Radial polydactyly: an outcome study

Radial polydactyly is a relatively common congenital disorder that frequently occurs as thumb duplication. A paucity of information exists on outcomes of Bilhaut-Cloquet procedures. To evaluate clinical outcomes, the results of various operative and nonoperative treatments were reviewed. Follow-up by retrospective chart review was performed on 21 patients treated between 1979 and 1994 at the Shriners Hospital for Crippled Children in Erie, Pennsylvania. Patient interview or physical examination, or both, was performed on 16 of these patients. The study was comprised of 9 boys and 12 girls (average age, 7.8 years; range, 1.5-15.8 years) and included 26 thumbs. Ablation alone was performed in 6 thumbs (6 patients), a combined procedure consisting of ablation with radial collateral ligament reconstruction and shaving of the metacarpal in 10 thumbs (9 patients), and a Bilhaut-Cloquet procedure in 5 thumbs (4 patients). Five thumbs (4 patients) with Wassel type I classification were managed without surgical intervention and simply observed. Of the 6 thumbs treated with ablation alone, 5 required subsequent procedures (radial collateral ligament reconstruction). Ablation with collateral ligament reconstruction and articular surface shaving improved clinical alignment and stability but did not return normal interphalangeal joint motion. The Bilhaut-Cloquet procedure improved the overall cosmetic and functional appearance but likewise did not restore normal joint motion. Our findings support current literature that finds that ablation of the thumb without reconstruction is contraindicated because of the high reoperation rate. Although techniques have evolved that improve alignment and stability or appearance, none guarantee normal joint motion. All patients were satisfied, however, that the thumb was significantly improved compared with the preoperative condition.