Advertisement

Radial Polydactyly

  • Goo Hyun Baek
Chapter

Abstract

Radial polydactyly is a common congenital difference of the upper extremity in all races.

The surgical outcomes of radial polydactyly have greatly improved recently due to the accumulation of clinical experience and knowledge, the development of surgical and anesthesiology techniques, and the rapid communication of information. This article focuses on surgical techniques for various clinical situations. Most of children with radial polydactyly may be treated with the “excision and reconstruction” principle. The main components of this procedure are arthroplasty, corrective osteotomy, and tendon realignment. When both polydactylic thumbs are hypoplastic and symmetrical, the Bilhaut-Cloquet procedure may be an option. However, complications such as joint stiffness, physeal growth disturbance, and nail-plate deformity were common after this procedure. Therefore, two modified techniques to overcome possible complications are introduced, one for Wassel type 2 and the other for Wassel type 4. The “on-top plasty” technique is another type of combination procedure. In certain patients with radial polydactyly, one thumb has better distal portion and the other one better proximal portion. The better distal part of one thumb can be transposed to the better proximal part of the other thumb.

Keywords

Proximal Phalanx Angular Deformity Corrective Osteotomy Ulnar Side Flexor Pollicis Longus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Upton J. Congenital anomalies of the hand and forearm. In: McCarthy JG, editor. Plastic surgery. Philadelphia: WB Saunders; 1980. p. 5240–398.Google Scholar
  2. 2.
    Oberg KC, Feenstra JM, Manske PR, Tonkin MA. Developmental biology and classification of congenital anomalies of the hand and upper extremity. J Hand Surg Am. 2010;35(12):2066–76. doi: 10.1016/j.jhsa.2010.09.031.PubMedCrossRefGoogle Scholar
  3. 3.
    Sesgin MZ, Stark RB. The incidence of congenital defects. Plast Reconstr Surg Transplant Bull. 1961;27:261–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Temtamy SA, McKusick VA. The genetics of hand malformations. Birth Defects (Original Article Series V). 1978;14:i–xviii, 1–619.Google Scholar
  5. 5.
    Wassel HD. The results of surgery for polydactyly of the thumb. A review. Clin Orthop Relat Res. 1969;64:175–93.PubMedGoogle Scholar
  6. 6.
    Ogino T, Minami A, Fukuda K, Kato H. Congenital anomalies of the upper limb among the Japanese in Sapporo. J Hand Surg Br. 1986;11(3):364–71.PubMedCrossRefGoogle Scholar
  7. 7.
    Baek GH, Chung MS, Park YB, Yoo KH. The relative incidence of congenital anomalies of the hand. J Korean Orthop Assoc. 1997;32(4):796–801.Google Scholar
  8. 8.
    Wood VE. Polydactyly and the triphalangeal thumb. J Hand Surg Am. 1978;3(5):436–44.PubMedCrossRefGoogle Scholar
  9. 9.
    Al-Qattan MM, Al Abdulkareem I, Al Haidan Y, Al Balwi M. A novel mutation in the SHH long-range regulator (ZRS) is associated with preaxial polydactyly, triphalangeal thumb, and severe radial ray deficiency. Am J Med Genet A. 2012;158A(10):2610–5. doi: 10.1002/ajmg.a.35584.PubMedCrossRefGoogle Scholar
  10. 10.
    Daluiski A, Yi SE, Lyons KM. The molecular control of upper extremity development: implications for congenital hand anomalies. J Hand Surg Am. 2001;26(1):8–22.PubMedCrossRefGoogle Scholar
  11. 11.
    Hill P, Götz K, Rüther U. A SHH-independent regulation of Gli3 is a significant determinant of anteroposterior patterning of the limb bud. Dev Biol. 2009;328(2):506–16. doi: 10.1016/j.ydbio.2009.02.017.PubMedCrossRefGoogle Scholar
  12. 12.
    Al-Qattan MM. The distribution of the types of thumb polydactyly in a Middle Eastern population: a study of 228 hands. J Hand Surg Eur Vol. 2010;35(3):182–7. doi: 10.1177/1753193409352417.PubMedCrossRefGoogle Scholar
  13. 13.
