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Inaba N, Takagi T, Seki A, Takayama S. Postoperative deviation in Wassel types II and III radial polydactyly: a retrospective analysis of 73 thumbs. J Hand Surg Eur Vol 2024; 49:463-469. [PMID: 37882671 DOI: 10.1177/17531934231209871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
This study examined the relationship between osteochondral stability and postoperative deviation at the interphalangeal (IP) joint in Wassel types II and III radial polydactyly. Cases with cartilaginous fusion between the radial distal phalanx and the proximal phalanx were classified as type IIB, while the remaining cases were categorized as type IIA. In conventional surgery, the cartilage was routinely resected on the radial aspect of the proximal phalangeal head, while in the modified procedure, this was preserved to avoid postoperative radial deviation. Postoperatively, there was no significant difference between both procedures in type IIA thumbs regarding IP joint deviation, whereas in type IIB/III thumbs, IP joint deviation was significantly higher in the conventional group (mean 19° [SD 16°]) compared to the modified group (mean 0.8° [SD 4.9°]). Surgeons should exercise caution against excessive cartilage excision to preserve osteochondral stability during procedures, especially for type IIB and III radial polydactylies.Level of evidence: IV.
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Affiliation(s)
- Naoto Inaba
- Division of Orthopaedic Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Takehiko Takagi
- Division of Orthopaedic Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Atsuhito Seki
- Division of Orthopaedic Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Shinichiro Takayama
- Division of Orthopaedic Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan
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2
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Kodama A, Ishibashi S, Munemori M, Tsuji K, Adachi N. On-Top Osteotomy of the Phalanx Base Combined With Modified Bilhaut: Cloquet Procedure for Atypical Radial Polydactyly. Cureus 2024; 16:e53285. [PMID: 38435922 PMCID: PMC10905421 DOI: 10.7759/cureus.53285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 03/05/2024] Open
Abstract
In this report, we present the combination of on-top plasty with a modified Bilhaut-Cloquet procedure for treating atypical radial polydactyly with duplication at the metacarpophalangeal (MP) joint and triphalangism of the radial and ulnar phalanges, hypoplastic middle phalanx of the radial thumb, and hypoplastic phalanx base of the ulnar thumb. To preserve the stable MP and interphalangeal joints of the radial and ulnar thumbs, respectively, on-top plasty involved osteotomizing the middle phalanx and transferring the distal end of the middle phalanx of the ulnar finger to the phalanx base of the radial thumb. A modified Bilhaut-Cloquet procedure was used to combine the tips and nails of both thumbs. Twelve months postoperatively, good joint alignment and thumb tip appearance were achieved. On-top plasties effectively combined the desirable parts of both thumbs. The modified Bilhaut-Cloquet technique is particularly well-suited for atypical cases, such as the present case.
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Affiliation(s)
- Akira Kodama
- Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Shigeki Ishibashi
- Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Masaru Munemori
- Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Kentarou Tsuji
- Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Nobuo Adachi
- Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
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3
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Chew EM, Wong KPL, Chan CMS, Teoh LC. Suture osteosynthesis in the bony reconstruction of thumb duplication. J Hand Surg Eur Vol 2021; 46:762-767. [PMID: 33884905 DOI: 10.1177/17531934211010078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Metacarpal osteotomies are done to correct deviation deformity in thumb duplication. We describe a suture-only technique of metacarpal osteosynthesis, without using K-wires. Thirteen Flatt Type IV thumbs and five Wassel Type VII thumbs were reconstructed with this technique. The median follow-up was 23 months. After osteotomy, the metacarpal bone fragments were sutured together with 5-0 polyglactin or 4-0 polydioxanone sutures. Metacarpal fragment displacement was not observed on postoperative radiographs obtained at 1 and 2 weeks. Bony union was achieved at 6 weeks without loss of alignment. The metacarpophalangeal joint alignment was anatomical (≤5° deviation) in eight cases. The mean pre- and postoperative metacarpophalangeal joint alignments were 27° and 9°, respectively. The 11 patients who were available for grading with the Japanese Society for Surgery of the Hand Score were assessed as good. Complete internalization of the bony fixation eliminates infections associated with exposed K-wires without compromising the overall outcome.Level of evidence: IV.
