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Montaño-Jiménez P, Pérez-Belloso AJ, Muriel-Sánchez JM, Márquez-Reina S, Goméz-Carrión A, Coheña-Jiménez M. Operative Management of Y-Shaped Metatarsal with Biphalangeal Sixth Toe. Adv Skin Wound Care 2024; 37:1-8. [PMID: 38767428 DOI: 10.1097/asw.0000000000000148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND In the literature, there is no consensus regarding the surgical management of postaxial polydactyly, and few cases of polymetatarsia with polydactyly have been reported. Treatment of the complete deformity will prevent further foot and gait disorders. OBJECTIVE To identify literature relevant to the operative management of Y-shaped metatarsal with biphalangeal sixth toe and related skin and wound care to improve surgical treatment protocols from a clinical experience perspective. DATA SOURCES The authors searched several electronic databases in December 2022 for articles related to postaxial polysyndactyly in the feet and polymetatarsia. Databases searched included PubMed, SciELO, ScienceDirect, Cochrane Database of Systematic Reviews, and Google Scholar gray literature. STUDY SELECTION Two independent researchers conducted the searches and read the article titles and abstracts. Studies were included if they were narrative reviews, case studies, or observational studies; written in English or Spanish; and published between 2012 and 2022. Nonhuman studies were excluded. Studies that met the inclusion criteria were fully evaluated. Disagreements between reviewers were resolved by consensus, and when there was no consensus, a senior researcher was consulted. DATA EXTRACTION The following data were extracted from the included studies using a standardized form: author and year of publication, study type, number of participants, sex, polydactyly location, polymetatarsia, type of polydactyly, participants' history of hereditary associated diseases or malformations, treatment, removal criteria, and timing of surgery. DATA SYNTHESIS Authors evaluated 11 studies of postaxial polydactyly that included a total of 153 participants (64 men, 89 women). They also document their clinical experience with a surgical technique used in cases of bilateral postaxial polydactyly of the foot with a Y-shaped metatarsal with biphalangeal sixth toe. CONCLUSIONS Surgical correction with lateral removal of the sixth toe is a resolutive treatment to improve the functionality of the foot, its aesthetic appearance, and the patient's quality of life. Case-specific treatment should be applied and tailored to meet the individual needs. The biomechanics of gait and shoe problems in these patients improve with surgical treatment, without presenting secondary aesthetic problems in skin care.
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Affiliation(s)
- Pedro Montaño-Jiménez
- In the Department of Podiatry of the Faculty of Nursing Physiotherapy and Podiatry, University of Seville, Spain, Pedro Montaño-Jiménez, PhD, RN, DP, is Associate Professor, Division of Podiatric Surgery; Ana Juana Pérez-Belloso, PhD, RN, DP, is Associate Professor; Juan Manuel Muriel Sánchez, PhD, DP, is Research Assistant; and Salvador Márquez-Reina, PhD, DP, is Associate Professor. Alvaro Goméz-Carrión, PhD, DP, is Associate Professor, University Complutense of Madrid, Spain. Also in the Department of Podiatry of the Faculty of Nursing Physiotherapy and Podiatry, University of Seville, Manuel Coheña-Jiménez, PhD, RN, DP, is Associate Professor
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Doucet O, Njessi P, Jaloux C, Bougie E. Secondary complications in Wassel II & IV thumb duplication: a comprehensive review of preventive measures. Hand Surg Rehabil 2024; 43:101642. [PMID: 38215882 DOI: 10.1016/j.hansur.2024.101642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/14/2024]
Abstract
OBJECTIVES Thumb duplication is one of the most challenging pediatric reconstructive hand surgeries. Wassel types II and IV are the most frequent, but also the most complex reconstructions as the duplication arises at the joint level. Ablation and reconstruction, the most widely used technique, aims at achieving a stable, well-aligned, mobile and esthetically acceptable thumb. The paucity of reliable surgical guidelines leads to high rates of suboptimal surgical outcomes. This review evaluated the various reconstruction techniques detailed in the literature and highlighted useful methods to prevent common secondary complications. METHODS A comprehensive PubMed and Embase literature search was made. Inclusion criteria were Wassel type II and/or IV, pediatric patients, and primary or secondary surgeries. Exclusion criteria were Bilhaut-Cloquet reconstruction and its modifications. Techniques were screened, collected and analyzed for the following secondary complications: instability, axial deformity, and contour deformity. RESULTS Thirty-two articles met the inclusion criteria and were reviewed. Postoperative instability was prevented by tightening the joint capsule by plication, advancement of the volar plate, or reconstruction of the collateral ligaments using a periosteal flap or the double-breasting technique. Axial deformity was prevented by arthroplasty, shaving a triangular portion of the metacarpal head, centralization of eccentric tendons, pulley reconstruction using flexor pollicis longus, or corrective osteotomies of the phalangeal or metacarpal bones using the wedge or oblique techniques. Limited range of motion was prevented by first webspace Z-plasty, and soft-tissue contouring was addressed by planned skin incisions and soft-tissue augmentation. Preoperative, perioperative and postoperative considerations, including splinting, imaging and immobilization, were also described. CONCLUSION Despite the ongoing advances and abundant knowledge in reconstructive strategies for thumb duplication, there are few studies that reviewed and analyzed the various reported options. This review provides physicians and trainees with guidance in surgical planning to prevent common secondary complications. Further research should focus on the development of standardized assessment tools, enabling reliable prospective comparative studies on thumb duplication reconstruction. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ophélie Doucet
- Division of Plastic and Reconstructive Surgery, University of Montreal, Montreal, QC, Canada
| | - Pharel Njessi
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Charlotte Jaloux
- Department of Hand Surgery and Reconstructive Surgery of the Limbs, La Timone University Hospital, Marseille, France; Institute of Neurophysiopathology, Marseille, France
| | - Emilie Bougie
- Division of Plastic and Reconstructive Surgery, University of Montreal, Montreal, QC, Canada; Division of Plastic and Reconstructive Surgery, CHU Sainte-Justine, Montreal, QC, Canada.
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Sluijter TE, Rüttermann M. Lower Extremity Polydactyly Does Not Disturb Finding One's Feet. J Foot Ankle Surg 2024; 63:220-225. [PMID: 37951458 DOI: 10.1053/j.jfas.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/20/2023] [Accepted: 11/04/2023] [Indexed: 11/14/2023]
Abstract
Little is known about functional outcomes in children with treated lower extremity polydactyly (LEP). No classification system has been shown to be prognostically useful for functional outcomes. This study investigates whether children with treated LEP learn to walk at an age comparable to the population and whether the SAM (severity of syndactyly, axis deviation and metatarsal involvement) classification system is prognostically useful. In a retrospective cohort of 18 patients, we tested for associations between patient characteristics and SAM scores, age at learning to walk, and ability to fit off-the-shelf shoes. The proportion of children with treated LEP able to walk at 18 months of age was compared with the general population. We found no association between the age at which the 17 participants learned to walk and the severity of syndactyly (p = .214), axis deviation (p = .723) and metatarsal involvement (p = .781), nor between the proportion of patients able to wear off-the-shelf shoes compared to those requiring extra wide off-the-shelf shoes and the severity of syndactyly (p = 1.000), axis deviation (p = 1.000) and metatarsal involvement (p = 1.000). We found a trend between older age at surgery and the need for extra wide off-the-shelf shoes (OR = 1.008, p = .080). We found no significant difference in the proportion of children able to walk at 18 months between our patients (proportion = 1.00) and the general population (proportion = 0.95) (p = 1.000). We found no significant association between different SAM scores and functional outcomes, and none in the proportion of children able to walk at 18 months between treated LEP patients and the general population.
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Affiliation(s)
- Tim E Sluijter
- Department of Plastic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Mike Rüttermann
- Department of Plastic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Sun WC, Chen PA, Chen BPR, Lee WC, Kao HK, Yang WE, Chang CH. Classification of radial polydactyly based on physical characteristics. Pediatr Neonatol 2024; 65:133-137. [PMID: 37658029 DOI: 10.1016/j.pedneo.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/31/2023] [Accepted: 04/20/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Previous classifications in polydactyly of the thumb were by the level of duplication on radiography. This study aimed to develop a practical algorithm based on physical characteristics for treatment guidelines. METHODS The polydactylies were stratified using four physical characteristics: floating, symmetry, dominant side, and joint angulation/nail size. The algorithm identified the hypoplastic type and then stratified the polydactylies as symmetric and asymmetric. The asymmetric type was divided into ulnar dominant and radial dominant. The symmetric type was divided into adequate type and inadequate type. The prediction of treatments was studied retrospectively by the distribution of surgical procedures in 500 patients with 545 affected thumbs, by the new classification and the Wassel-Flatt classification. RESULTS Of the 545 polydactylies, 78 (14.5%) were categorized as the hypoplastic type, 369 (67.5%) as the ulnar-dominant type, 8 (1.5%) as the radial-dominant type, 70 (12.8%) as the symmetric adequate nail type, and 20 (3.7%) as the symmetric inadequate type. Treatments were excision and reconstruction in 403 polydactylies (73.9%), simple excision in 135 polydactylies (24.8%), and the Bilhaut-Cloquet procedure, ray amputation, and on-top plasty procedures were only performed in 7 polydactylies (1.3%). The distribution of surgical procedures was distinct among the new classification types and was similar among the Wassel-Flatt types. CONCLUSIONS The new classification stratified polydactylies by physical findings in a stepwise manner. Though surgical technical details are not included, this simple classification is useful for paediatricians and parents to understand how a surgical decision is made. LEVEL OF EVIDENCE Diagnostic Level IV.
