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Shared decision making in the treatment of type B ulnar polydactyly: a systematic review and meta-analysis on
S H Ten Berge1,2, N J Nieuwdorp1,3,4, E B Burger1
1Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, The Netherlands.
Insights
Excision under local anesthesia offers the best outcomes for type B ulnar polydactyly, balancing high parental satisfaction and low complication rates. Parents prioritize avoiding anesthesia risks or pain when choosing treatments for this common hand anomaly.
Area of Science:
- Pediatric Surgery
- Congenital Hand Anomalies
- Plastic Surgery
Background:
- Type B ulnar polydactyly is a frequent congenital hand difference.
- Current treatment options lack clear optimal choices and limited data exist on parental perspectives.
- This review synthesizes treatment outcomes and parental satisfaction for type B ulnar polydactyly.
Purpose of the Study:
- To evaluate treatment outcomes for type B ulnar polydactyly.
- To assess parental satisfaction and preferences regarding different treatment modalities.
- To provide evidence for informed clinical decision-making.
Main Methods:
- Systematic literature search across major databases (Embase, Pubmed, Medline, Web of Science, Cochrane).
- Inclusion of studies reporting parental satisfaction, aesthetic outcomes, prioritizing factors, or complications.
- Meta-analysis of pooled parent-reported satisfaction scores and complication data.
Main Results:
- Fourteen studies (885 patients, 1279 digits) were included; overall parental satisfaction was high.
- Excision under local anesthesia demonstrated superior outcomes in treatment and aesthetics compared to other methods.
- Lower complication rates were observed with local anesthesia excision (0.01) versus suture ligation (0.16).
Conclusions:
- Excision under local anesthesia is the preferred treatment for type B ulnar polydactyly, offering the best results and highest parental satisfaction.
- While all treatments yielded high satisfaction, differences were marginal, with parental choices driven by anesthesia risk or pain avoidance.
- Findings support effective decision-making for type B ulnar polydactyly management.
Introduction:
Type B ulnar polydactyly is a common congenital hand anomaly. Treatment options include suture ligation, vascular clip ligation and excision under local or general anaesthesia. However, the optimal treatment remains unclear, and evidence on parental perspectives is limited. This review investigated treatment outcomes for type B ulnar polydactyly, in combination with parental satisfaction and preferences.
Methods:
A systematic search of Embase, Pubmed, Medline, Web of Science and Cochrane Central Register of Controlled Trials was conducted up to March 2025 for studies reporting parental satisfaction with treatment outcome or aesthetic appearance, parental prioritizing factors or complications. Meta-analyses were performed on pooled parent-reported satisfaction scores and complication data.
Results:
Fourteen studies, comprising 885 patients with 1279 supernumerary digits, met the inclusion criteria. Overall, parental satisfaction was high across all treatments. Excision under local anaesthesia resulted in significantly greater satisfaction on both treatment outcome and aesthetic appearance compared with suture ligation and excision under general anaesthesia. No parent-reported data were available on vascular clip ligation. Parents choosing suture ligation or excision under local anaesthesia mentioned avoiding anaesthesia risks and quick treatment as priorities, while parents selecting excision under general anaesthesia prioritized pain avoidance. The pooled complication rate was lowest for excision under local anaesthesia (0.01) and highest for suture ligation (0.16).
Conclusion:
Excision under local anaesthesia showed the best results regarding treatment of type B ulnar polydactyly, with the highest parental satisfaction outcomes and lowest complication rates. However, high parental satisfaction was observed in all treatment modalities and differences in outcomes were small. Parents primarily based their treatment choice on avoiding risks (with ligation or local anaesthesia) or avoiding pain (with general anaesthesia). Our results can be used for effective decision making.