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Affiliation(s)
- Ee Ming Chew
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore, Republic of Singapore.,Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore, Republic of Singapore
| | - Kenneth Pak Leung Wong
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore, Republic of Singapore
| | | | - Lam Chuan Teoh
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore, Republic of Singapore.,Department of Hand and Reconstructive Microsurgery, Tan Tock Seng Hospital, Singapore, Republic of Singapore
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Iba K, Saito A, Hanaka M, Yamashita T. Long-term outcomes after corrective cartilaginous joint resection based on arthrographic findings of duplicated thumbs. J Hand Surg Eur Vol 2021; 46:367-372. [PMID: 33625274 DOI: 10.1177/1753193421994780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report greater than 10-year outcomes in duplicated thumbs following corrective cartilaginous resection during the growth period. We have undertaken corrective resection of cartilaginous joint connections based on intraoperative arthrographic findings to reconstruct favourable alignment in six Wassel Type II and IV thumb duplication in six patients. The age at surgery was 13 months (range 10-15), and the average post-surgical follow-up was 134 months (range 120-160). We observed five excellent and one good outcome using the Japanese Society for Surgery of the Hand scoring method. Favourable joint congruency and alignment were preserved, and no growth plate arrest or joint space narrowing was present more than 10 years after surgery. We conclude that corrective resection of the cartilaginous joint based on intraoperative arthrographic findings has long-term reliability for duplicated thumbs, especially those of Wassel Type II and IV, which have a cartilaginous joint connection.Levels of evidence: IV.
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Affiliation(s)
- Kousuke Iba
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Akira Saito
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Megumi Hanaka
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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Lin S, Tong K, Zhang G, Cao S, Zhong Z, Wang G. Clinical Characteristics and Distribution of Thumb Polydactyly in South China: A Retrospective Analysis of 483 Hands. J Hand Surg Am 2020; 45:938-946. [PMID: 32473835 DOI: 10.1016/j.jhsa.2020.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 02/27/2020] [Accepted: 04/03/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE This study was intended to characterize the epidemiological features of thumb polydactyly (TP) in South China. METHODS Clinical records were retrieved from 1 central hospital in South China to identify the patients with a definite diagnosis of TP from January 2004 to January 2017. The cases were classified by their x-ray appearance. The data collected included sex, age at first operation, reoperation, family history, unilateral/bilateral polydactyly, right/left hand involvement in unilateral cases, classification of polydactyly, and the presence of associated congenital anomalies. RESULTS A total of 428 patients with a definite diagnosis of TP were identified (278 males and 150 females) involving 483 cases, 373 unilateral and 55 bilateral. A syndrome or associated congenital anomaly was found in 26 (18 unilateral and 8 bilateral cases). A dominant thumb, larger and more developed, was observed in 448 hands (93%), and was the ulnar thumb in 433. Owing to postoperative complications, 31 thumbs (6.4%) underwent reoperation. The average interval from initial surgery to reoperation was 4.8 years. CONCLUSIONS Thumb polydactyly had a male predominance in this Chinese cohort, mostly occurring on the right hand with an ulnar dominant thumb. Bilateral cases had a higher incidence of associated anomaly and positive family history than unilateral cases. The need for additional surgery for TP might occur as late as 4.8 years after primary surgery. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Shiyuan Lin
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong
| | - Kai Tong
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong; Department of Orthopaedic Surgery, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Guolei Zhang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong
| | - Shenglu Cao
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong
| | - Ziyi Zhong
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong
| | - Gang Wang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong.
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Finsterwald M, Guenkel S. A rare case of thumb polydactyly with metacarpophalangeal joint synostosis. Case Reports Plast Surg Hand Surg 2020; 6:121-124. [PMID: 32002458 PMCID: PMC6968632 DOI: 10.1080/23320885.2019.1596032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/13/2019] [Indexed: 10/27/2022]
Abstract
We report on a rare case of thumb polydactyly with metacarpophalangeal joint synostosis in a 14-year old otherwise healthy boy. Our case can only be classified in the Rotterdam classification, was treated with resection of the hypoplastic radial component and yielded a very satisfactory outcome with a stable thumb.