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Affiliation(s)
- Wei Chien Sun
- Department of Paediatric Orthopaedics, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Po An Chen
- Department of Paediatric Orthopaedics, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Brian Po Rong Chen
- Department of Paediatric Orthopaedics, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Wei Chun Lee
- Department of Paediatric Orthopaedics, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Hsuan Kai Kao
- Department of Paediatric Orthopaedics, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Wen E Yang
- Department of Paediatric Orthopaedics, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chia Hsieh Chang
- Department of Paediatric Orthopaedics, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
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Wu J, Shi W, Lin X, Li J, Hong K, Liu Y, Li Y, Canavese F, Xu H. Modified Radiographic Classification System for Congenital Thumb Duplication: An Analysis of 2,300 Thumbs in 2,108 Children. J Hand Surg Am 2024; 49:275.e1-275.e8. [PMID: 35940999 DOI: 10.1016/j.jhsa.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/10/2022] [Accepted: 06/01/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The objectives of this study were to (1) evaluate the radiographic characteristics of children with congenital thumb duplication (CTD) seen in our institution between August 2015 and April 2021; (2) introduce a modified radiographic classification system (MCS) capable of including all cases of CTD based on their radiographic pathoanatomy; and (3) evaluate the inter- and intrarater reliability of the new classification system. METHODS We retrospectively reviewed 2,108 patients with 2,300 CTDs. The MCS is based on the Wassel-Flatt and Chung et al classification systems and includes specific subtypes from the Rotterdam and modified Wassel-Flatt classifications. The MCS is characterized by 4 groups according to the anatomical morphology of the duplication: A (joint), B (epiphysis), C (bone), and D (soft tissues). Each group includes 4 subtypes according to the location of the CTD, with subtypes 1-3 extending from the distal phalanx to the metacarpal or interphalangeal joints, then to the carpometacarpal joint, and with subtype 4 only including the triphalangia of the main thumb. RESULTS Among the 2,300 fingers, 360 (15.7%), 2 (0.1%), and 3 (0.1%) CTDs could not be classified according to the Wassel-Flatt, Chung et al, and Rotterdam classifications, respectively. According to the MCS, the 2 most common forms of CTD were A2 (680/2,300; 29.6%) and D2 (308/2,300; 13.4%). All cases could be classified according to this classification system. The MCS showed excellent intrarater (0.875) and interrater (0.851) reliability relative to the Wassel-Flatt (0.863 and 0.820, respectively), Chung et al (0.793 and 0.822, respectively), and Rotterdam (0.873 and 0.836, respectively) systems. CONCLUSIONS The MCS is a potential radiographic classification for CTD that enables the classification of all patients and has excellent inter- and intrarater reliability. CLINICAL RELEVANCE Existing classification systems do not allow classification of the full spectrum of CTD and are not always related to surgery, and some existing systems are complex, with many categories that are rarely encountered, or are difficult to use widely in clinical practice.
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Affiliation(s)
- JianPing Wu
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou, China.
| | - WeiZhe Shi
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou, China
| | - XueMei Lin
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou, China
| | - JingChun Li
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou, China
| | - Kai Hong
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou, China
| | - YuanZhong Liu
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou, China
| | - YiQiang Li
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou, China.
| | - Federico Canavese
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou, China; Department of Pediatric Orthopedic Surgery, Lille University Center and Faculty of Medicine Henri Warenbourg, Jeanne de Flandre Hospital, Lille, France
| | - HongWen Xu
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou, China.
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Hovius SER, Kruit AS. Complications after radial polydactyly surgery: analysis, prevention and management. J Hand Surg Eur Vol 2024; 49:226-239. [PMID: 37917822 DOI: 10.1177/17531934231209863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Long-term follow-up after surgical correction of patients with radial polydactyly might reveal unexpected or undesired outcomes that are accentuated by growth. It should be stressed that assessment of outcomes differs considerably by the system used. Preoperative examination can elucidate the underlying pathological anatomy of these anomalies and consequently, these anatomical differences should be corrected as much as possible during the first operation to prevent worse outcomes at long-term follow-up. In various long-term studies, the reoperation rate was in the range of 7%-28%, with the most common reasons being deviation, instability, nail deformity and suboptimal appearance. Most unfavourable results occur during growth and are frequently revealed only at longer-term follow-up. Concentration of care to a few centres is advised since these malformations occur in small numbers and experienced surgeons tend to have better results. Consensus on the used assessment system and multicentred studies are essential in future to better understand how we can prevent reoperations.
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Affiliation(s)
- Steven E R Hovius
- Department of Plastic and Reconstructive Surgery, Radboudumc University Medical Centre, Nijmegen, The Netherlands
- Hand and Wrist Study Group, ErasmusMC University Medical Centre, Rotterdam, The Netherlands
- Xpert Clinics Hand and Wrist Surgery, The Netherlands
| | - Anne Sophie Kruit
- Department of Plastic and Reconstructive Surgery, Radboudumc University Medical Centre, Nijmegen, The Netherlands
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Guo X, Wei Y, Wang F, Zhou X, Zhao S. Modified Bilhaut-Cloquet procedure for Wassel type III-IV polydactyly. J Orthop Surg Res 2024; 19:71. [PMID: 38229071 DOI: 10.1186/s13018-024-04553-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/10/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND To investigate the functional and aesthetic results of a new modified Bilhaut-Cloquet procedure for the treatment of Wassel type III-IV thumb polydactyly. METHODS Thirteen patients with Wassel type III-IV thumb polydactyly who visited the Department of Orthopedics of Hebei Provincial Children's Hospital from 2019 to 2022 were selected. The surgical procedure involved a modified Bilhaut-Cloquet surgery, where two-thirds of the distal part of the dominant finger was retained as the p body of the reconstructed thumb. The triangular bone block of the ablated distal thumb that did not contain the epiphysis and articular cartilage was sutured and fixed, and the neurovascular flap of the ablated distal thumb was used as an augmenting segment of the reconstructed thumb, with the nail bed and nail matrix exquisitely sutured. The evaluation performed according to the Japanese Society for Surgery of the Hand (JSSH) system. RESULTS All 13 children showed bone healing, no wound infection, nonunion, or deformity healing. None of the children showed a significant reduction in the active and passive mobility of the thumb postoperatively compared with preoperatively. Postoperative evaluation was performed based on the JSSH score, with a mean of 17.15 points (14-19 points), with 11 children rated as excellent and two as good. No severe nail ridges, nail gaps, or nail split deformities of the thumb were observed postoperatively. Postoperative metacarpophalangeal and interphalangeal joint movements were not reduced compared with preoperative movements. All parents were satisfied with the appearance and function of the reconstructed thumb. CONCLUSION The modified Bilhaut-Cloquet procedure designed in this study was satisfactory for Wassel type III-IV thumb polydactyly without affecting the stability of the interphalangeal joints and preserving joint mobility. The postoperative thumb has a comparable circumference and nail width and was cosmetically and functionally satisfactory, especially for the asymmetric two thumbs, which achieved favorable results.
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Affiliation(s)
- Xuzhao Guo
- Department of Orthopaedics, Children's Hospital of Hebei, Shijiazhuang City, Hebei Province, People's Republic of China
| | - Yanfei Wei
- Department of Surgery 1, Zanhuang County Hospital, Shijiazhuang City, Hebei Province, People's Republic of China
| | - Fei Wang
- Department of Orthopaedics, Children's Hospital of Hebei, Shijiazhuang City, Hebei Province, People's Republic of China
| | - Xiaokang Zhou
- Department of Orthopaedics, Children's Hospital of Hebei, Shijiazhuang City, Hebei Province, People's Republic of China
| | - Shuo Zhao
- Department of Orthopaedics, Children's Hospital of Hebei, Shijiazhuang City, Hebei Province, People's Republic of China.
