A selective approach to treatment of ulnar polydactyly: preventing painful neuroma and incomplete excision

Ulnar polydactyly is common. The condition is often successfully treated by pediatricians using string (or suture) ligation in the newborn nursery. Patients with ulnar polydactyly or complications of unsuccessful string ligation such as traumatic neuroma may be referred to pediatric dermatologists. In some cases, the condition is better treated surgically. In case of a bony or ligamentous attachment, surgery is required. Additionally, a wide-base-precluding-string ligation would be better treated with surgery to avoid the need for later revision. We present a series of 10 patients (13 hands) in which previous string ligation produced an unsightly incomplete amputation, a tender neuroma, or both. Patients were successfully treated with completion amputation of the residual stump combined with proximal ligation of the supernumerary digital nerves. We advocate a selective approach in the management of this condition. Treatment options should be fully discussed with families prior to proceeding with suture ligation.