Mirror image duplication of the hands and feet: report of a sporadic case with multiple congenital anomalies

Laurin–Sandrow Syndrome: A Case Report and Review of Literature

Laurin–Sandrow syndrome (LSS) is an extremely rare syndrome of mirror hand and leg with less than 20 cases reported in literature. The syndrome has been attributed to a mutation in the MIPOL-1 (mirror-image polydactyly) gene located on locus 14q13.3-q21 coding for CCDC193 (coiled-coli domain containing 193) protein. It is characterised by limb, facial and central nervous system anomalies with the most constant being fibular dimelia with fibular ray duplication, polydactyly with secondary deformities of fixed equinus, knee joint instability and flexion deformity. It is associated less frequently with ulnar dimelia, thumb aplasia/hypoplasia, ulnar ray duplication, symbrachypolydactyly, ‘rosette’ hands, facial dysmorphism like hypertelorism, broad columella and flat nose, CNS anomalies like aplasia/hypoplasia of corpus callosum, hydrocephalus and muscular dystonia. We report a 2-year-old male child with LSS and perform a literature review to expound on this rare syndrome.

Level of Evidence: Level V (Therapeutic)

"Laurin-Sandrow Syndrome - a review of the literature and classification system"

INTRODUCTION

Laurin-Sandrow syndrome also known as tetramelic mirror-image polydactyly is a rare congenital disorder characterized classically by polysyndactyly of the hands, mirror feet and nose anomalies (hypoplasia of the nasal alae and short columella) often associated with ulnar and/or fibular duplication. As a pathologic entity, it is heterogeneous, the patients displaying a variety of symptoms. This review aims to analyze the different aspects of the condition, such as clinical findings and methods of treatment to summarize the principal features of Laurin-Sandrow syndrome.

MATERIALS AND METHODS

The review is based on searches on PubMed, Web of Science and Researchgate of the following terms: "Laurin-Sandrow syndrome", "mirror hands", "mirror feet", "tetramelic mirror-image polydactyly", "fibular dimelia" and "ulnar dimelia". Clinical cases, reviews and original articles were included.

RESULTS

As a consequence of our findings, we suggest a modification of the Al-Qattan classification system for Mirror Hand-Multiple Hand Spectrum.

CONCLUSION

Even though it has an extremely low incidence, a thorough understanding of the syndrome enables the surgeon to choose the appropriate treatment with the ultimate goal to improve the patient's life quality.

The management of mirror foot polydactyly: A case report

Background

Mirror foot or mirror image duplication of the foot is an extreme form and very rare congenital anomaly. There are limited management recommendations, and most cases are treated before walking age. We present the clinical findings, surgical treatment, and results of a rare case of mirror foot polydactyly.

Case presentation

A five-month-old girl with bilateral mirror foot was referred to our orthopaedic department. She was born full-term by the caesarian section and there was no family history of similar skeletal abnormalities and no history of drug or radiation exposure during gestation. The child had eight toes on the right foot and seven toes on the left with fully developed metatarsal, proximal, middle, and distal phalanges. Radiographs confirmed the diagnosis of mirror foot with a full complement of normal lateral toes and three additional complete rays medial to the right foot and two additional complete rays medial to the left foot. The patient underwent ray resection and concurrent reconstruction of the medial arch of the foot. A medial longitudinal incision was used to excised the right medial three rays and left medial two rays. The target of this surgical intervention was for aesthetic or cosmetic reasons and enabling the patient to allow shoe wear.

Conclusion

Mirror-foot abnormalities are distinctly uncommon entities and represent extreme forms of congenital duplication of the preaxial polydactyly spectrum. Treatment on age of five-month-old with medial longitudinal incision had a satisfying clinical and radiological results.

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An extreme form of preaxial foot polydactyly has been coined the term preaxial mirror polydactyly is rare congenital anomaly.

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Few cases have been reported, and there is little consensus concerning the optimal technique for surgical management.

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For the diagnosis of mirror foot, there has to be a mirror image polydactyly on the medial aspect of the foot.