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Kim JK, Yoon JO, Shin YH, Lee SH. Modified Wassel-Flatt Type III Radial Polydactyly: Subtypes and Their Outcomes. J Hand Surg Am 2024; 49:60.e1-60.e8. [PMID: 35803781 DOI: 10.1016/j.jhsa.2022.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 03/13/2022] [Accepted: 04/27/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE We aimed to subdivide modified type III radial polydactyly and evaluate the applied surgical procedures and outcomes according to the subtypes. METHODS This study included 32 thumbs of 32 patients treated for modified Wassel-Flatt type III radial polydactyly from March 2008 to December 2018. Each patient was subclassified into parallel, divergent, and convergent types according to the alignment of the duplicated digit. The parallel type was further divided according to the treatment method applied. The parallel A group comprised patients treated with reconstructing the radial collateral ligament of the interphalangeal (IP) joint after removing only the distal phalanx and preserving the proximal phalanx of the extra digit, and the parallel B group comprised patients treated with excision of the extra digit at the bifurcation site of the proximal phalanx. We evaluated the Japanese Society for Surgery of the Hand scores and radiographic angulation of the IP and metacarpophalangeal joints at a mean follow-up of 38 months. RESULTS Fourteen cases were parallel type (6 and 8 in the parallel A and B groups, respectively), 14 were divergent type, and 4 were convergent type. Patients in the parallel A group had significantly better IP and metacarpophalangeal joint angulation and Japanese Society for Surgery of the Hand scores than those in the parallel B group. Patients in the parallel A group had significantly better Japanese Society for Surgery of the Hand scores than those in the divergent and convergent groups. CONCLUSIONS Reconstructing the radial collateral ligament of the IP joint after removing only the distal phalanx and preserving the proximal phalanx of the extra digit was associated with better outcomes than the excision of the extra digit at the bifurcation site in the parallel type cases. The parallel type treated with proximal phalanx preservation and ligament reconstruction had better clinical outcomes than other types of modified Wassel-Flatt type III radial polydactyly. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Jae Kwang Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Jun O Yoon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Ho Shin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung Hyun Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Makino A, Saito S. Morphologic Changes in Postaxial Polydactyly of the Foot: A Standardized Quantitative Analysis Using the Watanabe-Fujita Classification. Plast Reconstr Surg 2024; 153:170e-180e. [PMID: 37075280 DOI: 10.1097/prs.0000000000010565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND Postaxial polydactyly of the foot is one of the most common congenital abnormalities. A wide forefoot, short toe, and lateral joint deviation are associated with aesthetic and functional outcomes. This study used the Watanabe-Fujita classification to characterize the preoperative and postoperative skeletal morphology of postaxial polydactyly of the foot. METHODS This retrospective study included 42 patients (51 feet) with postaxial polydactyly treated at age 1 year. Radiographs taken at ages 0 and 3 to 4 years were used for morphologic analysis. The length of the reconstructed toe, the distance between the fourth and fifth metatarsals, and joint deviation angles were measured. The length measures were standardized using the length of the third metatarsal. Morphologic characteristics were compared based on the Watanabe-Fujita classification at ages 0 and 3 to 4 years. Long-term outcomes were also evaluated in patients followed up for longer than 6 years. RESULTS The fifth-ray proximal phalangeal subtype had the shortest toe length both at ages 0 and 3 to 4 years. Proximal phalangeal joint lateral deviation improved postoperatively in 78% of patients with the fifth-ray middle phalangeal subtype, regardless of reconstruction type. There was no significant change in proximal phalangeal joint deviation between ages 3 to 4 years and 7 years or older. A residual metatarsal was associated with lateral metatarsophalangeal joint deviation and a wide intermetatarsal distance, and required revision surgery. CONCLUSIONS Morphologic changes of postaxial polydactyly of the foot were successfully characterized using the Watanabe-Fujita classification. This classification could be useful for planning surgical strategies and anticipating morphologic outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Aiko Makino
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Susumu Saito
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University
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Winge MI, Guéro S, Zavarukhin V, Paavilainen P, Baldrighi C, Kjørup A, Hülsemann W. Ulnar dimelia - a review of 24 cases. J Hand Surg Eur Vol 2023; 48:1126-1135. [PMID: 37684016 PMCID: PMC10785563 DOI: 10.1177/17531934231196418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/03/2023] [Accepted: 08/06/2023] [Indexed: 09/10/2023]
Abstract
Ulnar dimelia is a very rare unilateral congenital upper limb anomaly (CULA) affecting the whole extremity. Treatment remains difficult because of the complexity and multi-level involvement. Twenty-four cases with duplicated ulna, absent radius and polydactyly from seven European centres were reviewed according to a structured list of parameters. At first consultation, median age 8 months (1-178), the shoulder movement was good in 17 patients or poor in six, and the median passive elbow range of motion was 20° (0°-90°). The resting wrist position was flexed in 22/24 patients. Following stretching and splinting, elbow surgery included resection of the lateral proximal ulna in 11 patients and muscle transfers in six to improve passive movement and increase active elbow motion, respectively. Tendon transfers were performed in eight wrists and a pollicization or pseudo-pollicization in 23 patients. Overall, patients demonstrate acceptable function postoperatively. Guidelines for treatment of this severe CULA are presented.Level of evidence: IV.
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Affiliation(s)
- Mona I. Winge
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Vladimir Zavarukhin
- Saint Petersburg State University Hospital, Vasilievsky island, Saint-Petersburg, Russia
| | | | | | | | - Wiebke Hülsemann
- Children`s Hospital Wilhelmstift, Handsurgery Department, Hamburg, Germany
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Watanabe D, Hasebe Y, Mitsui H, Oishi N, Kasai S, Akahane K, Kojika S, Inukai T. Prenatal Torsion of Radial Polydactyly: A Gangrenous Mass at the Base of the Thumb. Acta Med Okayama 2023; 77:651-653. [PMID: 38145940 DOI: 10.18926/amo/66158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
A patient was born with a mass at the base of the thumb approximately 1.5 cm in diameter on the radial side of the fingers. The mass had globular swelling filled with hemorrhagic fluid and was dark red. X-rays and histology of the excised specimen suggested the diagnosis of gangrene and torsion of polydactyly. Prenatal torsion of polydactyly is not a common occurrence; moreover, prenatal torsion of polydactyly has only been found in ulnar polydactyly. Our case is a novel case of radial polydactyly that was gangrenous at birth owing to prenatal torsion. Diagnosing such a mass at the base of the thumb is important.
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Affiliation(s)
- Daisuke Watanabe
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi
| | - Yohei Hasebe
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi
| | - Hiroshi Mitsui
- Department of Dermatology, Faculty of Medicine, University of Yamanashi
| | - Naoki Oishi
- Department of Pathology, Faculty of Medicine, University of Yamanashi
| | - Shin Kasai
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi
| | - Koshi Akahane
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi
| | - Satoru Kojika
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi
| | - Takeshi Inukai
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi
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Zhong W, Sun L, Zhao J, Guo Y, Huang Z, Tian W. Triplication and tetraplication of the thumb: a modification of the Rotterdam classification. J Hand Surg Eur Vol 2023; 48:1191-1200. [PMID: 37211793 DOI: 10.1177/17531934231173111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We proposed a modification of the Rotterdam classification for thumb triplication and tetraplication. Twenty-one patients were included (24 cases of thumb triplication and four cases of tetraplication). These were analysed and classified according to a modification of the Rotterdam classification involving three steps; from the radial to ulnar side, we first identified each thumb on radiographs and gross appearance to divide into triplication or tetraplication. Second, we define the levels of duplication and established the nomenclature. Third, the aberrant features and their location were assigned for each thumb, again from radial to ulnar side. A surgical algorithm was also proposed. This modified classification may be helpful for characterizing the rare conditions of thumb triplication and tetraplication for use in patient and management and communication between surgeons.Level of evidence: III.
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Affiliation(s)
- Wenyao Zhong
- Center of Congenital Hand Deformity and Rare Disease, Department of Hand Surgery, Beijing Jishuitan Hospital, China
| | - Liying Sun
- Center of Congenital Hand Deformity and Rare Disease, Department of Hand Surgery, Beijing Jishuitan Hospital, China
| | - Junhui Zhao
- Center of Congenital Hand Deformity and Rare Disease, Department of Hand Surgery, Beijing Jishuitan Hospital, China
| | - Yang Guo
- Center of Congenital Hand Deformity and Rare Disease, Department of Hand Surgery, Beijing Jishuitan Hospital, China
| | - Zhifeng Huang
- Center of Congenital Hand Deformity and Rare Disease, Department of Hand Surgery, Beijing Jishuitan Hospital, China
| | - Wen Tian
- Center of Congenital Hand Deformity and Rare Disease, Department of Hand Surgery, Beijing Jishuitan Hospital, China
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Yin C, Liu W, Yu W, Wei S, Yu A, Jiang Y, Shen X. On-top plasty combined with modified Bilhaut-Cloquet procedure for reconstructing complicated radial polydactyly. J Plast Reconstr Aesthet Surg 2023; 86:315-320. [PMID: 37797379 DOI: 10.1016/j.bjps.2023.09.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE To present a surgical technique of combining the on-top plasty with modified Bilhaut-Cloquet procedure for reconstructing a rare type of complicated radial polydactyly and evaluate the outcomes. METHODS Fourteen complicated radial polydactyly in 13 patients were corrected by combining the on-top plasty with modified Bilhaut-Cloquet procedure. Osteotomies were performed as required, and the acral part of the ulnar thumb was transposed onto the proximal part of the radial thumb. The distal parts of the two thumbs were isolated as neurovascular pedicled composite tissue flaps, including part of the distal phalanx and nail bed, and were attached together in an extra-articular way. The tendons were rebalanced, and the nail bed was reconstructed. Objective and subjective outcomes were assessed. RESULTS The average follow-up time was 32.4 months (6-60 months). All reconstructed thumbs were rated as good in appearance and function. The mean Vancouver Scar Scale score was 1.3 (range 1-2) and the mean Wang-Gao score of the reconstructed thumbnail was 9.4 (range 8-11). The Tada score for the function of the reconstructed thumb was 5.5 (range 5-6). The main active range of motion (ROM) of the interphalangeal joint (IPJ) was 2.1-38.9°. All parents were satisfied with the outcomes. CONCLUSIONS Because of the diverse manifestations of thumb polydactyly, individualized surgical treatment is recommended, and careful preoperative planning should be made with the principle of combining the best parts of the two thumbs. By combining an on-top plasty with modified Bilhaut-Cloquet procedure, a satisfactory result can be achieved for treating complicated radial polydactyly.
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Affiliation(s)
- Chunhua Yin
- Department of Pediatric Orthopaedics, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.
| | - Wei Liu
- Department of Pediatric Orthopaedics, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.
| | - Wentao Yu
- Department of Pediatric Orthopaedics, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.
| | - Song Wei
- Department of Pediatric Orthopaedics, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.
| | - Aiping Yu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Yongkang Jiang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Xiaofang Shen
- Department of Pediatric Orthopaedics, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.
