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The CoULD Ulnar Polydactyly Classification: A Multicenter Analysis.

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This study introduces a new classification for type A ulnar polydactyly based on radiographic morphology. This expanded classification aids surgical decision-making for complex congenital hand differences.

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Area of Science:

  • Orthopedic Surgery
  • Pediatric Hand Surgery
  • Congenital Hand Anomalies

Background:

  • The Temtamy-McKusick classification distinguishes ulnar polydactyly types A and B.
  • Type A ulnar polydactyly presents diverse phenotypes and surgical challenges.
  • A refined classification based on radiographic morphology is needed to guide treatment.

Purpose of the Study:

  • To develop and validate an expanded classification for type A ulnar polydactyly.
  • To correlate radiographic subtypes with surgical reconstructive considerations.
  • To improve surgical decision-making for this condition.

Main Methods:

  • A multicenter cohort of type A ulnar polydactyly cases was analyzed.
  • Preoperative radiographs were used to determine morphologic themes and classify subtypes.
  • Interrater and intrarater reliability were assessed using Cohen κ.

Main Results:

  • Six radiographic subtypes of type A ulnar polydactyly were identified (A1-A6).
  • The classification is based on the proximal extent of skeletal duplication.
  • Reconstructive plans were proposed for each subtype, with high interrater and intrarater reliability (97% agreement).

Conclusions:

  • The developed CoULD Ulnar Polydactyly classification is feasible and comprehensive.
  • This classification is relevant for surgical management and aids in decision-making.
  • The classification has been adopted by the CoULD Study Group to standardize care pathways.