Treatment of congenital clasped thumb in arthrogryposis.

We report the result of treatment of 69 complex clasped thumbs in 39 patients with distal arthrogryposis. The mean age at surgery was 30 months. Surgical reconstruction included skin augmentation of the first web using modified dorsal rotation advancement flap (Abdel-Ghani flap), a la Carte release of tight structures of the first web, and chondrodesis of the thumb metacarpophalangeal joint. The mean follow-up was 4 years. We prefer chondrodesis because of the presence of global instability, abnormal joint structure, abnormal articular surfaces, and inefficient muscles for transfer. Also, chondrodesis shortens the thumb and may alleviate the need for release of deficient palmar skin and lengthening of a short flexor pollicis longus. The Abdel-Ghani flap provides ample skin that gives a wide rounded web. It is a simple procedure with minimal donor site morbidity. Surgical reconstruction significantly improved the cosmetic appearance and function of the thumb.

LEVEL OF EVIDENCE: IV.