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Yao F, Yin C, Yu W, Liu W, Yang G, Shen X. Intraoperative Observation of the Proper Digital Nerves in Wassel-Flatt Type Ⅳ Radial Polydactyly. J Hand Surg Am 2023; 48:1169.e1-1169.e6. [PMID: 36100486 DOI: 10.1016/j.jhsa.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 06/06/2022] [Accepted: 07/20/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of the study was to present the intraoperative findings of the relevant digital nerves of the duplicated thumbs in an excision and reconstruction procedure for the Wassel-Flatt type Ⅳ radial polydactyly. METHODS The study was conducted on patients with Wassel-Flatt type IV radial polydactyly who underwent excision and reconstruction between 2018 and 2021 at our institution. The ulnar digital nerve of the radial thumb and the radial digital nerve of the ulnar thumb were identified and traced intraoperatively. The level of the bifurcation of the nerves and abnormal findings were documented. RESULTS A total of 123 hands in 119 patients were included in this study. In 114 hands, the bifurcation of the nerves was located within 1 cm of the metacarpophalangeal flexion crease. The radial digital nerve to the ulnar thumb was abnormally compressed in deep fascial tissue in 7 of these 114 hands. In 5 hands, the level of bifurcation was more than 1 cm proximal to the crease. No radial digital nerve to the ulnar thumb was identified in the remaining 4 hands. CONCLUSIONS Although rare, abnormal nerve compression of the digital nerve may exist in duplicated thumbs of Wassel-Flatt type IV radial polydactyly. CLINICAL RELEVANCE In an excision and reconstruction procedure, we suggest that the bifurcation of the nerves should be identified before the nerve to the radial thumb is excised to avoid injuring the nerve to the main ulnar thumb.
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Affiliation(s)
- Feng Yao
- Department of Pediatric Orthopedics, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Chunhua Yin
- Department of Pediatric Orthopedics, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Wentao Yu
- Department of Pediatric Orthopedics, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Wei Liu
- Department of Pediatric Orthopedics, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Guang Yang
- Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Xiaofang Shen
- Department of Pediatric Orthopedics, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.
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Goebel GJ, Loewenstein SN, Adkinson JM. Parent Perspectives for Type B Ulnar Polydactyly Management. Hand (N Y) 2023; 18:1357-1361. [PMID: 35658690 PMCID: PMC10617471 DOI: 10.1177/15589447221096707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Type B ulnar polydactyly is one of the most commonly encountered congenital hand differences and can be treated with ligation or excision. The purpose of this study was to determine what factors families consider in selecting treatment for their child with type B ulnar polydactyly. METHODS We reviewed treatment outcomes and administered a survey by telephone to parents of children with type B ulnar polydactyly treated at a pediatric hospital between 2015 and 2020. We assessed satisfaction, reasons for choosing treatment, and post-management complications. RESULTS The families of 70 of the 156 consecutive treated patients were successfully contacted and agreed to participate (45% response rate). The mean follow-up was 27 months. Twenty-eight chose in-office suture ligation and 42 chose excision. Rapid treatment was prioritized by those who opted for in-office ligation (P = .044). The complication rate for suture ligation was significantly higher than excision (P < .0001), with the most common complication being a residual remnant (nubbin or neuroma stump) (64%). Respondents with residual remnant reported significantly less satisfaction with the appearance of their child's hand (P < .001) and with treatment outcomes (P = .028) compared to those without residual remnants. CONCLUSIONS Factors considered by parents in choosing type of treatment for type B ulnar polydactyly vary and may be significantly influenced by the surgeon. Although the majority of parents remain extremely satisfied with their child's outcome regardless of management type, time to treatment plays a determinative role in parents opting for ligation rather than excision in the operating room.
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Kou X, Wu Y, Ma G, Liu S. Surgical treatment of congenital polydactyly of the four limbs: A case report. Asian J Surg 2023; 46:4511-4512. [PMID: 37169684 DOI: 10.1016/j.asjsur.2023.04.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 05/13/2023] Open
Affiliation(s)
- Xianshuai Kou
- The First Clinical Medical College of Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - Yunbiao Wu
- The First Clinical Medical College of Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - Guifu Ma
- Department of Orthopedics, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Shengfen Liu
- Department of Orthopedics, Gansu Provincial Hospital, Lanzhou, 730000, China.
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Muhammad H, Hardiyanti L, Anwar S, Hanif F, Ditta AAM, Harahap ISK. Tourniquet-Related Nerve Injury Following Reconstructive Surgery for Wassel Type IV Preaxial Polydactyly of 13-Year-Old Boy: A Case Report. Am J Case Rep 2023; 24:e940977. [PMID: 37715365 PMCID: PMC10507954 DOI: 10.12659/ajcr.940977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/03/2023] [Accepted: 07/28/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Congenital thumb duplication comes under the Wassel type IV classification is the hypoplastic variety, with the extra digit growing from the dominant thumb's soft tissue alone. Excising the hypoplastic finger while reconstructing for the retained one has been the most adopted approach. Tourniquets are commonly utilized tools in orthopedic surgeries to reduce the amount of blood, thus enhancing the visibility. Unfortunately, tourniquet-related nerve injury (TNRI) is gaining more attention as a serious complication of tourniquet use in surgery. CASE REPORT A 13-year-old Asian boy with preaxial polydactyly Wassel type IV of the right hand underwent reconstruction surgery. A pneumatic tourniquet was applied at 200 mmHg on the right mid-upper arm and maintained for 90 min. After the surgery, the patient had total weakness with numbness, tingling, and burning sensation from his right upper arm to his fingertips. The neurological examination and nerve conduction studies (NCS) results were consistent with axonotmesis lesions. Pharmacological and physical rehabilitation therapy had successfully restored full motoric and sensory function after 6 months. CONCLUSIONS Nerve injury should be acknowledged as a possible complication from routinely-utilized tourniquets in orthopedic surgeries. Our cases may expand the need for further studies to establish a guideline for tourniquet use and TRNI management.
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Affiliation(s)
- Hilmi Muhammad
- Division of Orthopaedics and Traumatology, Department of Surgery, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
| | - Lulus Hardiyanti
- Division of Rehabilitation, Department of Surgery, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
| | - Saeful Anwar
- Division of Orthopaedics and Traumatology, Department of Surgery, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
| | - Faishal Hanif
- Department of Neurology, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
| | - Adist Azizy Mara Ditta
- Department of Neurology, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
| | - Indra Sari Kusuma Harahap
- Department of Neurology, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
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Chen PA, Sun WC, Chen BPR, Lee WC, Kao HK, Yang WE, Chang CH. Prediction of Surgical Outcomes of Radial Polydactyly From the Wassel-Flatt Type and Symmetry of Duplication. J Pediatr Orthop 2023; 43:e305-e309. [PMID: 36728384 DOI: 10.1097/bpo.0000000000002349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The Wassel classification is commonly used for cases of radial polydactyly but has not been used to predict surgical outcomes. This study aimed to investigate the predictive factors of surgical outcomes using the Wassel type and symmetry of duplication. METHODS Forty-five patients with 47 radial polydactylies were reviewed using the Japanese Society for Surgery of the Hand (JSSH) scores 4.6 years after minor thumb excision and reconstructive surgery. The symmetry index was defined as the metaphyseal width ratio of the minor thumb to the dominant thumb. The relationships between the JSSH scores and operation age, sex, side, follow-up duration, Wassel type, symmetric index, divergent angle, and joint angulation were analyzed by linear regression. RESULTS The mean JSSH score of the 47 thumbs was 18.3 points (range, 15-20). Five thumbs had fair or poor outcomes (scores <17), all of which were Wassel type IV. The hypoplastic type had a better JSSH score (19.4) than other Wassel types. The symmetric index had a negative relationship with JSSH scores, especially for Wassel type IV (r=-0.68, P =0.001). Linear regression revealed that the symmetric index was the only independent factor significantly associated with JSSH scores among Wassel type IV polydactylies ( P <0.05). The receiver operating characteristic curve suggested a symmetric index <0.74 could predict good or excellent outcomes. CONCLUSION The symmetry of the 2 duplicated thumbs is an important factor for surgical outcomes. The Wassel type IV polydactylies with a symmetric index >0.74 are at greater risk of fair or poor outcomes after excision and reconstruction, and further studies are warranted to confirm whether the Bilhaut-Cloquet procedure is a good choice. LEVEL OF EVIDENCE Level IV-Case-control study.
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Affiliation(s)
- Po An Chen
- Division of Pediatric Orthopedics, Bone and Joint Research Center, Department of Orthopedic Surgery, Chang Gung Memorial Hospital - Linkou Branch, Taoyuan, Taiwan
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Stults WP, Peljovich AE. Surgical Excision of Postaxial Polydactyly Type B in the Office Setting. J Pediatr Orthop 2023; 43:255-258. [PMID: 36622639 DOI: 10.1097/bpo.0000000000002346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Simple postaxial polydactyly (type B) is a common congenital hand malformation often treated by suture or clip ligation. METHODS We present a case series of patients with simple postaxial polydactyly treated by surgical excision using local anesthesia in an office setting. RESULTS The procedure was performed on 78 digits in 48 children with a mean age of 10.2 weeks. There were no intraoperative or early postoperative complications. A follow-up by phone interview was performed at an average of 3.2 years postoperatively. All patients were reported to be pain-free and have normal function without a perceived range of motion deficits. All parents selected the highest level of satisfaction regarding cosmetic outcomes and overall experience with the procedure. CONCLUSIONS These results demonstrate that an office-based surgical excision is a safe, effective, and economical treatment option and has developed into our standard of care for this common condition.