Long term follow-up and development of foot complaints in a surgically treated mirror foot-A case report and review of literature

BACKGROUND

Mirror foot is a rare anomaly and limited long term follow-up information is available.

METHODS

Seven years after operation a mirror foot patient returned with foot complaints and was evaluated using radiographs and clinical examination. A systematic literature search was conducted to study foot complaints in mirror feet.

RESULTS

Different origins of foot pain were considered in our patient; tibia length difference, deformed talus and accessory osseous structures in the tarsal region. Literature search resulted in 118 mirror feet. Based on cases reporting osseous structures, 74.2% showed tibia abnormalities and 94.5% an abnormal tarsal region. Only three cases mentioned a normal talus. Nine cases reported a follow-up period of more than five years.

CONCLUSION

Osseous abnormalities are not always visible at birth, but are often present. Therefore, detailed examination of the affected limb in mirror foot patients with foot pain is important, in order to localize the origin.

Mirror foot--a reflection on three cases

INTRODUCTION AND AIMS

Mirror-foot abnormalities are distinctly uncommon entities and represent extreme forms of congenital duplication. We present a reflection on three different cases of mirror foot and discuss their surgical management.

PATIENTS AND METHODS

The first patient had a right-sided mirror foot with a central great toe and three complete medial rays. The second patient had quadruplication of the left great toe ray. The third had a full complement of metatarsals associated with two extra complete rays placed medial to the great toe of the right foot. All patients underwent complex ray resection and concurrent reconstruction of the medial arch of foot. All three cases of mirror foot presented and were operated on in the pre-ambulatory period.

RESULTS

All three patients recovered with good functional and aesthetic results. Follow-up duration ranged from 3 to 5 years.

CONCLUSION

Surgical treatment of the mirror foot is less complicated than that of its upper limb equivalent. Essentially, there must be an initial surgical reduction in the number of digits, coupled with tendon transfers as necessary to maintain foot arches.

Mirror foot and our surgical experience: a case report and literature review

Preaxial mirror polydactyly of foot is a rare congenital anomaly with even fewer documentations for definitive treatment. To provide a sensate, near normal foot with ability to wear shoes is difficult to achieve in this variant with fibular dimelia and calcaneal duplication, with a delayed presentation at 6 years. Our case obtained satisfactory cosmetic and functional outcome upon excision of accessory calcaneum and the medial three toes along with covering the defect with local full thickness skin flap: a first of its kind mentioned in literature. We report this case because of its rarity and to share our surgical experience and its acceptable outcome.

Mirror foot: treatment of three cases and review of the literature

PURPOSE

To describe three cases of mirror foot and to develop a new classification of the mirror feet with an emphasis on their treatment.

METHODS

Surgical treatment was performed on three patients with mirror foot. Mirror feet in the English literature were surveyed and cases found in PubMed as well as our three cases were classified according to a new classification that was an analogy of the mirror hand classification proposed by Al-Qattan et al. (J Hand Surg Br 23:534-536, 1998).

RESULTS

All three cases obtained satisfactory outcome after the treatment. In addition to these cases, 28 mirror feet were well described in the English literature, among which only seven cases have been documented for their treatment. All of the cases could be assigned to one of the categories of the proposed classification.

CONCLUSION

Mirror foot is a very rare congenital deformity of the foot. We successfully treated three novel cases of mirror feet. A classification of the mirror feet proposed in this article was useful in order to understand its nature and obtain a guideline for its treatment.