    Tonkin MA. Thumb duplication: concepts and techniques. Clin Orthop Surg. 2012;4(1):1–17. doi: 10.4055/cios.2012.4.1.1.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Chung MS, Baek GH, Gong HS, Lee HJ, Kim J, Rhee SH. Radial polydactyly: proposal for a new classification system based on the 159 duplicated thumbs. J Pediatr Orthop. 2013;33(2):190–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Townsend DJ, Lipp Jr EB, Chun K, Reinker K, Tuch B. Thumb duplication, 66 years’ experience—a review of surgical complications. J Hand Surg Am. 1994;19(6):973–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Waters PM, Bae DS. Pediatric hand and upper extremity surgery. A practical guide. 1st ed. Philadelphia: Lippincott Williams & Wilkins; 2012. p. 41.Google Scholar
  17. 17.
    Goldfarb CA, Patterson JM, Maender A, Manske PR. Thumb size and appearance following reconstruction of radial polydactyly. J Hand Surg Am. 2008;33(8):1348–53. doi: 10.1016/j.jhsa.2008.03.011.PubMedCrossRefGoogle Scholar
  18. 18.
    Kozin SH. Deformities of the thumb. In: Wolfe SW, Hotchikiss RN, Pederson WC, Kozin SH, editors. Green’s operative hand surgery. 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2011. p. 1383.Google Scholar
  19. 19.
    Jobe MT. Congenital anomalies of the hand. In: Canale ST, Beaty JH, editors. Campbell’s operative orthopaedics. 12th ed. St. Louis: Elsevier Mosby; 2013. p. 3755.Google Scholar
  20. 20.
    Leber GE, Gosain AK. Surgical excision of pedunculated supernumerary digits prevents traumatic amputation neuromas. Pediatr Dermatol. 2003;20(2):108–12.PubMedCrossRefGoogle Scholar
  21. 21.
    Manske PR. Treatment of duplicated thumb using a ligamentous/periosteal flap. J Hand Surg Am. 1989;14(4):728–33.PubMedCrossRefGoogle Scholar
  22. 22.
    Tupper JW. Pollex abductus due to congenital malposition of the flexor pollicis longus. J Bone Joint Surg Am. 1969;51(7):1285–90.PubMedGoogle Scholar
  23. 23.
    Lister G. Pollex abductus in hypoplasia and duplication of the thumb. J Hand Surg Am. 1991;16(4):626–33.PubMedCrossRefGoogle Scholar
  24. 24.
    Hovius SE, Zuidam JM, de Wit T. Treatment of the triphalangeal thumb. Tech Hand Up Extrem Surg. 2004;8(4):247–56.PubMedCrossRefGoogle Scholar
  25. 25.
    Bilhaut M. Guerison d’un poucebifide par un nouveau procedeoperatoire. Congr Fr Chirg. 1889;4:576–80.Google Scholar
  26. 26.
    Miura T. Duplicated thumb. Plast Reconstr Surg. 1982;69:470–81.PubMedCrossRefGoogle Scholar
  27. 27.
    Tada K, Yonenobu K, Tsuyuguchi Y, Kawai H, Egawa T. Duplication of the thumb. A retrospective review of two hundred and thirty-seven cases. J Bone Joint Surg Am. 1983;65:584–98.PubMedGoogle Scholar
  28. 28.
    Baek GH, Gong HS, Chung MS, Oh JH, Lee YH, Lee SK. Modified Bilhaut-Cloquet procedure for Wassel type-II and III polydactyly of the thumb. J Bone Joint Surg Am. 2007;89(3):534–41.PubMedCrossRefGoogle Scholar
  29. 29.
    Baek GH, Gong HS, Chung MS, Oh JH, Lee YH, Lee SK. Modified Bilhaut-Cloquet procedure for Wassel type-II and III polydactyly of the thumb. Surgical technique. J Bone Joint Surg Am. 2008;90(Suppl 2 Pt 1):74–86.PubMedGoogle Scholar
  30. 30.
    Hartrampf CR, Vasconez LO, Mathes S. Construction of one good thumb from both parts of a congenitally bifid thumb. Plast Reconstr Surg. 1974;54(2):148–52.PubMedCrossRefGoogle Scholar
  31. 31.
    Samson P, Salazard B, Magalon G. The “Bilhaut-Cloquet” technique for treatment of thumb duplication. Handchir Mikrochir Plast Chir. 2004;36(2–3):141–5.PubMedGoogle Scholar
  32. 32.
    Tonkin MA, Bulstrode NW. The Bilhaut-Cloquet procedure for Wassel types III, IV and VII thumb duplication. J Hand Surg Eur Vol. 2007;32(6):684–93.PubMedCrossRefGoogle Scholar
  33. 33.
    Baek GH, Chung MS, Gong HS, Lee S, Lee YH, Kim HH. Abnormal triangular epiphysis causing angular deformity of the thumb. J Hand Surg Am. 2006;31(4):544–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Orthopedic SurgerySeoul National University HospitalSeoulSouth Korea

Personalised recommendations