Surgical Reconstruction of Unstable, Hypoplastic Fingertips With Allograft and BMP-2 Augmentation: Surgical Technique and Case Series

Objective: Unstable hypoplastic digits can lead to poor function due to instability with pinch and manipulation of objects. The primary goals of surgical reconstruction in these patients are to create 2 stable digits for pinch and improve finger opposition, pinch strength, and digit mobility. In this paper, we present a surgical technique and case series of pediatric patients who underwent surgical reconstruction of unstable/telescoping hypoplastic fingertips using bony allograft augmented with BMP-2. Materials and Methods: A surgical technique for reconstruction of unstable, hypoplastic fingertips was performed using a bony allograft augmented with BMP-2. The series included pediatric patients with hypoplastic digits with instability affecting grip-pinch strength and hand prehension. Results: Ten patients between the ages of 2 and 4 years were included, with 8 thumbs and 2 index fingers being reconstructed. All 10 patients developed clinically stable digits with parent-reported improvements in pinch-grip function including using a switch, opening a bag, and putting on clothes. Postoperative radiographic outcomes did not show any cases of bony overgrowth; 2 patients had evidence of bony resorption though this did not correspond to a significant change in finger length postoperatively. Conclusion: Hypoplastic fingertip reconstruction using bony allograft augmented with BMP-2 is a surgical option for the stabilization of unstable hypoplastic fingertips in congenital hand anomalies. The use of allograft augmented with BMP-2 eliminates donor site morbidity seen with autograft reconstructive options and may limit the concerns with healing/incorporation traditionally reported with allograft use in the literature.