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Affiliation(s)
- William P Stults
- Department of Orthopaedic Surgery, WellStar Atlanta Medical Center
| | - Allan E Peljovich
- Department of Orthopaedic Surgery, WellStar Atlanta Medical Center, The Hand and Upper Extremity Center of Georgia, Atlanta, GA
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Tawfeeq Y, Hendry JM, Wood KS. Update of surgical treatment of polydactyly. Curr Opin Pediatr 2023; 35:124-130. [PMID: 36412268 DOI: 10.1097/mop.0000000000001204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE OF REVIEW Polydactyly presents with variable extent of duplication and may involve preaxial/radial (hand)/medial (foot), postaxial/ulnar (hand)/lateral (foot) or central duplication. This review will summarize recent advancements in the surgical management of this common entity. RECENT FINDINGS Modifications to classification systems aim to help guide surgical management of polydactyly. Attempts have been made at quantifying preoperative angulation of the duplicated digits to minimize the chance of residual or recurrent deformity after surgical reconstruction. As a result, consideration should be given to the need for soft tissue correction vs. osteotomy to optimize the clinical outcome. On-top plasty is an option that may be beneficial in 'unequal' preaxial polydactyly, where neither duplicate is preferred on its own. SUMMARY Polydactyly is one of the most common congenital anomalies in the hands and feet. Determination of surgical intervention often begins with classification systems that exist, which primarily separate these into preaxial, postaxial, and central. Referral for surgical consideration is indicated, given the management is often surgical.
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Affiliation(s)
- Yaser Tawfeeq
- Division of Orthopaedic Surgery, Department of Surgery
- Department of Orthopedic Surgery, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - J Michael Hendry
- Division of Plastic Surgery, Department of Surgery, Queen's University, Kingston, Ontario, Canada
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Burger E, 't Hart J, Hovius S, Van Nieuwenhoven C. Quality of life in children with preaxial polydactyly of the foot in comparison to adults, postaxial polydactyly and healthy controls. J Pediatr Orthop B 2023; 32:27-33. [PMID: 36125884 DOI: 10.1097/bpb.0000000000001004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The effect of preaxial polydactyly of the foot on health-related quality of life (HR-QoL) has not been investigated in current literature. To improve counseling, we investigated HR-QoL in this patient group. A patient-control study was performed with children with preaxial polydactyly ( n = 20), adults with preaxial polydactyly ( n = 15), children with postaxial polydactyly ( n = 15) and healthy controls ( n = 62). The primary outcome was the difference in the foot-specific quality of life (FS-QoL) between children with preaxial polydactyly and adults with preaxial polydactyly, children with postaxial polydactyly and controls, using the Oxford Ankle and Foot Questionnaire (OxAFQ-c) and five foot-specific visual analogue scales (VAS). The secondary outcome was the difference in general HR-QoL, using the Pediatric Quality of Life Inventory (PedsQL). Outcomes were compared with the Mann-Whitney-U test. Comparison between children with preaxial polydactyly and healthy controls and postaxial polydactyly showed worse outcomes in all OxAFQ-c domains. The foot-specific VAS score was significantly worse in children with preaxial polydactyly compared to postaxial polydactyly and controls. Only the PedsQL physical domain showed a lower outcome in children with preaxial polydactyly than in postaxial polydactyly and controls. Children and adults with preaxial polydactyly scored the same in all domains. The OxAFQ-c and the PedsQL physical domain showed significantly worse outcomes in children with preaxial polydactyly compared with healthy controls and postaxial polydactyly. However, large variation was observed, suggesting large differences between patients. In children and adults, the foot and scar appearance seems to be the biggest problem, while diminished foot function seems less of an issue.
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Affiliation(s)
- Elise Burger
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam
| | - Judith 't Hart
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam
| | - Steven Hovius
- Department of Plastic, Reconstructive and Hand surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Abstract
BACKGROUND Surgical excision for postaxial polydactyly type B is advocated to avoid long-term complications. Excision with local anesthesia (LA) in infancy represents a safe and effective treatment for this condition, although general anesthesia (GA) is employed by many surgeons. We present a comparison of surgical outcomes, cost, and time between LA and GA to support widespread change in management. METHODS A retrospective review of patients under 12 months of age undergoing surgical polydactyly excision by a single surgeon was performed. Anesthesia type, patient demographics, and complications were recorded. Comparisons were made between LA and GA groups on procedure cost, operating time, length of stay (LOS), and time from procedure end to discharge. Stepwise forward regression was used to identify the best model for predicting total costs. RESULTS Ninety-one infants with a mean age of 3 months (±1.9) were examined; 51 (56%) underwent LA alone, 40 (44%) underwent GA. Mean operating time was 11.53 ± 4.36 minutes, with no difference observed between anesthesia groups (P = .39). LA infants had a significantly shorter LOS (2.5 vs 3.5 hours; P < .05), quicker postoperative discharge (32 vs 65 minutes, P < .05), and fewer overall expenses, 2803 vs 6067 U.S. dollars (USD), P < .05. Two minor surgical complications (1 in each group) were reported. CONCLUSIONS This study demonstrates significantly decreased cost, LOS, and time to discharge using LA alone for surgical excision of postaxial polydactyly type B. Results suggest the approach is quick, economical, and avoids the risks of GA in early infancy.
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Affiliation(s)
- Kim A. Bjorklund
- Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, USA
| | - Meghan O’Brien
- Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, USA
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Swed S, Nashwan AJ, Saleh HH, Chawa Y, Baria A, Etr A. Triphalangeal thump, thumb duplication, and syndactyly: The first case report in the literature. Medicine (Baltimore) 2022; 101:e31237. [PMID: 36281136 PMCID: PMC9592472 DOI: 10.1097/md.0000000000031237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
RATIONALE Triphalangeal thumb (TPT) is a rare congenital malformation where the thumb has three phalanges instead of two. Syndactyly is a condition in which children are born with fused or webbed fingers. The combination of TPT, Syndactyly, and thumb duplication is extremely rare, especially when these deformities are combined in one hand. PATIENT CONCERNS Hand abnormalities and polydactyl have been reported in a 1-year-old boy. DIAGNOSIS A clinical examination reveals two thumb duplications, finger fusion (Syndactyly), and a thumb with three phalanges (TPT). The diagnosis was based on clinical findings and an X-ray image of the hand. INTERVENTIONS The Z-plasty method was used to remove the adhesion between the thumb and forefinger, as well as the removal of the medial and distal phalanx of the thumb's medial tip. OUTCOMES The patient was followed for 2 months and found him in good health. To authors' knowledge, we described an unusual case from Syria, considered the first in medical history. LESSONS LEARNED General and plastic surgeons should be aware about this unusual mix of the three abnormalities. The family history must also be carefully investigated to explore the occurrence of hereditary illnesses.
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Affiliation(s)
- Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Abdulqadir J. Nashwan
- Nursing Department, Hamad Medical Corporation, Doha, Qatar
- * Correspondence: Abdulqadir J. Nashwan, Hamad Medical Corporation, Doha, P.O. Box 3050, Qatar (e-mail: )
| | | | - Yamane Chawa
- Department of Endocrinology, Aleppo University Hospital, Aleppo, Syria
| | - Alaa Baria
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Aladdin Etr
- Department of Plastic Surgery, Aleppo University Hospital, Aleppo, Syria
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Abstract
BACKGROUND The purpose of this research is to study the modified surgical effect of Wassel type III radial polydactyly thumbs of equal or nearly equal size treated. METHODS The study sample consisted of 12 reconstructed cases of Wassel type III radial polydactyly. The proximal phalanx was unequally combined by the curvature osteotomy and aligned the articular surface, and the distal phalanx was symmetrically combined. A fragment bone was filled in the depression of the distal phalanx to correct nail curvature and prevent seagull deformities. Twelve cases were available for assessment using an evaluation form on the Japanese Society for Surgery of the Hand. RESULTS An average functional point was 13.75 points (maximum 14 points). The interphalangeal joint motion was reduced, but this joint was stable in all cases. The cosmetic score was averaged 3.6 (maximum 4 points), and most parents were satisfied with the postoperative appearance and functional results. CONCLUSION Our modification of Bihaut-Cloquet procedure is an effective way to provide a well-functioning thumb for Wassel type III radial polydactyly thumbs. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Zijing Du
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
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Khabyeh-Hasbani N, Tozzi D, Guerra SM, Koehler SM. Radial Polydactyly. JBJS Rev 2022; 10:01874474-202205000-00002. [PMID: 37545004 DOI: 10.2106/jbjs.rvw.21.00214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Radial polydactyly is one of the most common congenital anomalies of the hand, with an incidence of 0.08 to 1.40 per 1,000 live births; it requires surgical treatment early in life.» Polydactyly occurs during weeks 5, 6, 7, and 8 of embryogenesis, principally due to misregulation of the sonic hedgehog protein within the developing limb bud.» The Flatt classification system of preaxial polydactyly (types I to VII), as published by Wassel, categorizes preaxial polydactyly based on osseous abnormalities, but it has substantial limitations.» For improved function and appearance, preaxial polydactyly ideally requires surgical intervention at an early age (between 1 and 2 years of age) before the development of fine motor skills.
