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Treatment for Wassel Types V and VI Thumb Polydactyly
Yuki Bessho1, Takehiko Takagi1, Atsuhito Seki1
1Division of Orthopaedic Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan.
The Journal of Hand Surgery Asian-Pacific Volume
|April 22, 2020
Summary
Surgical strategies for Wassel types V and VI thumb polydactyly, focusing on tendon and muscle relocation, yielded satisfactory outcomes. Careful follow-up and reoperation improved results for cases with initial poor outcomes.
Area of Science:
- Orthopedics
- Congenital Hand Surgery
Background:
- Thumb polydactyly is a common congenital hand anomaly.
- Wassel types V and VI are rare, with limited published reports.
- This study addresses surgical management for these specific types.
Purpose of the Study:
- To present surgical strategies for Wassel types V and VI thumb polydactyly.
- To evaluate the outcomes of these surgical approaches.
- To analyze functional and radiographic results.
Main Methods:
- Included 29 thumbs (17 type V, 12 type VI) from 29 patients.
- Initial surgery focused on tendon and muscle relocation, avoiding opponensplasty or osteotomy.
- Evaluated pinch ability, reoperation rates, first web space angle (1-2 MCA), and MCP joint instability (1 MPA).
Main Results:
- 22 patients achieved pulp pinch.
- Five cases (17%) showed first web narrowing (1-2 MCA < 40°).
- Seven cases (24%) had MCP joint radial instability (1 MPA > 20°).
- Seven patients required additional surgery for opposition, instability, or web narrowing.
- All reoperated patients achieved pulp pinch.
Conclusions:
- Initial surgical strategies focusing on tendon/muscle relocation can yield satisfactory outcomes.
- Careful follow-up and timely reoperation are crucial for managing complex thumb polydactyly.
- Reoperation effectively addressed residual functional deficits.
