WOFAPS 2025 8th World Congress of Pediatric Surgery

Gergo Jozsa ¹, Tamas Kassai ²

¹ Department of Paediatrics, Division of Paediatric Surgery, University of Pécs Medical School, Pécs, Hungary
² (2) Department of Pediatric Traumatology, Dr. Manninger Jenő National Traumatology Center, Budapest

Introduction: Opponensplasty is a surgical procedure performed to restore thumb opposition, a critically important function for hand dexterity that allows for proper grasp. In children, congenital hand deformities, trauma, or conditions like cerebral palsy can cause thumb deficiency.

The goal of opponensplasty is to reconstruct the dynamic movement of the thumb. Various techniques are used, often involving tendon transfers to recreate this vital movement.

Purpose: The authors present 4 cases treated by two types of opponensplasty and their results.

Methods: The authors performed opponensplasty in all four children due to congenital thumb deficiency. They examined demographic data, the type of surgery, and functional outcomes.

Results: Three girls and one boy were involved. The median age was 4.5 years (ranging from 1.5 to 10 years). In three cases, the surgery was unilateral, and in one case, bilateral surgery was performed in two stages. A total of three Huber opponensplasties and two EIP (extensor indicis proprius) opponensplasties were performed. Good functional outcomes were observed during follow-up.

Conclusion: The need for opponensplasty in the pediatric population is relatively rare but can be crucial for improving hand function in affected children, such as writing, holding objects, and self-care activities. Due to the adaptive and developing nature of the pediatric musculoskeletal system, careful surgical planning and a thorough understanding of pediatric anatomy are essential. In our experience, these surgical techniques reliably improve thumb opposition for children with thumb deficiency. Additionally, postoperative care and rehabilitation play a critical role in achieving optimal functional outcomes.