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Affiliation(s)
| | - Declan Tozzi
- SUNY Downstate Medical Center, Brooklyn, New York
| | - Sara M Guerra
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Steven M Koehler
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York
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Affiliation(s)
- Lei Zeng
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
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Zhou R, Tian X, Zhang S, Qiu L, Fu Y. Nail-based reconstruction strategies for Wassel-Flatt type IVh thumb polydactyly with a floating ulnar digit: A preliminary report with 63 thumbs. J Plast Reconstr Aesthet Surg 2021; 75:1476-1482. [PMID: 34961698 DOI: 10.1016/j.bjps.2021.11.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 05/04/2021] [Accepted: 11/12/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To present a surgical regimen based on nail morphology for Wassel-Flatt type IVh thumb polydactyly with a floating ulnar digit. METHODS Cases within six years were retrospectively analyzed and followed up for an average of 18 months. Three types of classifications were defined based on nail morphology ‒ ulnar nail dominant type with two subtypes of nail lateral fold symmetric or asymmetric, radial nail dominant type, and equal nail size type. One out of three procedures, on-top plasty (Ⅰ), soft tissue augmentation (Ⅱ), and the combination of the above two (Ⅲ), was performed. The Tada scoring system was used to evaluate the results. RESULTS Sixty-three thumbs were enrolled, forty-one of better ulnar nail type underwent top transposition, and in cases of asymmetric nail lateral fold subtype, the result of procedure Ⅲ was better than that of procedure Ⅰ, thirteen of the radial nail dominant type and nine of equal nail size type both had procedure Ⅱ. The equal nail size type was the least effective among groups, with an average Tada of four points. Six cases underwent secondary revision surgery. According to the Tada scoring system, the results were excellent in 61, fair in two. CONCLUSIONS Classifications based on the morphology of the nail can guide surgical planning. On-top plasty is suitable for symmetric nail lateral fold subtype. Soft tissue augmentation is ideal for radial nail dominant type and equal nail size type, and the combination of the two procedures is a better option for asymmetric nail lateral fold subtype.
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Affiliation(s)
- Rong Zhou
- Department of Burns and Plastic Surgery of Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing key Laboratory of Pediatrics, Chongqing, China
| | - Xiaofei Tian
- Department of Burns and Plastic Surgery of Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing key Laboratory of Pediatrics, Chongqing, China.
| | - Shenghui Zhang
- Department of Burns and Plastic Surgery of Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing key Laboratory of Pediatrics, Chongqing, China
| | - Lin Qiu
- Department of Burns and Plastic Surgery of Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing key Laboratory of Pediatrics, Chongqing, China
| | - Yuexian Fu
- Department of Burns and Plastic Surgery of Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing key Laboratory of Pediatrics, Chongqing, China
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Abstract
BACKGROUND The aim of the study was to present a new operative technique for aesthetic and anatomic reconstruction of polysyndactyly of the fifth toe fused with the fourth toe. METHODS Surgery was performed in 86 feet in 73 patients with polysyndactyly of the fifth toe fused with the fourth toe. The operation involved polydactyly excision, syndactyly release using an improved dorsal asymmetric gullwing flap for web space reconstruction without skin grafting, and simultaneous correction of valgus deformity and brachydactyly of the toes. The web shape (height and width),scar contracture, and aesthetic outcomes (foot contour and morphology of the reconstructed fifth toe) were assessed using the criterion of D'Arcangelo, Vancouver Scar Scale score, and older children and parent-based satisfactory questionnaire, respectively. RESULTS The patients were followed up for 12 to 36 months. The reconstructed web spaces were slightly deeper than normal, with an hourglass shape and a physiological slope. Valgus deformity was completely corrected without recurrence. The reconstructed fifth toes appeared to be visually lengthened. On the basis of the criterion of D'Arcangelo, the height and width of the webs were good in 76, fair in 10, and poor in none of the feet. The mean Vancouver Scar Scale score was 1.5. All parents and patients were satisfied with the appearance and function. CONCLUSIONS Our new operative procedure could achieve aesthetic and anatomic reconstruction of polysyndactyly of the fifth toe fused with the fourth toe with good shape of the reconstructed web space without skin grafting, favorable appearance and axis alignment of the reconstructed fifth toes, and good foot contour.
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Affiliation(s)
| | | | - Wei Huang
- Department of Joint Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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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: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Mishra JK, Borkar NK, Kar BK, Sahu SA, Shrimor P. Isolated hexadactylia: A rare case of central polydactyly of the foot. Foot (Edinb) 2020; 42:101633. [PMID: 31731072 DOI: 10.1016/j.foot.2019.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/29/2019] [Accepted: 08/18/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Central polydactyly of foot is uncommon form of polydactyly but it usually causes intermetatarsal widening because of metatarsal bifurcation. Central polydactyly associated with T shaped bifurcation of metatarsal in vertical plane has not been reported yet. CASE We present a 4 year male child with extra toe on the dorsal aspect of right foot with complains of difficulty in wearing footwear and poor cosmesis. The extra digit was fully developed with bifurcation of 2nd metatarsal bone proximal to the head without any intermetatarsal widening. The angular deviation was 45° to the longitudinal axis of foot and in a plane vertical to the transverse arch of foot. The child was operated with excision of extra toe without any residual bony deformity. CONCLUSION The central polydactyly is rare type of polydactyly of foot. Central polydactyly with metatarsal extension causing intermetatarsal widening has been well described entity. But the previous classifications need to be modified to include central polydactyly with vertical oriented T bifurcation of metatarsal bone without intermetatarsal widening.
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Affiliation(s)
- Jiten Kumar Mishra
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, 492099, India
| | - Nitin Kumar Borkar
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, 492099, India
| | - Bikram Keshari Kar
- Department of Orthopedic Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, 492099, India
| | - Shamendra Anand Sahu
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, 492099, India.
| | - Prachi Shrimor
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, 492099, India
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Wright J, Pickford M, Khandwala A. A child with a congenital hand anomaly. BMJ 2019; 365:l1847. [PMID: 31171503 DOI: 10.1136/bmj.l1847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jenny Wright
- The University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK
| | - Mark Pickford
- Queen Victoria Hospital, East Grinstead, West Sussex, UK
| | - Asit Khandwala
- Queen Victoria Hospital, East Grinstead, West Sussex, UK
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Kubat O, Antičević D. Does timing of surgery influence the long-term results of foot polydactyly treatment? Foot Ankle Surg 2018; 24:353-358. [PMID: 29409237 DOI: 10.1016/j.fas.2017.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 03/16/2017] [Accepted: 04/04/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is an evident lack of research on timing of polydactyly surgery and its effects on treatment results. METHODS Retrospective comparative study on foot polydactyly patients treated at our department from 1995 to 2009. Patients were divided into 2 groups, group A - under the age of 5 at surgery, and group B - 5 years and older. RESULTS There were 24 patients (8 male, 16 female), 30 feet. Median age at surgery was 1 year (range, 9 months-4.5 years) for group A, and 8.5 years (range, 6-37 years) for group B. Median follow-up was 16.2 years (range, 7-21 years). There were 16 postaxial and 8 preaxial cases. At the last follow-up 12 patients' feet were "excellent" and 12 "good". No significant differences were identified between the two groups at final follow-up. CONCLUSIONS Timing of surgery for foot polydactyly is not crucial for final results.
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Affiliation(s)
- Ozren Kubat
- Department of Orthopaedic Surgery, Clinical Hospital Centre Zagreb, Šalata 6-7, 10000 Zagreb, Croatia.
| | - Darko Antičević
- Children's Hospital Zagreb, Vjekoslava Klaića 16, 10000 Zagreb, Croatia.
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Abstract
Postaxial type B polydactyly is the presence of a supernumerary digit attached by soft tissue in a pedunculated fashion to the fifth digit. In the present case, a newborn with bilateral postaxial type B polydactyly underwent suture ligation to remove the supernumerary digit, but multiple ligation attempts were required. Ultimately, residual tissue remained bilaterally, but it did not seem to be painful. A comprehensive review of the literature revealed no clear recommendation on treatment options for patients with postaxial polydactyly. Although suture ligation has been common practice, surgical excision is an acceptable option that can be performed in the neonatal unit and may result in fewer complications than suture ligation.
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Abstract
RATIONALE Heptadactylia is a rare congenital disorder from the polydactyly family. Polydactyly is generally classified into 3 major groups: preaxial (medial ray), postaxial (lateral ray), and central polydactyly. Most common cases are related to preaxial or postaxial polydactyly. The rarity of central polydactyly can be explained in 3 ways. First, central polydactyly with duplication appearing on metatarsal is pretty uncommon. Second, the duplication appears isolated on the foot. Polydactyly is mostly associated with other physical defects or others duplications. Last, the duplication of the digital rays does not appear once but twice concerning all the digital rays and makes 7 functional toes appear. We describe this malformation with supporting iconography and radiography as well as its surgical management and functional results. PATIENT CONCERNS We analyzed an original case of isolated heptadactylia on the foot of a 14-month-old girl. The supernumerary toes made it impossible for the child to wear standard shoes and her parents were worried about this problem. DIAGNOSES Clinical foot examination and radiographs revealed the presence of 7 complete rays. Every toe was composed of phalanx and metatarsal ray. There was no other congenital deformity. INTERVENTIONS Decision was made to resect the second and third rays (the two most misaligned toes in our consideration). The first stage of surgery was the ray resection and the second stage was the reconstruction of the intermetatarsal ligament to achieve a good functional and cosmetic results. OUTCOMES After wound healing, the child was able to walk alone while wearing normal shoes. LESSONS We demonstrated that treatment of foot polydactyly requires careful preoperative assessment, including radiographs and photography. A good clinical evaluation of the medial polydactyly improves type-specific recognition which may enhance the accuracy of surgical treatment. Polydactyly is frequently associated with other malformations. We recommend performing a general clinical examination to exclude concomitant malformations. We recommend surgical treatment around the onset of walking.
