Trends in Bunnell and Huber Abductorplasty are Driven by Differences in Patient Age, Geographical Region, and Surgical Training

Purpose: Congenital thumb hypoplasia is a rare condition often treated with tendon transfers to restore thumb abduction and stability.The two most common techniques are the Bunnell (flexor digitorum superficialis transfer) and the Huber (abductor digiti minimi transfer), but evidence guiding choice between procedures and surgeon preferences remains limited.Methods: We conducted a retrospective analysis of 426 children who underwent Bunnell or Huber transfers for thumb hypoplasia between 2004 and 2024 using the Pediatric Health Information System database.Multivariable regression was used to evaluate the association of patient, surgeon, and hospital characteristics with procedure choice.Results: Bunnell transfers were significantly more common than Huber transfers overall, with increasing relative use over time.Census region, surgical specialty, patient age, and institutional context were all independently associated with procedure choice.Children aged 5-12 years were more than twice as likely to undergo Bunnell transfers than younger patients, whereas 70% of infants aged under 12 months underwent Huber procedures.Orthopedic surgeons were nearly four times more likely to perform Bunnell transfers than plastic surgeons at high-volume hospitals, and there was substantial variation among high-volume hospitals, including opposite preferences at two children's hospitals in the South.Conclusions: Our findings demonstrate that procedure selection reflects not only patient age and clinical factors, but also surgeon training and institutional culture.Trends toward increasing Bunnell use, particularly in older children and at orthopedic-led centers, highlight the importance of balanced surgical training and context-aware decision making in the management of congenital thumb hypoplasia.