Abstract
Purpose This study reports the results of surgical treatment of thumb duplication in the Clinique d'Orthopédie et de Chirurgie de l'Enfant de l'Hôpital Jeanne de Flandre in Lille (France). Methods Thirty patients (33 thumbs) operated on between 1995 and 2003 are clinically reviewed. Results The mean postoperative follow-up was 3 years and 11 months. According to Wassel's classification, the series included 12 type II duplications, two type III, 14 type IV, two type V, one type VI and two type VII. The surgical approaches consisted of simple resection of the most hypoplastic thumb (16 thumbs), the Bilhaut-Cloquet procedure (ten thumbs) and resection associated with reconstructive surgery (seven thumbs). The Bilhaut-Cloquet procedure was used in three cases for treatment of type IV duplication On the basis of the Tada scoring system, we obtained 24 good results, eight fair results and one poor result. Conclusion Based on our results, we recommend that the Bilhaut-Cloquet procedure be used not only for the treatment of type II duplication when the thumbs are both hypoplastic and symmetric but also for type IV duplication with the same clinical parameters. For the other types of duplications, we consider that resection of the most hypoplastic thumb associated with reconstructive surgery is the best surgical approach. For type VII duplication, ablation of the triphalangeal thumb remains the best option. We do not recommend osteotomy at the first surgery.
Highlights
Thumb duplication is a pre-axial polydactyly and one of the most frequent congenital deformities of the hand after syndactyly [1]
Martinot-Duquennoy Service de Chirurgie Plastique et Reconstructrice, Hopital Roger Salengro, 59037 Lille Cedex, France duplications, we consider that resection of the most hypoplastic thumb associated with reconstructive surgery is the best surgical approach
Fifteen patients presented an axial deviation after surgery, of whom 73.3% had an interphalangeal clinodactyly and 46.7% a metacarpophalangeal one
Summary
Thumb duplication is a pre-axial polydactyly and one of the most frequent congenital deformities of the hand after syndactyly [1]. It mostly appears as an isolated deformity, it can sometimes be associated with other abnormalities. The current surgical approach is to create a functional thumb [2], i.e. one that is mobile, with a good axis and stable, together with a good cosmetic result. Such an approach may require more complex reconstructive techniques than the simple resection
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