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Yang SH, Sun WG, Li YL, Chen XN, Qi DM, Sun YJ. [Effects of different doses of dexmedetomidine combined with ropivacaine for brachial plexus nerve block in children undergoing polydactyly surgery]. Nan Fang Yi Ke Da Xue Xue Bao 2017; 37:833-836. [PMID: 28669962 PMCID: PMC6744140 DOI: 10.3969/j.issn.1673-4254.2017.06.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To observe the anesthetic effect and safety of different doses of dexmedetomidine combined with ropivacaine for brachial plexus nerve block in children undergoing polydactyly surgery. METHODS Eighty children undergoing polydactyly surgery were randomized into 4 groups to receive brachial plexus nerve block with dexmedetomidine at 0.25, 0.50 or 0.75 µg/kg combined with 0.25% ropivacaine (0.20 mL/kg) (D1, D2, and D3 groups, respectively) or with 0.25% ropivacaine (0.20 mL/kg) only (control group). The onset time, duration of brachial plexus nerve block, awakening time, success rate, and incidence of complications were compared among the groups. Results In D2 and D3 groups, the onset time and awakening time were shorter and anesthesia lasted longer than those in the control group. The onset time and awakening time were shorter and anesthesia maintenance time was longer in D3 group than in D1 group. The success rates of brachial plexus nerve block were significantly higher in D1-3 groups than in the control group (P<0.05). Hematoma was found in one of the patients. In each of the 4 groups, laryngeal nerve block occurred in 1 child and respiratory depression in another; 2 or 3 patients had Horner syndrome, and 1 patient in D3 group experienced an episode of lowered heart beat to below 70 min-1. All the complications were managed properly and the patients all recovered uneventfully. CONCLUSION Brachial plexus nerve block with 0.5 µg/kg dexmedetomidine combined with 0.25% ropivacaine (0.20 mL/kg) is safe for effective anesthesia in children undergoing surgery for polydactyly.
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Affiliation(s)
- Shi-Hui Yang
- Department of Anesthesiology, Guangdong Women and Children's Hospital, Guangzhou 510010, China. E-mail:
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Carpenter CL, Cuellar TA, Friel MT. Reply: Office-Based Postaxial Polydactyly Excision in Neonates, Infants, and Children. Plast Reconstr Surg 2017; 139:318e. [PMID: 28027268 DOI: 10.1097/prs.0000000000002875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Weiyang G, Wei S, Jian D, Anyuan W, Long W, Zongwei Z. [Reconstruction for dysplastic polydactyly of thumb with an island compound flap]. Zhonghua Zheng Xing Wai Ke Za Zhi 2016; 32:321-327. [PMID: 30066555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the necessity and feasibility of digit fusion with an advanced island flap in thumb dysplasia of radial polydactyly. METHODS From February 2007 to January 2015,we collected the patients with radial polydactyly, whose nail width or thumb girth was less than 80% of contralateral side. Among them, some patients were also associated with radial deviation deformities in two thumbs or a shorter radial thumb compared with ulnar thumb. In these cases, an island compound flap, which was based on proper palmar digital artery (PPDA) in radial thumb and contained nail, part distal phalanx and skin, combining with ulnar side of ulnar thumb was used to reconstruct a new thumb. Only the patients with a smaller thumb girth were treated by an island flap to augment the thumb size. There were 26 patients, including 29 sides.Preoperative Doppler ultrasonic examination was assigned to observe the amount and distribution of princepspollicisartery(PPA) and PPDA. Appearances were evaluated by Wang -Gao scoring system and functions were evaluated by Tata scoring system. RESULTS There were two basic artery forms through preoperative ultrasonography and surgical exploration in 29 hands: both thumbs only had one PPDA; the main thumb had two while the extra thumb still had one. The former was responsible in 82.76% (24 hands).All cases were operated according to preoperative design using an island compound flap.26 hands in 23 patients were followed up more than 6 months. Flap results included survival in 22 patients, tension vesicle in 2 patients and tip necrosis in 2 patients. The incision was infected in one patient with the treatment of changing dressing regularly. The function results were excellent in 21 patients, good in 4,fair in 1.Aesthetic results were excellent in 13 patients, good in 4 and fair in 1. CONCLUSIONS There is always one developed PDAA in extra thumb, which can be used to design a flap. The longitudinal advanced flap can also eliminate the tension caused by unequal length in two thumbs. Using an axial or island flap to reconstruct a new thumb can not only change the appearance, but also make the reconstructed thumb acquire two sets of blood supply and nerve system.
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Abstract
There are few long-term follow-up reports concerning the treatment of thumb duplication. We reviewed the treatment of 19 of 74 patients treated at our institution between 1956 and 2002. The average follow-up was 22 (range, 7 years to 35 years) years. Satisfactory function was achieved in 18 thumbs and cosmesis in 12 thumbs. Six thumbs were cold-intolerant at this late follow-up. Pinch strength was similar to the contralateral normal thumbs. Collateral ligament repair did not significantly contribute to joint stability. An objective method of postoperative evaluation showed good results in five, fair results in 12 and poor results in two thumbs.
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Affiliation(s)
- M Larsen
- Department of Plastic Surgery, University Hospital, Groningen, The Netherlands
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Al-Aithan B, Al-Blaihed L, Mahmoud S, Hassanain J, Al-Qattan MM. Thumb Polydactyly with Symphalangism. ACTA ACUST UNITED AC 2016; 30:346-9. [PMID: 15950337 DOI: 10.1016/j.jhsb.2005.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2005] [Accepted: 04/12/2005] [Indexed: 12/01/2022]
Abstract
Three cases of thumb polydactyly in which one of the components demonstrates symphalangism are reported. This is a very rare anomaly and only one similar case could be found in the literature. The rarity of this anomaly was explained by the occurrence of two different abnormal molecular events along two different limb growth axes. Finally, the anomaly does not fit into the classification systems described for thumb polydactyly.
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Affiliation(s)
- B Al-Aithan
- Division of Plastic Surgery, King Saud University, Riyadh, Saudi Arabia
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Faust KC, Kimbrough T, Oakes JE, Edmunds JO, Faust DC. Polydactyly of the hand. Am J Orthop (Belle Mead NJ) 2015; 44:E127-E134. [PMID: 25950541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Polydactyly is considered either the most or second most (after syndactyly) common congenital hand abnormality. Polydactyly is not simply a duplication; the anatomy is abnormal with hypoplastic structures, abnormally contoured joints, and anomalous tendon and ligament insertions. There are many ways to classify polydactyly, and surgical options range from simple excision to complicated bone, ligament, and tendon realignments. The prevalence of polydactyly makes it important for orthopedic surgeons to understand the basic tenets of the abnormality.
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Affiliation(s)
- Katherine C Faust
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA.
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Weiyang G, Anyuan W, Jian D, Zhijie L, Xinglong C, Zhi L, Xiaoyang L. [The classification and surgical treatment of the terminal phalanx of congenital thumb duplication ]. Zhonghua Zheng Xing Wai Ke Za Zhi 2014; 30:330-334. [PMID: 25522481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To study the classification and individualized treatment of the terminal phalanx of thumb duplication. METHODS From Apr. 2003 to Dec. 2012, 76 patients with 77 involved thumbs duplication at the level which is distal to the interphalangeal joint were retrospectively studied. Based on the morphology (the nail width and the thumb circumference) and the deviation of the thumb, we classified the terminal phalanx of thumb duplication into 5 types as Type A (no bony connection called floating thumb), Type B(asymmetry and no deviation), Type C(asymmetry and deviation), Type D (symmetry and no deviation) and Type E(symmetry and deviation). Different surgical procedures were selected according to different types. Simple excision of the smaller thumb was adopted for Type A case. Removement of the smaller thumb (usually the radial) and of the collateral ligament of the interphalangeal joint were selected for Type B. Removement of the smaller thumb (usually the radial) and reconstruction of the collateral ligament of the interphalangeal joint, as well as corrective osteotomies at the neck of the proximal phalanx were performed for Type C. The modified Bilhaut-Cloquet procedure with reconstruction of the collateral ligament of the interphalangeal joint were adopted in Type D. The classical Bilhaut-Cloquet procedure, or the modified Bilhaut-Cloquet procedure with reconstruction of the collateral ligament of the interphalangeal joint and corrective osteotomies at the neck of the proximal phalanx were performed in Type E. The results were assessed by an evaluation form for thumb duplication by the Japanese Society for Surgery of the Hand. RESULTS According to our new classification standard, there were 3 cases with Type A duplicated thumbs, 36 with Type B, 13 with Type C, 15 with Type D, 10 with Type E. All the 76 patients underwent the individualized surgical treatment. The patients were followed up for 6-60 months. According to the evaluation form, excellent results were achieved in 66 thumbs, good in 9 thumbs and fair in 2 thumbs. CONCLUSIONS The new classification could comprehensively describe the clinical features of the terminal phalanx of congenital thumb duplication. Individualized therapy, including basic and repeated surgical procedure could be adopted for each type with satisfactory results.
