Surgical outcomes of treatment preaxial polydactyly of the hand in children: a systematic review



Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Preaxial polydactyly is congenital disease characterized by an increase in the number of fingers. Along with a variety of surgical approaches, the range of possible complications varies widely. The high rate of complications requires a detailed study of problem. The aim is to evaluate long-term functional results and determine the effective direction of surgical treatment of children with a pre-axial form of hand polydactyly by systematizing data on complications. PubMed, Google Scholar, and eLibrary databases were searched for all articles in the last 24 years. Search terms used included ‘surgery’, ‘polydactyly’, ‘хирургическое лечение’, ‘полидактилия’. The following data were analyzed: the number of patients, gender, age, affected limb, follow-up period, surgical treatment method, evaluation scale of treatment results, the presence of complications, reoperations. 38 sources were selected, representing 2,752 patients, 1,671 (60.7%) boys and 1,081 (39.3%) girls. The right hand is affected in 60% of cases (n=1216), the left in 33% (n=681), in 7% (n=139) on both sides. The total number of fingers is 2,949. The family history of polydactyly was 4.4% (n=121). In 92% (n=1048), the dominant finger was located ulnar, in 6% (n=63) it was radial, and in 2% (n=24) it was equally developed. The average age at the time of treatment was 19.23 months. The average follow–up period was 70.9 months (5.91 years). According to Wassel classification (1969), the most common type is IV (55%, n=1201). The most common surgical technique is reconstruction (68%, n=733). The popular scale for evaluating outcomes is JSSH, 34%. 541 complications were recorded (18.35%), mainly structural (42%) and aesthetic (21%). In 7.36% (n=205) reoperation was required, in case of complications — in 38% of cases. Data analysis revealed a high frequency of poor results in the treatment of children with a preaxial polydactyly. Structural complications were most common diagnosed, leading to a decrease in the functional capabilities of the first finger of the hand and requiring improved methods of intra- and postoperative approaches to patient treatment.

Full Text

Restricted Access

About the authors

Aleksandr Y. Makarov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: makarov.alexandr97@mail.ru
ORCID iD: 0000-0002-1546-8517
SPIN-code: 1039-1096
Scopus Author ID: 57364317300

MD

Russian Federation, 196603, 64-68 Parkovaya street, Pushkin, Saint-Petersburg, Russia

Yaroslav N. Proshchenko

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: yar2011@list.ru
ORCID iD: 0000-0002-3328-2070
SPIN-code: 6953-3210

MD, PhD

Russian Federation, 196603, 64-68 Parkovaya street, Pushkin, Saint-Petersburg, Russia

Kristina N. Rodionova

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery; Peter the Great Saint Petersburg Polytechnic University

Email: rkn0306@mail.ru
ORCID iD: 0000-0001-6187-2097
SPIN-code: 4627-3979
Scopus Author ID: 57903567500
Russian Federation, 196603, 64-68 Parkovaya street, Pushkin, Saint-Petersburg, Russia

