Thank you for your letter outlining the limitations of current classification schemes for thumb polydactyly. In our Current Concepts article on congenital hand differences, I chose to include the Zuidam et al classification diagram for thumb polydactyly
1
because I believe it is the most comprehensive yet practical system available. As depicted in the diagram and expanded on in the manuscript, the authors have included 6 subtypes (with modifiers) of the well-accepted Wassel classification.2
However, I share your concerns relating to ossification center development; specifically, the schematic depiction of thumbs represents older children. I agree that most children are treated surgically before these growth centers are radiographically clear. Likewise, I agree that symphalangism may not be present radiographically at an age before surgical intervention.
As noted in the Introduction of their manuscript, Zuidam et al. “propose several modifications to Wassel's classification that result in a more complete taxonomy and more flexible nomenclature to facilitate communication, analysis, and treatment of all known variations.” Although they are imperfect, I believe that their modifications of the Wassel classification meet these stated goals and help both clinician and researcher better understand and treat radial polydactyly.
References
- A classification system of radial polydactyly: inclusion of triphalangeal thumb and triplication.J Hand Surg. 2008; 33: 373-377
- The results of surgery for polydactyly of the thumb.Clin Orthop Relat Res. 1969; 64: 175-193
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- Congenital Hand DifferencesJournal of Hand SurgeryVol. 35Issue 1
- Distal Tunnel Placement Improves Scaphoid Flexion With the Brunelli Tenodesis Procedure for Scapholunate DissociationJournal of Hand SurgeryVol. 33Issue 10
- PreviewTreatment of scapholunate dissociation remains difficult. The modified Brunelli procedure, a flexor carpi radialis tenodesis through the scaphoid and secured with dorsal wrist ligaments, has shown promising results. This study compares the biomechanical effects on scaphoid flexion and scapholunate gap between proximal and distal tunnel placement in the modified Brunelli procedure.
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