Surgical correction of polydactyly in a camel (Camelus dromedarius)

A 2-mo-old, 90-kg, intact male camel (Camelus dromedarius) was admitted for surgical removal of a supernumerary digit associated with the medial aspect of the right carpus and metacarpus. Radiographic views of the carpus and metacarpus revealed the supernumerary digit articulating with the middle carpal joint via an extra carpal bone. The supernumerary digit consisted of three bones. Surgical removal of the supernumerary digit was recommended to restore normal limb conformation, limit the possibility of future lameness, and improve the cosmetic appearance of the limb. Complete surgical removal of the digit was performed by disarticulating the extra carpal bone from its attachments to the second and radial carpal bones. One year after surgery, the leg appeared grossly normal and the camel showed no sign of lameness.

[Polydactyly of the foot]

Polydactyly may be preaxial or tibial (hallux-side), postaxial or ulnar (side of the little toe) and central (middle toes). The duplication may appear at the distal and medial phalanges or at the whole digit. The metatarsal bone may be part wise or completely duplicated, the accessory toes may share only one metatarsal. Surgical intervention may be indicated in shoe problems, for esthetic reasons or, especially in duplication of the metatarsales, because of secondary deviation of the toes and therefore shoe problems or plantar callosities. Preoperative analysis including x-ray is of great importance to achieve good functional and cosmetic results.

[Hallux varus congenitus]

INTRODUCTION

The congenital hallux varus is a rare hereditary deformity of the big toe, which often is combined either with polydactylia or with systemic deformities of the skeleton. The congenital hallux varus can be easily diagnosed clinically. The X-ray shows the ossified bony elements and provides information about the shape and number of the digits as well as their axial deviation. An operative treatment is required. So far a standardized surgical technique has not been accepted for all types of hallux varus.

METHODS

The correction of the bony structures and soft tissues is planned by means of preoperative scetches. The amount of correction depends on the degree of the deformity. As consequence of the reorientation of the first ray a soft tissue flap has to be planned and prepared for wound closure which otherwise would need larger grafts.

RESULTS

Based on this series the clinical and radiological appearance of the congenital hallux varus are discussed. The operative treatment is explained step by step illustrated by photographs as well as planing scetches. Our procedures are compared to other operative methods reported in the literature.

CONCLUSIONS

There are no diagnostic problems with the hallux varus deformity. For therapy surgery is mandatory and recommended between 9 and 24 months of age. For microsurgical preparation and correction of the deformity planning of all surgical steps and alternatives is advocated, this allows for good functional and cosmetic results.

An unusual case of polydactyly of the thumb

We present an unusual case of polydactyly of the thumb. The patient, despite having a fully developed nail bed, had a duplication at the metacarpophalangeal level consisting of a single bony phalanx. The Wassel classification of polydactyly, which is the most commonly cited classification scheme, does not include this particular anomaly. In addition, there has been no reference to this type of polydactyly in the literature.

Congenital tibial aplasia with preaxial polydactyly. A case report

An anatomical study of a left lower limb with congenital tibial aplasia and preaxial polydactyly amputated at 10 months of age was carried out. The tibia was replaced by a fibrous band (a band of connective tissue) and there were four cuneiforms, six metatarsal bones and seven toes. The second metatarsal bone showed characteristics of the hallux. An intermuscular septum which showed an orifice for the anterior tibial artery was found on the medial side of the leg and foot. All the muscles of the leg and foot were present except for the tibialis posterior muscle, which was replaced by two atypical muscles. No muscular attachments reached the fibrous band. Several intertendinous connection bands were found. Also, an accessory muscular belly split from the tibialis anterior tendon and attached to the common flexor tendinous sheet of the foot. An unusual motor branch of the deep peroneal nerve ran together with this belly to supply the intrinsic muscles of the hallux. We also observed other minor anomalies of the nerve pattern. The arterial pattern was complete, except for some arteries which showed both an anomalous origin and course. The findings of this study suggest that the development of the skeletal elements plays an important role in the differentiation of the muscles, tendons, arteries and nerves. We postulate that a dysmorphogenic event involving the development of the tibial field of the limb could give rise to both defective histodifferentiation of the tibia and defective programmed cell death in the pre-hallucial anlage. These anomalies would determine secondary adaptations of muscles, tendons, vessels and nerves of the limb.