References

  1. Castilla E, Paz J, Mutchinick O, et al. Polydactyly: a genetic study in South America. Am J Hum Genet. 1973;25(4):1–562.
  2. Malik S, Ullah S, Afzal M, et al. Clinical and descriptive genetic study of polydactyly: a Pakistani experience of 313 cases. Clin Genet. 2014;85(5):482–486. doi: 10.1111/CGE.12217
  3. Evanson BJ, Hosseinzadeh P, Riley SA, et al. Radial polydactyly and the incidence of reoperation using a new classification system. Journal of Pediatric Orthopaedics. 2016;36(2):158–160. doi: 10.1097/BPO.0000000000000395
  4. Sun WC, Chen PA, Chen BPR, et al. Classification of radial polydactyly based on physical characteristics. Pediatr Neonatol. 2024;65(2):133–137. doi: 10.1016/J.PEDNEO.2023.04.013
  5. Hovius SER, Kruit AS. Complications after radial polydactyly surgery: analysis, prevention and management. J Hand Surg Eur Vol. 2024;49(2):226–239. doi: 10.1177/17531934231209863
  6. Shin YH, Yoon JO, Kim SS, et al. Reoperation after primary operation for pre-axial polydactyly of the hand: A 12-year experience at a single institute. Journal of Plastic, Reconstructive and Aesthetic Surgery. 2022;75(8):2658–2663. doi: 10.1016/J.BJPS.2022.04.015
  7. Liu Y, Xu X, Wang L, et al. Resection and reconstruction for radial polydactyly Type IV-D in 206 cases: a retrospective clinical analysis. BMC Musculoskelet Disord. 2022;23(1):167. doi: 10.1186/s12891-022-05119-w
  8. Wassel HD. The results of surgery for polydactyly of the thumb. A review. Clinical Orthopaedics and Related Research. 1969;64:175–93.
  9. Kim JK, Yoon JO, Shin YH, et al. Modified Wassel-Flatt Type III Radial Polydactyly: Subtypes and Their Outcomes. Journal of Hand Surgery. 2024;49(1):60.e1–60.e8. doi: 10.1016/j.jhsa.2022.04.024
  10. Guo X, Wei Y, Wang F, et al. Modified Bilhaut-Cloquet procedure for Wassel type III–IV polydactyly. J Orthop Surg Res. 2024;19(1):71. doi: 10.1186/s13018-024-04553-x
  11. Yin C, Liu W, Yu W, et al. On-top plasty combined with modified Bilhaut-Cloquet procedure for reconstructing complicated radial polydactyly. Journal of Plastic, Reconstructive and Aesthetic Surgery. 2023;86:315–320. doi: 10.1016/J.BJPS.2023.09.037
  12. Chen PA, Sun WC, Chen BPR, et al. Prediction of Surgical Outcomes of Radial Polydactyly From the Wassel-Flatt Type and Symmetry of Duplication. Journal of Pediatric Orthopaedics. 2023;43(4):E305–E309. doi: 10.1097/BPO.0000000000002349
  13. Horii E, Koh S, Otsuka J, et al. Midterm Surgical Outcomes of Duplicated Thumbs According to New Classification. Plast Reconstr Surg. 2023;152(1):116E–125E. doi: 10.1097/PRS.0000000000010267
  14. Du Z, Cui Y, Jiang H, et al. Aesthetic outcomes of and anatomic reconstruction for Wassel type IV-D radial polydactyly using a modified Bilhaut-Cloquet procedure. Front Pediatr. 2023;11:1192168. doi: 10.3389/FPED.2023.1192168/BIBTEX
  15. Breidung D, Megas IF, Dittrich Y, et al. Experience with Management of Radial Polydactyly: The Multicenter Analysis of 28 Surgical Procedures with Follow-Up. Healthcare (Basel). 2023;11(23):3045. doi: 10.3390/HEALTHCARE11233045
  16. He B, Nan G. A modified Bilhaut-Cloquet procedure for thumb duplication: Reconstruction of functionality and appearance. Journal of Plastic, Reconstructive and Aesthetic Surgery. 2022;75(8):2644–2649. doi: 10.1016/J.BJPS.2022.02.036
