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Mid-term to Long-term Follow-up Results of Reconstruction for Thumb Radial Polydactyly
Hyun-Joo Lee1,2, Kang-San Lee2, Seung-Ho Chung2
1Departments of Orthopaedic Surgery.
Insights
Reconstruction of radial polydactyly in children can lead to long-term joint instability and deformities. Careful surgical planning is essential to minimize these sequelae and improve thumb function.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Congenital Hand Anomalies
Background:
- Preaxial (radial) polydactyly is a common congenital hand anomaly.
- Surgical reconstruction aims to correct deformities and improve function.
- Various techniques exist, tailored to the specific type of polydactyly.
Purpose of the Study:
- To report mid-term to long-term outcomes of surgical reconstruction for thumb (radial) polydactyly.
- To evaluate clinical results including range of motion, pain, and complications.
- To assess radiographic evidence of arthritis or residual deformities.
Main Methods:
- Retrospective review of patients undergoing preaxial polydactyly reconstruction.
- Inclusion criteria: minimum 5-year follow-up and available radiographs.
- Surgical techniques varied, with Bilhaut-Cloquet method preferred for similar-sized thumbs.
Main Results:
- 26 thumbs included with a mean follow-up of 128.8 months.
- Mean range of motion (ROM) was 32.7° (DIP) and 57.5° (MP) joints.
- Complications included joint instability (26.9%), arthritis (7.7%), and residual deviation (50.0% radial, 7.7% ulnar).
Conclusions:
- Mid-term to long-term follow-up reveals potential sequelae like joint instability and stiffness.
- Metacarpophalangeal (MP) joint instability can occur, especially with limited distal interphalangeal (DIP) joint motion.
- Careful surgical consideration is needed to address potential long-term complications.
Background:
Preaxial or radial polydactyly is one of the most common hand congenital anomalies in newborns. Contemporary reconstruction methods include ligament reconstruction, excision of the polydactylous thumb, osteotomy, and other surgical techniques according to the type of polydactyly. The purpose of this study was to report mid-term to long-term reconstruction results for thumb (radial) polydactyly.
Methods:
We retrospectively reviewed the medical records of patients who underwent reconstruction surgery for preaxial polydactyly. Clinical outcomes, including the range of motion (ROM), pain, and complications, were evaluated. We assessed the final radiographs of the reconstructed thumb to identify the potential development of arthritis or other remaining deformities. After excluding cases without a simple radiograph and cases with a short follow-up period of fewer than 5 years, 26 thumbs were included. The surgical technique followed including excision of polydactylout thumb was tailored to the type of polydactyly. If the nail size of the thumbs was similar, the Bilhaut-Cloquet method was preferred.
Results:
The mean age of the patients at the surgery and final follow-up was 14.9 months (range: 8 to 30 mo) and 11.9 years (range: 5.8 to 19.3 y), respectively. The mean follow-up was 128.8 months years (range: 60 to 219 mo), and the mean ROM of the thumb was 32.7 and 57.5 degrees in the distal interphalangeal joint (DIP) and metacarpophalangeal (MP) joint, respectively. Ulnar or radial side instability was prominent in 7 patients in the involved joints (26.9%). One patient underwent interphalangeal (IP) fusion for extension lag with pain. The radiologic evaluation revealed that 2 patients developed radiographic evidence of IP joint arthritis (7.7%). Radial deviation of the MP or IP joint existed in 13 cases (range: 5 to 40 degrees) (50.0%), and ulnar deviation of the MP or IP joint existed in 2 cases (range: 19 to 20 degrees) (7.7%).
Conclusions:
In mid-term to long-term experience, sequelae such as joint instability, joint stiffness, and remaining deformity cannot be neglected. An unstable MP joint may result if the DIP joint remains stiff or has a lower ROM.
Level Of Evidence:
Level IV-therapeutic studies.