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Affiliation(s)
- Michael Finsterwald
- Department of Orthopedics and Traumatology, Buergerspital Solothurn, Solothurn, Switzerland
| | - Sebastian Guenkel
- Department of Orthopedics and Traumatology, Buergerspital Solothurn, Solothurn, Switzerland
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Shen X, Yin F, Rui Y, Lin W, Liu S, Yu J. [Diagnosis and treatment of thumb polydactyly with symphalangism in children]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1317-1320. [PMID: 30129335 PMCID: PMC8414141 DOI: 10.7507/1002-1892.201803006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/23/2018] [Indexed: 11/03/2022]
Abstract
Objective To investigate the diagnosis and treatment of thumb polydactyly with symphalangism in children. Methods Seven cases of thumb polydactyly with symphalangism were treated between January 2013 and May 2017. There were 5 males and 2 females, aged from 10 months to 11 years, with an average age of 3.1 years. The thumb-polydactyly was diagnosed with MRI and it was seen that the base of radial multi-finger and the proximal phalangeal joint were connected by cartilage. All patients were treated with resection, lateral collateral ligament reconstruction, bone osteotomy and internal fixation. Results The operation was successfully completed, and there was no early complications such as infection and flap necrosis. All patients were followed up 6-23 months (mean, 14.1 months). At last follow-up, there was no deformity finger, scar contracture, and other complications. The extension of the interphalangeal joint was no limited, and the flexion range of the interphalangeal joint was 20-75° (mean, 56.7°). The appearance and function of the thumb was rated as excellent in 3 cases and good in 4 cases by Japanese Society for Surgery of the Hand (JSSH) scoring, with the excellent and good rate of 100%. Conclusion The thumb polydactyly with symphalangism in children can be combined with clinical manifestations, X-ray film, and MRI examination to diagnose, and can obtain satisfactory results through the reconstruction of lateral collateral ligament, bone osteotomy, and internal fixation.
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Affiliation(s)
- Xiaofang Shen
- Department of Pediatric Orthopaedic, Wuxi No.9 People's Hospital Affiliated to Soochow University, the Orthopaedic Hospital of Wuxi, Wuxi Jiangsu, 214000, P.R.China
| | - Fei Yin
- Department of Pediatric Orthopaedic, Wuxi No.9 People's Hospital Affiliated to Soochow University, the Orthopaedic Hospital of Wuxi, Wuxi Jiangsu, 214000, P.R.China
| | - Yongjun Rui
- Department of Pediatric Orthopaedic, Wuxi No.9 People's Hospital Affiliated to Soochow University, the Orthopaedic Hospital of Wuxi, Wuxi Jiangsu, 214000,
| | - Weifeng Lin
- Department of Pediatric Orthopaedic, Wuxi No.9 People's Hospital Affiliated to Soochow University, the Orthopaedic Hospital of Wuxi, Wuxi Jiangsu, 214000, P.R.China
| | - Shuai Liu
- Department of Pediatric Orthopaedic, Wuxi No.9 People's Hospital Affiliated to Soochow University, the Orthopaedic Hospital of Wuxi, Wuxi Jiangsu, 214000, P.R.China
| | - Jiong Yu
- Department of Pediatric Orthopaedic, Wuxi No.9 People's Hospital Affiliated to Soochow University, the Orthopaedic Hospital of Wuxi, Wuxi Jiangsu, 214000, P.R.China
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Abstract
This article classifies symphalangism of the hand into three grades and suggests surgical indications. Grade I and early grade II joints can be mobilized with early surgical intervention. Surgical results may vary but even a 20° gain in motion could be helpful for children and their parents. Postoperative passive range-of-motion exercises are very important in maintaining mobility of the joints. It is important that the parents understand exercise may cause some pain and they must be motivated to help their children during the rehabilitation period.
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9
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de Oliveira R, Ribak S, Irisarri C. Polidactilias del pulgar. Tratamiento quirúrgico. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2016. [DOI: 10.1016/j.ricma.2016.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Las polidactilias del pulgar, especialmente sus duplicaciones, constituyen una anomalía de frecuente presentación. Sus variantes son múltiples, lo que nos obliga a conocer cuáles son las diferencias anatómicas más relevantes en cada tipo en particular. Han sido muchas sus clasificaciones, pero la propuesta por Wassel, basada en los hallazgos radiológicos, continúa siendo tan simple como práctica. Excepto en los casos más simples, su cirugía reconstructiva es difícil, y debe ser encomendada a cirujanos con experiencia. Aun así, en los casos complejos el resultado dista de ser la obtención de un pulgar «normal», incluso con la técnica de «resección y reconstrucción» que utilizamos y que describimos en el presente artículo. Con frecuencia el tratamiento de las polidactilias se considera como algo simple y banal, y su dificultad real solamente se hace patente con el resultado desastroso de la cirugía. Las complicaciones que pueden presentarse son diversas y, en un significativo número de casos, van a requerir posteriormente una nueva cirugía reconstructiva para mejorar el resultado funcional y/o estético.