  17. Zhou R, Tian X, Zhang S, et al. Nail-based reconstruction strategies for Wassel-Flatt type IVh thumb polydactyly with a floating ulnar digit: A preliminary report with 63 thumbs. Journal of Plastic, Reconstructive and Aesthetic Surgery. 2022;75(4):1476–1482. doi: 10.1016/J.BJPS.2021.11.071
  18. Du Z, Qiu X, Han D, et al. Modified Bilhaut-Cloquet Procedure for the Reconstruction of Wassel Type III Radial Polydactyly. Journal of Pediatric Orthopaedics. 2022;42(6):E636–E640. doi: 10.1097/BPO.0000000000002139
  19. Lee HJ, Lee KS, Chung SH, et al. Mid-term to Long-term Follow-up Results of Reconstruction for Thumb Radial Polydactyly. Journal of Pediatric Orthopaedics. 2022;42(8):439–442. doi: 10.1097/BPO.0000000000002195
  20. Luangjarmekorn P, Virojanawat N, Pongpacharaamphon P, et al. Preoperative angulation as a predictor for operations of Wassel type IV polydactyly. Journal of Pediatric Orthopaedics Part B. 2021;30(6):605–610. doi: 10.1097/BPB.0000000000000806
  21. Wang DH, Zhang GP, Wang ZT, et al. Pedicle complex tissue flap transfer for reconstruction of duplicated thumbs with unequal size. World J Clin Cases. 2021;9(35):10909–10918. doi: 10.12998/WJCC.V9.I35.10909
  22. Hong SW, Kim J, Oh S, et al. When Is Primary Metacarpal Corrective Osteotomy Recommended in Patients with Flatt Type IV Radial Polydactyly? Plast Reconstr Surg. 2021;147(2):399–408. doi: 10.1097/PRS.0000000000007526
  23. Lin S, Tong K, Zhang G, et al. Clinical Characteristics and Distribution of Thumb Polydactyly in South China: A Retrospective Analysis of 483 Hands. Journal of Hand Surgery. 2020;45(10):938–946. doi: 10.1016/J.JHSA.2020.04.003
  24. Bessho Y, Takagi T, Seki A, et al. Treatment for Wassel Types V and VI Thumb Polydactyly. J Hand Surg Asian Pac Vol. 2020;25(2):153–157. doi: 10.1142/S2424835520500162
  25. Shen XF, Yin F, Wang J, et al. Reconstruction of Wassel IV-D radial polydactyly with a boot-shaped neurovascular island flap: A Consecutive series of 91 thumbs. Journal of Plastic, Reconstructive and Aesthetic Surgery. 2020;73(10):1801–1805. doi: 10.1016/J.BJPS.2020.05.071
  26. Bauer AS, Netto AP, James MA. Thumb Hypoplasia Occurring in Patients With Preaxial Polydactyly. Journal of Hand Surgery. 2020;45(3):182–188. doi: 10.1016/J.JHSA.2019.11.001
  27. Yeung CM, Choi AKY, Tong JWS, et al. Long-Term Results of Surgically Treated Radial Polydactyly — An Outcome Correlation Study. J Hand Surg Asian Pac Vol. 2019;24(3):264–269. doi: 10.1142/S2424835519500322
  28. Chang CF, Chen IC, Tsai YC, et al. Transposition of Duplicated Thumb for Reconstruction of Asymmetric Radial Polydactyly. Ann Plast Surg. 2019;82(1S Suppl 1):S13–S17. doi: 10.1097/SAP.0000000000001722
  29. Suzuki A, Kawabata H, Hayashi J, et al. Clinical Findings and Treatments of a Radially Deviated Type of Thumb Polydactyly. J Hand Surg Asian Pac Vol. 2019;24(1):17–23. doi: 10.1142/S2424835519500048
  30. Gholson JJ, Shah AS, Buckwalter JA. Long-Term Clinical and Radiographic Follow-Up of Preaxial Polydactyly Reconstruction. Journal of Hand Surgery. 2019;44(3):244.e1–244.e6. doi: 10.1016/J.JHSA.2018.05.030
  31. Bell B, Butler L, Mills J, et al. “On-Top Plasty” for Radial Polydactyly Reconstruction. Journal of Hand Surgery. 2017;42(9):753.e1–753.e6. doi: 10.1016/J.JHSA.2017.05.029
  32. Kim BJ, Choi JH, Kwon ST. Oblique Osteotomy for the Correction of the Zigzag Deformity of Wassel Type IV Polydactyly. Plast Reconstr Surg. 2017;140(6):1220–1228. doi: 10.1097/PRS.0000000000003877