Urinary hydrocolpos, cloacal malformation and pre-axial polydactyly: a rare variant of neonatal hydrocolpos

Hydrocolpos is characterized by a vaginal obstruction with cystic dilatation of the vagina. The latter is usually caused by accumulation of cervical and endometrial mucus but in rare instances urine is accumulated through a vesicovaginal fistula proximal to the obstruction. Hydrocolpos and hydrometrocolpos may be associated with other malformations, such as postaxial polydactyly, anal atresia, esophageal atresia, renal agenesis, genital anomalies, and cardiopathy. Each neonate presenting with hydrocolpos should be evaluated for other clinically silent malformations, such as hamartoblastoma of the hypothalamic region. We report a patient with urinary hydrocolpos and cloacal malformation; it is the first case of hydrocolpos with pre-axial polydactyly. We briefly describe embryogenesis of the different types of vaginal obstruction and discuss prenatal and neonatal diagnosis and differential diagnosis.

[A case of the CHARGE association with failed tracheal intubation]

We experienced a patient with the CHARGE association whose trachea could not be intubated in spite of attempts of laryngoscopy by four experienced anesthesiologists. Laryngeal fiberscope and neck X-ray examination carried out after the surgery, revealed the obvious enlargement of adenoid and tonsils, pressing the epiglottis to the posterior wall of the larynx. Although it is unknown whether enlargement of adenoid and tonsils are specific to the CHARGE association or not, patients with the CHARGE association are considered to have difficult airway. Preanesthetic evaluation of airway is indispensable for anesthesia in the patients with the CHARGE association.

Finger polydactyly

Polydactyly is one of the most common congenital differences. Duplications of the index finger, central rays, and small digit each have unique characteristics and associations. Complex anomalies such as the mirror hand and pentadactyly represent specialized forms of polydactyly. The goal of reconstructing a functional hand is met by appreciating the anatomic variations and systemic implications, then employing the challenging technical and intellectual concepts described.

Thumb duplication

Thumb duplication is a complex congenital anomaly. Treatment requires a detailed understanding of the pathophysiology as well as an appreciation of all the components involved. The goals of surgery are to restore the normal anatomic relationships of the residual thumb. Successful reconstruction requires evaluation and correction of the bony axis; articular congruity; size and angulation; intrinsic and extrinsic musculotendinous abnormalities; and ligament, skin, and soft-tissue elements. The reconstructed thumb may not match the normal thumb because of the hypoplasia that is inherently associated with the condition. With careful preoperative planning and attention to detail, however, a satisfactory cosmetic and functional result can be achieved.

Complete digital duplication: a case report and review of ulnar polydactyly

An unusual case is presented of bilateral, complete digital duplication on the hand of a 9-month-old boy. Radiographic evaluation showed duplication of intact phalanges and metacarpals. Although ulnar polydactyly has been described as one of the most common congenital anomalies of the extremities, it usually manifests itself as a rudimentary skin tag. Ulnar polydactyly can be classified on the basis of genetic, morphologic, and clinical implications. Although polydactyly is reported to occur among approximately 1 in 1000 live births, most of these malformations are rudimentary skin tags. Complete ulnar polydactyly is uncommon; it occurs among approximately 0.014% of all live births. The main goal of surgical treatment of patients with complete-duplication ulnar polydactyly is to establish adequate function. This case report describes the preoperative evaluation and management of complete bilateral duplication of the ulnar digits of the hand.

Plantar-advancement skin flap for central ray resections in the foot: description of a technique

A surgical technique using an advancement plantar skin flap to maintain the resection gap closure when performing central ray resections is described and illustrated. The concept, applicable to central polydactyly or polysyndactyly of the foot, was developed with goals of providing a skin tether to maintain a normally narrow foot as well as to improve the appearance of the surgical scar.

