Midterm and Long-term Follow-up After Surgical Reconstruction for Lateral Polydactyly of the Foot With Mosaic-like Alignment of the Phalanx Bones

Iba, Kousuke; Ozasa, Yasuhiro; Hanaka, Megumi; Hayakawa, Hikaru; Kanaya, Kohei; Yamashita, Toshihiko

doi:10.1097/bpo.0000000000001381

Cited by 6 publications

(11 citation statements)

References 7 publications

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“…Uda et al [14] reported that a valgus deformity persisted when the medial toe of the phalangeal type was excised. Iba et al [17] reported a surgical procedure in which the alignment between the distal and proximal phalanges for the excision of the sixth toe and medial excess bone from the fifth toe was independent of the middle phalanx alignment and restored ligamentous stability. Nakamura et al [6] asserted that this deformity could be corrected by trimming the joint face and tacking the medial soft tissue around the joint.…”

Section: Discussionmentioning

confidence: 99%

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Reconstruction of polysyndactyly of the fused fifth toe with the fourth toe

Du¹,

Chen²,

Jiang³

et al. 2023

Journal of Pediatric Orthopaedics B

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Polysyndactyly of the fused fifth toe with the fourth toe is a common subtype of postaxial polydactyly. The aim of the study was to present an operative technique for cosmetic improvement and reconstruction of polysyndactyly of the fused fifth toe with the fourth toe. We retrospectively reviewed the details of 22 patients with postaxial polydactyly treated from January 2018 to May 2021. The operation involved medial toe excision and web space reconstruction using a dorsal rectangular flap without skin grafting and simultaneous correction of a valgus deformity by chondroplasty and soft tissue balancing without an osteotomy. The web shape, scar, and aesthetic outcomes were evaluated on the criteria of the D'Arcangelo, Vancouver Scar Scale score, and satisfactory questionnaire, respectively. The patients were followed up for 7-43 months. At the last follow-up, valgus deformity was completely corrected without recurrence. On the basis of the criterion of D'Arcangelo, the height and width of the webs were good in 24 of the feet, fair in four of the feet, and poor in none of the feet. The mean Vancouver Scar Scale score was 1.55. All parents and patients were satisfied with the appearance and function. The described medial toe excision technique and reconstruction of the web space without a skin graft corrected the valgus deformity and were able to satisfy functional and cosmetic requirements.

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Section: Discussionmentioning

confidence: 99%

“…Iba et al . [17] reported a surgical procedure in which the alignment between the distal and proximal phalanges for the excision of the sixth toe and medial excess bone from the fifth toe was independent of the middle phalanx alignment and restored ligamentous stability. Nakamura et al .…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of polysyndactyly of the fused fifth toe with the fourth toe

Du¹,

Chen²,

Jiang³

et al. 2023

Journal of Pediatric Orthopaedics B

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“…Although various surgical methods for postaxial polydactyly of the foot have been described, 2,4,12,14 there is little information available, especially with respect to predictors of surgical outcomes. In addition, some authors have attempted to classify postaxial polydactyly to assist in determining the most appropriate treatment options.…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcomes and Predictive Factors of Medial Toe Excision for Polysyndactyly of the Fifth Toe

Shim

Kang

et al. 2020

Foot Ankle Int.

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Background: We aimed to report surgical outcomes and analyze prognostic factors of medial toe excision for polysyndactyly of the fifth toe. Methods: We reviewed the details of 139 consecutive patients who underwent surgery for postaxial polydactyly of the foot from 2009 to 2018. Among these, 83 patients (90 feet) with polysyndactyly of the fifth toe, treated by medial toe excision (between the duplicated toes) and reconstruction of the fourth web space using a dorsal rectangular flap, were included. The toe alignment and stability were restored by chondroplasty and soft tissue balancing without an osteotomy. A full-thickness skin graft was performed in 52 feet. The mean age at surgery was 27.1 ± 17.5 months and the mean duration of follow-up was 42.8 ± 24.9 months. Results: At the last follow-up, a relatively small size of the reconstructed toe was observed in 19 feet (19/90, 21.1%). Proximal duplication level (metatarsal or proximal phalanx type) and preoperative hypoplasia of the remaining toe were related to the small postoperative size. Valgus deformity of the remaining toe was observed in 2 feet (2/90, 2.2%). We observed 17 cases with delayed healing or early postoperative wound infection. Among these, 7 cases (7/90, 7.8%) showed postoperative thickening or advancement of the web, which was not observed in cases without wound problems. No cases had functional disturbance or pain. Conclusion: The overall surgical outcomes were satisfactory without an osteotomy. Patients with a proximal duplication level or preoperative hypoplasia of the remaining toe should be informed of its possible small size postoperatively. Levels of Evidence: Level IV, retrospective case series.