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Yin Y, Tian W, Zhao J, Tian G. [CLINICAL RESEARCH OF POSTOPERATIVE DEVIATION SECONDARY TO THUMB DUPLICATION RESECTION]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2014; 28:835-839. [PMID: 26462345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To study the causes and treatment of postoperative deviation secondary to thumb duplication resection. METHODS Between February 2007 and June 2013, 32 cases (33 thumbs) of postoperative deviation secondary to thumb duplication resection were treated, and the clinical data were retrospectively analyzed. There were 13 males and 19 females, aged 2-34 years (median, 8 years). The left thumbs were involved in 7 cases, the right thumbs in 24 cases, and bilateral thumbs in 1 case. Of 33 thumbs, 2 were rated as type II, 4 as type III, 10 as type IV, 7 as type V, and 10 as type VII according to Wassel classification. The average time between duplicated thumb resection and admission was 6.5 years (range, 1-29 years). Nine thumbs only had ulnar deviation of the metacarpophalangeal (MP) joint; 8 thumbs only had radial deviation of the interphalangeal (IP) joint; 10 thumbs only had ulnar deviation of the IP joint; and 6 thumbs had ulnar deviation of the MP joint combined with radial deviation of the IP joint. The mean deviation degree of the MP joint was 32.3 (range, 20-40*), and the mean deviation degree of the IP joint was 42.5° (range, 30-110°). Operation methods were chosen specially according to the deformity, including remnant bone or cartilage resection, restoring normal alignment, and soft tissue balance. RESULTS All wounds got first stage healing and there was no complication associated with operation. Postoperative follow-up period ranged from 6 to 70 months (mean, 34 months). The skeleton alignment of the thumbs was improved on the X-ray images; all osteotomy got union at 5-10 weeks (mean, 6 weeks). Deviation was completely corrected in 31 thumbs; the preoperative deviation degree was too large to correct completely in 2 thumbs with a postoperative deviation degree of 10°. The motion degree was similar to that at preoperation in 13 thumbs; the motion degree decreased in 20 thumbs, which did not affect the function of the thumbs. Nineteen cases (20 thumbs) were followed more than 2 years, there was no recurrence of deviation and all thumbs developed well, but the size of affected thumb was smaller than that of the contralateral side in 14 cases (14 thumbs). CONCLUSION Getting good result and preventing postoperative deviation for thumb duplication resection acquires appropriate preoperative design, reconstruction of the insertion of the abductor poll icis brevis, transposition of the flexor and extensor pollicis longus insertion, and essential osteotomy play important roles in preventing postoperative deviation after thumb duplication resection. Individualized treatment plan for deviation should be made according to the degree and the cause of deviation.
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Fernandez-Crehuet P, Ruiz-Villaverde R, Rios-Martin JJ, Camacho-Martinez FM. Symmetrical cutaneous bilateral appendage - a case study. Aust Fam Physician 2014; 43:283-284. [PMID: 24791768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Pablo Fernandez-Crehuet
- PhD, MD, is a consultant, Department of Dermatology, Hospital Alto Guadalquivir, Andújar, Jaén, Spain
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Nguyen MP, Lawler EA, Morcuende JA. A case report of bilateral mirror clubfeet and bilateral hand polydactyly. Iowa Orthop J 2014; 34:171-174. [PMID: 25328478 PMCID: PMC4127732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We report a rare case of a patient with bilateral mirror clubfeet and bilateral hand polydactyly. The patient presented to our orthopaedic clinic with bilateral mirror clubfeet, each with eight toes, and bilateral hands with six fingers and a hypoplastic thumb. The pattern does not fit any described syndrome such as Martin or Laurin-Sandrow syndrome. Treatments by an orthopaedic pediatric surgeon and an orthopaedic pediatric hand surgeon are described. The patient achieved excellent functional and cosmetic outcomes at four year follow-up.
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Affiliation(s)
- Mai P Nguyen
- Department of Orthopaedics and Rehabilitation University of Iowa Hospitals and Clinics
| | - Ericka A Lawler
- Department of Orthopaedics and Rehabilitation University of Iowa Hospitals and Clinics
| | - Jose A Morcuende
- Department of Orthopaedics and Rehabilitation University of Iowa Hospitals and Clinics
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Jia ZW, Bai DM, Long JT, Guo XS, Tian Y, Zhang LQ, Liu BB, Ren L. [Optimal surgical timing and treatment of thumb duplication in children]. Zhonghua Zheng Xing Wai Ke Za Zhi 2013; 29:336-340. [PMID: 24409773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To investigate the optimal surgical timing and treatment of congenital duplication of the thumb in children. METHODS A clinical study was performed on 154 fingers of the 132 patients (including 85 males, 47 females;mean age (1.53 +/- 2.47) years; ranged from 2 months to 13 years). Duplicated thumbs were surgically treated from December 2007 to February 2012. All patients underwent detailed physical examination and radiological assessment. Surgical methods should be selected according to the age, Wassel classification and deformity. The operation steps included resection of the most hypoplastic thumb, followed by skin flap plasty, tendon shift (transplantation) , reconstruction of collateral ligament and articular capsule. 11 cases over the age of 6 underwent osteotomy discretion as appropriate. RESULTS A total of 117 fingers of the 104 patients were followed up for an average 36. 7 months (range,6-55 months). We adopted upgrade Tada standard to evaluate the follow-up results as excellent in 77 thumbs, good in 21 thumbs, fair in 15 thumbs and poor in 4 thumbs. Three thumbs appeared secondary angular deformity 2 years after operation and one thumb appeared residual osteoepiphysis in the radial side of metacarpophalangeal joint 3 years after operation. The appearance and the function were almost normal after second operation. CONCLUSIONS The optimal surgical timing of congenital duplication of thumb should be based on the appearance of thumb ossification center. The surgical timing of Wassel type- I and II should be chosen at 1. 5 years old when the ossification center of distal phalanx appears, Wassel type-III and IV should be chosen at 1 year old when the ossification center of proximal phalanx appears, Wassel type-V and VI should be chosen at 2. 5 years old when the ossification center of metacarpal appears, and Wassel type-VII should be chosen at 2. 5 years old. The surgical method should be selected on individualized principle. The key points are reconstruction of collateral ligament, tendon and articular capsule and correction of ulnar deviation (or radial deviation).
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Affiliation(s)
- Zhong-Wei Jia
- Department of Orthpaedic, Shanxi Provincial Children's Hospital, Taiyuan 030013, China
| | - De-Ming Bai
- Department of Orthpaedic, Shanxi Provincial Children's Hospital, Taiyuan 030013, China
| | - Jiang-Tao Long
- Department of Orthpaedic, Shanxi Provincial Children's Hospital, Taiyuan 030013, China
| | - Xue-Song Guo
- Department of Orthpaedic, Shanxi Provincial Children's Hospital, Taiyuan 030013, China
| | - Yu Tian
- Department of Orthpaedic, Shanxi Provincial Children's Hospital, Taiyuan 030013, China
| | - Li-Qiang Zhang
- Department of Orthpaedic, Shanxi Provincial Children's Hospital, Taiyuan 030013, China
| | - Bin-Bin Liu
- Department of Orthpaedic, Shanxi Provincial Children's Hospital, Taiyuan 030013, China
| | - Liang Ren
- Department of Orthpaedic, Shanxi Provincial Children's Hospital, Taiyuan 030013, China
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Collier KT, Nakayama DK. Volar flap closure of a broad-based supernumerary finger. Am Surg 2013; 79:e292-e293. [PMID: 24069964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Kristin T Collier
- Department of Surgery, Mercer University School of Medicine and the Medical Center of Central Georgia, Macon, Georgia, USA
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Guo B, Lee SK, Paksima N. Polydactyly: a review. Bull Hosp Jt Dis (2013) 2013; 71:17-23. [PMID: 24032579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Polydactyly of the hand is a difficult problem and poses a unique challenge for the hand surgeon. The embryology of limb development is complex, leading to a host of different phenotypes of polydactyly. Polydactyly can occur in any digit and is described as preaxial, postaxial, and central, based on location. Classification systems exist for each of these locations, which guide treatment options. Surgical treatment needs to address the aesthetic and functional aspect of hand reconstruction. Careful consideration and planning of surgical treatment individualized to each patient is required to obtain the best possible outcome.
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Shigeta E, Kariya N, Shii H, Miyagawa Y, Tatara T, Kaminoh Y, Tashiro C. [Use of the air-Q intubating laryngeal airway for tracheal intubation in predicted difficult airway management in a pediatric patient]. Masui 2012; 61:1077-1079. [PMID: 23157089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The intubating laryngeal airway, air-Q ILA, was recently introduced in Japan. It has been used in adult patients for difficult airway management; however, there are few reports available on its use in pediatric patients. We report the use of the air-Q ILA in predicted difficult airway management in a 16-month-old patient with Apert syndrome characterized by acrocephalosyndactyly undergoing a syndactyly operation. It was somewhat difficult to keep his airway with a facemask, and an air-Q ILA was inserted. Following the ventilation via air-Q ILA, tracheal intubation guided by a tracheal fiberscope was attempted through the air-Q ILA. Five months after this operation, the patient again underwent the same operation. We managed his airway in the same way as previously, and the tracheal was intubated. This case shows that the air-Q ILA can be an alternative device in pediatric difficult airway management.
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Affiliation(s)
- Emi Shigeta
- Department of Anesthesiology, Hyogo College of Medicine, Nishinomiya 663-8501
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