Lateral ray polydactyly: a case of duplicated metatarsal with normal phalanges

Lateral ray polydactyly of the foot is morphologically classified on the basis of the external appearance and the anatomic patterns of bony structures. Classification is difficult when the level of duplication is not apparent. We encountered a case of a duplicated metatarsal with no duplication of phalanges. The anomaly was considered to be a case of polydactyly because there were supernumerous metatarsals. On the basis of embryological failure, limb malformations are classified into several categories, and polydactyly belongs to that of duplication. There are, however, some malformations that are difficult to classify clearly. We considered our case to be a result of duplication followed by fusion of the digits.

Acrocallosal syndrome: a case report

This report describes the case of an 18-month-old Caucasian male infant with clinical and radiological findings indicative of the Schinzel acrocallosal syndrome. He was born to non-consangiuneous parents. His father had been diagnosed with Greig syndrome. The patient underwent surgery for preaxial polysyndactyly of both hands and feet. The similarity to the Greig syndrome is discussed. It is possible that both the acrocallosal syndrome and the Greig syndrome are variant expressions of the same autosomal dominant condition. Surgery may improve thumb opposition and shoe wear.

Surgical manipulation of mammalian embryos in vitro

Whole-embryo culture systems are useful in the fields of not only embryology but also teratology, toxicology, pharmacology, and physiology. Of the many advantages of whole-embryo culture, we focus here on the surgical manipulation of mammalian embryos. Whole-embryo culture allows us to manipulate mammalian embryos, similarly to fish, amphibian and avian embryos. Many surgical experiments have been performed in mammalian embryos in vitro. Such surgical manipulation alters the destiny of morphogenesis of the embryos and can answer many questions concerning developmental issues. As an example of surgical manipulation using whole-embryo culture systems, one of our experiments is described. Microsurgical electrocauterization of the deep preaxial mesodermal programmed cell death zone (fpp) in the footplate prevented the manifestation of polydactyly in genetic polydactyly mouse embryos (Pdn/Pdn), in which fpp was abolished.

Polydactyly of the foot: manifestations and treatment

Polydactyly of the foot is not an uncommon foot problem. However, it is not well understood and not often reported. Its clinical manifestations vary, as do treatment methods and results. During the period of 1979 to 1994, 54 children with polydactyly of 65 feet were treated in our clinic. Bilateral involvement was seen in 11 patients, and six had accompanying polydactyly of the hand. By Blauth and Olason's classification, duplication of the fifth ray (43 feet) was most common, followed by first ray duplication (20 feet) and other ray duplication (2 feet). A rudimentary form was found in one foot. Polysyndactyly was present in 18 feet. Hallux varus was the most common associated problem and was present in seven feet. Surgery for both cosmetic and functional purposes was performed in 38 patients (44 feet). Treatment included excision of the extra toe and reconstruction of the soft tissue around the remaining toe, of which the alignment was restored in cases of deviation. Results were evaluated with Phelps-Grogan's protocol; 39 feet (88%) were classified as having excellent results, two (5%) had good, and three (7%) had poor results. Postoperative complications included residual hallux varus in three feet with polydactyly of the first ray, and unpleasant surgical scars in another two. We conclude that polydactyly of the foot should be treated individually, depending on classification. Special attention should be paid to complex first ray polydactyly.

Concomitant syndactyly and polydactyly in a pediatric foot

Syndactyly and polydactyly in a child may warrant surgical treatment to avert resultant emotional and psychologic problems. The authors present a unique case report of a bilateral polydactyly of the hallux and bilateral syndactyly of the second and third toes in a normal 6-year-old Hispanic female. The article will discuss the surgical management of these problems, using the skin harvested from resection of the extra hallux for the adjacent side of the lesser toes after desyndactyly.

Upper limb triplication with radial dimelia

We report a very unusual case of upper limb triplication. The fused upper two limbs present as a duplicated mirror hand, joined along the ulnar side from the small finger up to the humerus. This exceptional abnormality further corroborates the theory that the development of the more distal segments of the limb is determined by the more proximal segments.

Ulnar dimelia. Is it a true duplication of the ulna?

