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.
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