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.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Causes of secondary deformity after surgery to correct Wassel type IV-D thumb duplication.J Hand Surg Eur Vol. 2016; 41: 739-744
- Soft tissue abnormalities in Wassel type VI radial polydactyly: a detailed anatomical study.J Hand Surg Eur Vol. 2021; 46: 352-359
- Reconstruction for type IV radial polydactyly.J Hand Surg Am. 2015; 40: 1873-1876
- Analysis of surgical results and of residual postoperative deformities in preaxial polydactyly of the hand.J Plast Reconstr Aesthet Surg. 2017; 70: 1420-1432
- Long-term clinical and radiographic follow-up of preaxial polydactyly reconstruction.J Hand Surg Am. 2019; 44: 244.e1-244.e6
- Long-term results of surgical treatment of thumb polydactyly.J Hand Surg Am. 1996; 21: 478-486
- Long-term outcomes following radial polydactyly reconstruction.J Hand Surg Am. 2014; 39: 1549-1552
- Long-term results of surgically treated radial polydactyly – an outcome correlation study.J Hand Surg Asian Pac Vol. 2019; 24: 264-269
- Duplication of the thumb. A retrospective review of two hundred and thirty-seven cases.J Bone Joint Surg Am. 1983; 65: 584-598
- Thumb duplication at the metacarpophalangeal joint. Management and a new classification.Clin Orthop Relat Res. 1996; 323: 31-41
- Preoperative angulation as a predictor for operations of Wassel type IV polydactyly.J Pediatr Orthop B. 2021; 30: 605-610
- Factors affecting surgical results of Wassel type IV thumb duplications.J Hand Surg Eur Vol. 2014; 39: 934-943
- Prognostic value of age and Wassel classification in the reconstruction of thumb duplication.J Child Orthop. 2013; 7: 551-557
- Polydactyly of the thumb: a modification of the Wassel-Flatt classification.J Hand Surg Eur Vol. 2021; 46: 346-351
- Comparison of functional outcome scores in radial polydactyly.J Bone Joint Surg Am. 2014; 96: 463-470
- Evaluation sheet for polydactyly of the thumb.J Jpn Soc Surg Hand. 2007; 24: 422
- When is primary metacarpal corrective osteotomy recommended in patients with Flatt type IV radial polydactyly?.Plast Reconstr Surg. 2021; 147: 399-408
- Reconstruction for Wassel type III radial polydactyly with two digits equal in size.J Hand Surg Am. 2009; 34: 1802-1807
Article info
Publication history
Published online: July 05, 2022
Accepted:
April 27,
2022
Received:
September 13,
2021
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