Ulnar dimelia (mirror hand) is a rare congenital disorder, characterized by duplication of the ulna, absence of the radius and polydactyly. Approximately 60 cases have been reported worldwide. We present a new case, with its own distinguishing features. These features illustrate that the aetiology of ulnar dimelia is probably failure of differentiation of a part of the ray rather than its pure duplication.

Postaxial type-B polydactyly. Prevalence and treatment

A prospective screening program of 11,161 newborns identified twenty-one infants who had postaxial type-B polydactyly (a prevalence of one in 531 live births). Sixteen infants (76 per cent) had bilateral postaxial type-B polydactyly. Eighteen infants (86 per cent) had a family history of the anomaly. The racial prevalence was one in 143 live births of black infants and one in 1339 live births of white infants. The duplicated small fingers were treated in the newborn nursery with suture ligation at the base of the pedicle. One infant had a second procedure to remove a blackened digit that remained firmly attached one month after the initial treatment. No other complications occurred. Fifteen patients (twenty-eight fingers) were reexamined at an average age of twenty months (range, twelve to thirty-seven months). Twelve fingers (43 per cent) had a residual bump, with an average diameter of two millimeters (range, one to six millimeters). Despite the residual bumps, all of the parents were satisfied with the cosmetic result.

A rare variant of mirror hand: a case report

Mirror hand is one of the rarest congenital differences of the upper extremity. Typically, there is absence of the radius, duplication of the ulna, and 7 digits in mirrored symmetry about the middle finger. We report a case of a rarer subset of hand duplication in which there is a normal radius and ulna and a hand with 8 digits. The patient underwent surgery to excise the radial 3 digits and to reconstruct the remaining radial digit to function as an opposable, 2 phalanx thumb. Wrist extension was augmented by transferring the digital extensors from the excised fingers to the radial wrist extensors.

[Polydactyly in a foal--a case report]

Polydactylism, an excess deformity in a foal is described. The hereditary pathology and etiopathogenesis are discussed. A method of surgical correction of the deformed extremity is introduced. Indication and prognosis of the surgical correction of polydactylism and aspects concerning the breeding management are discussed.

Long-term results of surgical treatment of thumb polydactyly

One hundred thirteen hands exhibiting thumb polydactyly were treated and followed up for an average of 49 months. Of these, 109 hands were treated by resection of a supernumerary hypoplastic thumb. Radial thumbs were resected in 107 hands and ulnar thumbs in 2 hands. Four hands were treated using a modified Bilhaut procedure. According to a modified Tada's evaluation, the results were evaluated as good in 97 hands, fair in 12 hands, and poor in 4 hands. Patients and/or their parents were satisfied with the results in 100 hands and dissatisfied with the results in 13 hands. The factors that influenced the surgical results were analyzed. The incidence of unsatisfactory results was relatively high in Wassel types 3, 5, and 6 and triphalangeal-type thumb polydactyly. It was higher when the ulnar digit was removed than when the radial digit was removed. The results for those patients treated between 1983 and 1991 were better than for those treated between 1976 and 1982. The type of deformity, type of procedure, and skillfulness of the surgeon were factors in the results after surgery.

Congenital digital deformities

Congenital digital deformities are often challenging to treat. Several deformities and their treatments are discussed. Familiarity with the deformities is important because early treatment is often necessary for a successful outcome.

Central-type eight-toed polydactyly associated with ipsilateral complex renogluteal agenesis: a case report with 8 years' follow-up

At birth, a baby girl was found to have central-type eight-toed polydactyly of the left foot associated with ipsilateral nonvisualization of the kidney and atrophy of the gluteal maximum muscle. X-ray examination showed eight completely developed metatarsal and digit bones, and a chromosome study showed a normal 46, XX karyotype. She received ray amputation of the extra toes when she was 1 year old. Follow-up examination at age 9 showed unchanged renogluteal anomalies and a slightly smaller left foot. In addition, a bony defect over the posterior iliac spine and a wide femoral neck-shaft angle were found on the radiograph. Her left leg was found to be 1 cm shorter than the right, but there was no evidence of valgus or varus. Presently she can walk and run quite well, and there is no callus formation over her sole. The timing and options for excision of the supernumerary digits are discussed and this rare disease reviewed.