome
- TAR syndrome
- VACTERL syndrome
Why choose Children's Hospital Colorado for hypoplasia or aplasia care?
Our Hand and Upper Extremity Program team takes a comprehensive, multidisciplinary approach to care. This means your child has access to leading specialists from multiple departments who work together to determine the best treatment plan. In addition to top orthopedic and reconstructive hand surgeons, we also provide rehabilitation and therapy to help your child after surgery.
For finger or thumb hypoplasia and finger or thumb aplasia, your child's care team includes pediatric experts from orthopedic surgery, plastic and reconstructive surgery, rehabilitation and physical medicine, and occupational therapy.
How do we diagnose finger or thumb hypoplasia or aplasia?
We diagnose finger hypoplasia, thumb hypoplasia, finger aplasia and thumb aplasia with a physical examination, usually just after birth. An underdeveloped or missing finger or thumb is usually obvious upon birth. We use X-rays to understand just how underdeveloped the bones of the finger or thumb may be. Your child’s doctor may also order other tests to check for syndromes that are associated with finger or thumb hypoplasia and aplasia.
How do we treat finger or thumb hypoplasia and finger or thumb aplasia?
Treatment for finger or thumb hypoplasia and aplasia varies and may include surgery. In both cases, it is important to take into account the child's overall health, medical history and whether surgery will improve how the hand works. Infants and children born with these hand differences learn to use their hands to pinch and grasp using the structures of the hand they do have. Some activities are still harder for these children to perform, but most children can adapt to use their hands very effectively.
Surgery for finger or thumb hypoplasia or aplasia
If your child’s doctor does recommend surgery, some things to keep in mind include:
- Surgery recommend for hypoplasia and aplasia is usually reconstructive (rebuilding or remaking) surgery.
- Your child’s surgeon may perform surgery to make the web space (skin between the fingers or thumb and fingers) less tight, and sometimes they will use a skin graft.
- The surgery may be performed on bones, tendons, ligaments, muscles, joints or nerves.
- The surgery will be done in the operating room under general anesthesia.
What is pollicization?
Pollicization is a surgery in which the index finger is put in the place where the thumb usually is, or where there is a small thumb that does not work normally. A hand with a thumb and three fingers usually works much better than a hand with four fingers. It is also harder to see the hand difference when the child has a thumb. The index finger must work well for the surgery to be successful. We have performed many pollicization surgeries with a very high level of success.
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