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Affiliation(s)
- R. de Oliveira
- Cirugía de la Mano, Hospital Infantil Santo Antônio da Santa Casa, Porto Alegre, Brasil
- Unidad Cirugía de la Mano, Hospital Mãe de Deus, Porto Alegre, Brasil
| | - S. Ribak
- Cirugía de la Mano, Hospital Nossa Senhora do Pari, São Paulo, Brasil
- Unidad Cirugía de la Mano, Pontifícia Universidade Católica de Campinas, Campinas, São Paulo, Brasil
| | - C. Irisarri
- Cirugía de la Mano, Centro Médico El Castro, Vigo, España
- Hospital Vithas-Fátima, Vigo, España
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10
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Ciloglu NS, Duran A, Buyukdogan H. Wassel type III polydactyly with symphalangism: a rare entity. J Hand Surg Am 2014; 39:1021. [PMID: 24766835 DOI: 10.1016/j.jhsa.2014.02.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 02/24/2014] [Accepted: 02/25/2014] [Indexed: 02/02/2023]
Affiliation(s)
- N Sinem Ciloglu
- Department of Plastic and Reconstructive Surgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Alpay Duran
- Department of Plastic and Reconstructive Surgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Hasan Buyukdogan
- Department of Plastic and Reconstructive Surgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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11
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Dijkman RR, van Nieuwenhoven CA, Selles RW, Hovius SER. Comparison of functional outcome scores in radial polydactyly. J Bone Joint Surg Am 2014; 96:463-70. [PMID: 24647502 DOI: 10.2106/jbjs.m.00067] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A wide range of outcome assessment systems have been used to describe the results and evaluate residual impairment after surgery for radial polydactyly. We conducted a study to determine which of these assessment systems should be considered superior for the most common types of radial polydactyly (types II and IV). METHODS Ten outcome assessment systems were selected. Three examiners independently evaluated thirty-seven patients, aged four to twenty-two years, with radial polydactyly. Patients completed two manual activity questionnaires. Interobserver reliability was determined with use of an intraclass correlation coefficient (ICC). Validity was assessed by correlating the results derived with the outcome assessment systems with functional visual analog scale (VAS), aesthetic VAS, and manual activity questionnaire scores. RESULTS Thirty-seven patients (forty-one hands with radial polydactyly) were evaluated. All patients were assessed by at least two examiners. Reliability was highest for the Japanese Society for Surgery of the Hand (JSSH), Cheng et al., and Tada et al. assessment systems (overall ICCs ≥ 0.70). The JSSH system had the highest overall correlations (rs ranging from 0.48 to 0.80 and 0.45 to 0.63) with functional and aesthetic VAS scores. No significant correlations were found between the outcome scores and the results of the manual activity questionnaires after an average follow-up time of 112 months. CONCLUSIONS Interobserver reliability was highest for the JSSH classification, which also showed superior correlations with both examiner-rated and patient-rated VAS scores for functional and aesthetic outcome compared with the other nine assessment systems. The finding of a poor correlation between the outcome scores and the results of manual activity questionnaires is in agreement with findings in published literature. We recommend the JSSH assessment method for the scientific evaluation of the outcomes, in terms of body structure and function, of the treatment of radial polydactyly.
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Affiliation(s)
- Robert R Dijkman
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, P.O. Box 2040, Room EE.15.91, 3000 CA Rotterdam, the Netherlands. E-mail address for R.R. Dijkman: . E-mail address for R.W. Selles:
| | - Christianne A van Nieuwenhoven
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, P.O. Box 2040, Room HS 511, 3000 CA Rotterdam, the Netherlands. E-mail address:
| | - Ruud W Selles
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, P.O. Box 2040, Room EE.15.91, 3000 CA Rotterdam, the Netherlands. E-mail address for R.R. Dijkman: . E-mail address for R.W. Selles:
| | - Steven E R Hovius
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, P.O. Box 2040, Room HS 501, 3000 CA Rotterdam, the Netherlands. E-mail address:
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12
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Xu YL, Shen KY, Chen J, Wang ZG. Flexor pollicis longus rebalancing: a modified technique for Wassel IV-D thumb duplication. J Hand Surg Am 2014; 39:75-82.e1. [PMID: 24369941 DOI: 10.1016/j.jhsa.2013.