  33. de Almeida CEF. Analysis of surgical results and of residual postoperative deformities in preaxial polydactyly of the hand. Journal of Plastic, Reconstructive and Aesthetic Surgery. 2017;70(10):1420–1432. doi: 10.1016/J.BJPS.2017.05.031
  34. Stutz C, Mills J, Wheeler L, et al. Long-term outcomes following radial polydactyly reconstruction. Journal of Hand Surgery. 2014;39(8):1549–1552. doi: 10.1016/J.JHSA.2014.05.006
  35. Lee CC, Park HY, Yoon JO, et al. Correction of Wassel type IV thumb duplication with zigzag deformity: results of a new method of flexor pollicis longus tendon relocation. J Hand Surg Eur Vol. 2013;38(3):272–280. doi: 10.1177/1753193412460809
  36. Engelhardt TO, Baur EM, Pedross F, et al. Supporting the collateral ligament complex in radial polydactyly type Wassel IV. Journal of Plastic, Reconstructive and Aesthetic Surgery. 2013;66(1):104–112. doi: 10.1016/J.BJPS.2012.07.023
  37. Cabrera González M, Pérez López LM, Martínez Soto G, et al. Prognostic value of age and Wassel classification in the reconstruction of thumb duplication. J Child Orthop. 2013;7(6):551–557. doi: 10.1007/S11832-013-0534-3
  38. Chung MS, Baek GH, Gong HS, et al. Radial polydactyly: Proposal for a new classification system based on the 159 duplicated thumbs. Journal of Pediatric Orthopaedics. 2013;33(2):190–196. doi: 10.1097/BPO.0B013E3182648CA8
  39. Kemnitz S, De Smet L. Pre-axial Polydactyly: Outcome of the Surgical Treatment. Journal of Pediatric Orthopaedics, Part B. 2002;11(1):79–84. doi: 10.1097/00009957-200201000-00013
  40. Takagi R, Kawabata H, Matsui Y. Thumb polydactyly with symphalangism in young children. Journal of Hand Surgery: European Volume. 2009;34(6):800–804. doi: 10.1177/1753193408092254
  41. Goo HB, Hyun SG, Moon SC, et al. Modified Bilhaut-Cloquet procedure for Wassel type-II and III polydactyly of the thumb. Journal of Bone and Joint Surgery. 2008;90:74–86. doi: 10.2106/JBJS.G.01104
  42. Goldfarb CA, Patterson JM, Maender A, et al. Thumb Size and Appearance Following Reconstruction of Radial Polydactyly. Journal of Hand Surgery. 2008;33(8):1348–1353. doi: 10.1016/J.JHSA.2008.03.011
  43. Yen CH, Chan WL, Leung HB, et al. Thumb polydactyly: clinical outcome after reconstruction. J Orthop Surg (Hong Kong). 2006;14(3):295–302. doi: 10.1177/230949900601400312
  44. Imaeda T, Toh S, Nakao Y, et al. Validation of the Japanese Society for Surgery of the Hand version of the Disability of the Arm, Shoulder, and Hand questionnaire. Journal of Orthopaedic Science. 2005;10(4):353. doi: 10.1007/S00776-005-0917-5
  45. Tada K, Yonenobu K, Tsuyuguchi Y, et al. Duplication of the thumb. A retrospective review of two hundred and thirty-seven cases. Journal of Bone and Joint Surgery — Series A. 1983;65(5):584–98. doi: 10.2106/00004623-198365050-00002
  46. Horii E, Koh S, Otsuka J, et al. Midterm Surgical Outcomes of Duplicated Thumbs According to New Classification. Plast Reconstr Surg. 2023;152(1):116E–125E. doi: 10.1097/PRS.0000000000010267
  47. Tawfeeq Y, Hendry JM, Wood KS. Update of surgical treatment of polydactyly. Curr Opin Pediatr. 2023;35(1):124–130. doi: 10.1097/MOP.0000000000001204
  48. Paterson N, Waterhouse P. Risk in pediatric anesthesia. Pediatric Anesthesia. 2011;21(8):848–857. doi: 10.1111/J.1460-9592.2010.03366.X
  49. Flatt AE. Webbed Fingers. Baylor University Medical Center Proceedings. 2005;18(1):26–37. doi: 10.1080/08998280.2005.11928029

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) Eco-Vector


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77-76249 от 19.07.2019.