Laurin-Sandrow syndrome: review and redefinition

We report on a newborn infant with characteristics of Laurin-Sandrow syndrome (LSS). She had hypertelorism, flat nose with grooved collumella, "V" shaped mouth with thin lips, 7 well-recognized and fused digits and 1 additional postaxial bilateral appendix on each hand. The right and left feet had 12 and 11 toes, respectively, the 4 external ones were recognizable, and the rest were fused in a uniform mass but with independent nails. There was also a 2.3 cm-long digitiform appendix in the internal part of both feet. Radiographs showed seven metacarpals and seven metatarsals with similar morphology; both hands lacking thumbs. The four lateral-most toes had regular shaped phalanges and the rest were irregular. The left digitiform appendix had three bones and the right only two. Tibiae were shorter than fibulae. Central Nervous System examination showed an abnormally shaped olivary nucleus, cerebellar cortical heterotopias, gray matter ectopias in both spinal cord and hemispheric white matter, marked ventricular dilatation, and moderate diffuse white matter gliosis. Karyotype was 46XX. A complete necropsy study is presented and all reported cases are reviewed focusing on their phenotypic differences and their nosologic classification. We propose the entity LSS only in cases with symmetric tetrameric polysyndactyly, especially cup-shaped hands and mirror feet, in association with nasal anomalies.

[Complex polydactyly of the limbs: mirror foot. Report of two cases and review of literature]

Polydactyly is the most common congenital limb anomaly occurring both as an isolated defect or as part of a syndrome. However mirror foot is an exceptional abnormality (14 cases reported). The authors describe two sporadic cases of mirror foot. The first case presents a mirror polydactyly of the left foot, an hexadactyly of the right foot and a central polysyndactyly of both hands. The second case presents a mirror polydactyly of both feet. Mirror foot is a very rare defect. Both sporadic and familiar cases have been reported. This malformation can affect one or both feet. Some cases are associated with other congenital anomalies. The definition of mirror foot is warying according to the authors and the review of literature shows an important variability in the patterns of mirror polydactyly. Mirror duplication of hands and feet result of aberrant positioning of the zone of polarizing activity in relation to the apical ectodermal ridge during limb bud development. Different genes encoding limb pattern have been described.

An Unusual and Nonclassified Central Polydactyly of the Foot

Central-type, 8-toed polydactyly is a distinctly rare congenital foot anomaly. In this report, a new subtype of the metatarsal type of the central ray polydactyly of the foot is presented. This includes a triplication, one of which is Y-shaped of the second metatarsal and 8 toes. In the literature, polydactyly of the foot has been usually operated during childhood after walking age. We performed the surgery at 6 months of age. After ray amputation of the extra toes, we reapproximated the muscle pieces that remained on the original first and second metatarsals and repaired the transverse metatarsal ligament. Despite the early surgery, we did not encounter any problems intraoperatively and postoperatively.

Mirror foot

Mirror image polydactyly is a rare congenital abnormality that may occur in isolation, or in association with multiple congenital anomalies. A case of unilateral mirror foot with an ipsilateral short, broad tibia is described. The clinical, radiologic, and operative findings are presented, and current theories of embryo-pathogenesis are reviewed.

A sporadic case of tetramelic mirror-image polydactyly and unilateral tibial hypoplasia without associated anomalies

We report a sporadic case of tetramelic mirror-image polydactyly in combination with unilateral tibial aplasia. No chromosomal or other associated abnormalities were found. The appearance and function of the upper and lower limbs were improved by surgery.

Classification of the mirror hand-multiple hand spectrum

A rare variant of mirror hand is described. The hand had eight fingers and the forearm contained an ulna and a hypoplastic radius. A classification of the mirror hand-multiple hand spectrum is offered and its embryology discussed.

A 1.2-megabase BAC/PAC contig spanning the 14q13 breakpoint of t(2; 14) in a mirror-image polydactyly patient

We previously assigned a 14q13 breakpoint of t(2; 14) in a patient with mirror-image polydactyly to a segment between two loci, AFM200ZH4 and D14S306, within a genetic distance of 0.6 cM. In the present study, we constructed a 1.2-Mb high-resolution physical map with a contig composed of 16 bacterial artificial chromosomes (BACs) and 6 P1-derived artificial chromosomes (PACs) at a region around the breakpoint, extending from D14S75 to D14S728 loci. Thirty-four novel sequence-tagged sites (STSs) were also characterized at this region. Of nine ESTs that had been mapped between D14S75 and D14S288, T99065 was confirmed to be in two BAC clones, B102 and B319. This BAC/PAC contig with STSs is useful for further genomic sequencing, for construction of a transcription map, and for the isolation of the putative gene for mirror-image polydactyly.