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 10/06/2013] [Accepted: 10/11/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To report a modified reconstructive technique for Wassel type IV-D thumb duplication that preserves and transfers the flexor pollicis longus (FPL) from the removed radial portion. METHODS We analyzed the hands of 16 patients (average age, 2 y) with Wassel IV-D thumb duplication. Patients were treated with ablation of the radial thumb and reconstruction of the ulnar thumb by a series of soft tissue procedures, including FPL rebalancing. The postoperative range of motion and the alignment at the metacarpophalangeal and interphalangeal joints of the affected thumbs were compared with the preoperative measurements. RESULTS Of 16 cases, 14 were observed for an average of 29 months. Motion at the interphalangeal joint and alignment at metacarpophalangeal and interphalangeal joints showed improvement after surgery. According to the Japanese Society for Surgery of the Hand scoring system, the results were excellent in 2 cases, good in 11, and fair in 1. A disadvantage of this technique proved to be restricted interphalangeal joint motion with an extension lag that averaged 14°. CONCLUSIONS The FPL rebalancing technique with soft tissue stabilization of the metacarpophalangeal and interphalangeal joints can establish dynamic rebalance of the bifurcated FPL tendon in Wassel IV-D duplicated thumb. It shows excellent results in alignment and joint stability. The long-term results are under evaluation. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Yun-lan Xu
- Department of Pediatric Orthopedics, Shanghai Children's Medical Center, affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kai-Ying Shen
- Department of Pediatric Orthopedics, Shanghai Children's Medical Center, affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ji Chen
- Department of Pediatric Orthopedics, Shanghai Children's Medical Center, affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi-gang Wang
- Department of Pediatric Orthopedics, Shanghai Children's Medical Center, affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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13
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Iba K, Wada T, Kanaya K, Oki G, Yamashita T. Arthrography in thumb polydactyly with bifurcation at the interphalangeal or metacarpophalangeal joints provides practical information at surgery. J Hand Surg Eur Vol 2013; 38:267-71. [PMID: 22733700 DOI: 10.1177/1753193412450530] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We carried out arthrography in 19 thumbs of 18 patients in whom duplication was observed at the interphalangeal (Wassel type II) or metacarpophalangeal (Wassel type IV) joints on radiographs. The average age at surgery was 12.3 months and average duration of post-surgical follow-up was 21.3 months. Based on the arthrographic findings, the types of cartilaginous connections were subdivided into five groups. In group 1, there was a cartilaginous connection at the base of duplicated phalanges. In group 2, there was a cartilaginous connection of the radial digit between the distal and proximal phalanges, or between the proximal phalanx and metacarpal. In group 3, the phalanges separated at a common joint without any cartilaginous connection. In group 4, the radial digit demonstrated fibrous attachment to the capsule without any joint formation. In group 5, each joint was completely separated without any cartilaginous connection. These arthrographic findings could not be detected on radiographs. Different surgical procedures were carried out according to the form of cartilaginous connection.
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Affiliation(s)
- K Iba
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
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14
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Yen CH, Ho PC, Hung LK. Sushi hand roll dressing for thumb polydactyly. J Orthop Surg Res 2012; 7:26. [PMID: 22691314 PMCID: PMC3413560 DOI: 10.1186/1749-799x-7-26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 06/12/2012] [Indexed: 11/14/2022] Open
Abstract
Surgery for thumb polydactyly is a commonly performed orthopaedic procedure in Asia Pacific region. Despite extensive publications on topical dressing methods and dressing materials in paediatric wounds, there is no single design that affords a secure and yet comfortable post-operative wound dressing for thumb polydactyly. We have devised a new dressing method, which can easily be fabricated for such purpose from readily available materials in operation theatre.
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Affiliation(s)
- Chi-Hung Yen
- Department of Orthopaedics and Traumatology, Kwong Wah Hospital, The Hong Kong Special Administrative Region, Kowloon, Hong Kong.
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15
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Iba K, Wada T, Yamashita T. Atypical thumb polydactyly with duplicated metacarpal bone: a report of 2 cases. Ann Plast Surg 2011; 70:38-41. [PMID: 21629070 DOI: 10.1097/sap.0b013e31821b6ced] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report 2 cases of patients with thumb polydactyly that were difficult to classify into either Wassel type VI with a remarkable hypoplastic metacarpal or Wassel type VII (triphalangeal thumb). The radial digit was functional but hypoplastic, and the ulnar digit presented a dominant appearance but no active motion. The operative findings revealed that the radial and ulnar MP joints were completely independent and the metacarpal bones were separated, simulating Wassel type VI thumb polydactyly. In both cases, the ulnar digit was transported to the top of the radial metacarpal, accompanied by tendon transfer from the radial to the ulnar digit and rotation flap for web plasty. One year after surgery, the postoperative results showed good appearance and function of the preserved ulnar thumb in both cases.
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Affiliation(s)
- Kousuke Iba
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Chuo-ku, Sapporo, Japan.
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