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“…MPPP was defined as a specific type of postaxial polydactyly in which the duplication starts at a common proximal interphalangeal (PIP) joint. 10 In this study, 37 feet of 37 patients were included. Four patients presented with bilateral postaxial-type polydactyly, but the duplication on the opposite side was at the proximal phalanx or metatarsal level on simple radiography; hence, only 1 foot was included in the study.…”

Section: Patient Selectionmentioning

confidence: 99%

“…7,8 In countries with negative cultural atmospheres about polydactyly, parents of patients prefer performing the operation in early childhood. 9,10 Owing to the same tendency in South Korea, operative treatment is performed at around 1 year of age when children start to walk and have increased outdoor activities.…”

mentioning

confidence: 99%

Classification of Middle Phalangeal Postaxial Polysyndactyly Based on Intraoperative Arthrography Is Useful for Surgical Decision-making in Children Younger Than 2 Years

Bae

Kang

Kim

et al. 2021

Journal of Pediatric Orthopaedics

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Background: The middle phalangeal type of postaxial polysyndactyly (MPPP) of the foot is a common congenital limb anomaly and is usually treated surgically at a young age. Owing to the insufficiency of radiologic evaluation due to largely cartilaginous portions of the pediatric foot, we performed intraoperative arthrography (IOA) for MPPP. This study was aimed at presenting a new classification system for foot MPPP in young children based on IOA findings and investigating its intraoperative decision-making. Methods: Thirty-seven patients aged below 2 years who underwent IOA and surgical treatment of foot MPPP in our institute between January 2018 and April 2020 were retrospectively reviewed. The mean patient age at operation was 1.31 years (range, 0.91 to 1.99 y). IOA was performed in the common proximal interphalangeal (PIP) joint. The excisional level and side were determined on the basis of the IOA findings and bony alignment between the proximal and distal phalanges for functional and cosmetic purposes. Arthrographic findings and surgical procedures were recorded. Results: A new classification divided MPPP into 2 major types according to the presence (type A) or absence (type B) of longitudinal contrast filling between the fifth and sixth middle phalanges. These 2 major types were further divided into 4 subtypes according to the shape of the PIP joint by contrast filling. There were 19, 15, and 3 cases of type A, B, and indeterminate IOA. Fifth and sixth ray excisions were performed in 26 and 11 cases, respectively. Interobserver reliability of the classification represented excellent agreement (Cohen κ coefficient = 0.823). Conclusions: Our new classification based on IOA helped determine the articular dominance and its detailed morphology, which can help predict postoperative stability and mobility of the remaining toe. IOA is a simple, safe, and useful imaging tool for the surgical treatment of foot MPPP in patients aged below 2 years. Level of Evidence: Level III.

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Midterm and Long-term Follow-up After Surgical Reconstruction for Lateral Polydactyly of the Foot With Mosaic-like Alignment of the Phalanx Bones

Cited by 6 publications

References 7 publications

Reconstruction of polysyndactyly of the fused fifth toe with the fourth toe

Reconstruction of polysyndactyly of the fused fifth toe with the fourth toe

Surgical Outcomes and Predictive Factors of Medial Toe Excision for Polysyndactyly of the Fifth Toe

Classification of Middle Phalangeal Postaxial Polysyndactyly Based on Intraoperative Arthrography Is Useful for Surgical Decision-making in Children Younger Than 2 Years

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