Thumb Polydactyly: Clinical Outcome after Reconstruction

Abstract

Purpose. To evaluate clinical and cosmetic outcomes of reconstruction in thumb polydactyly and prognostic value of the Wassel classification. Methods. Between 1993 and 2000 inclusive, out of the patients with thumb polydactyly (involving 80 thumbs) operated on, 34 patients (36 thumbs) were available for review and underwent clinical and radiological assessment. Outcomes in terms of the Tada score and complications were recorded. Results. The mean age of patients at the time of operation was 2.8 (range, 0.6-47) years. The mean follow-up period was 5 (range, 2.4-10) years. According to the Wassel classification, 12 were type-II thumb polydactyly, 3 type-III, 11 type-IV, 6 type-V, one type-VI, and 3 type-VII. There was no perioperative mortality or wound infection. More than 88% of the patients were satisfied or very satisfied with functional and cosmetic outcomes. Postoperative complications such as scar hypertrophy, pulp atrophy, joint deformity, and instability were common but minor. Ridge nail deformity after the Bilhaut Cloquet procedure was amenable to second- [295][296][297][298][299][300][301][302] ary corrective procedures. All types of operated thumb polydactyly achieved similar mean Tada scores (14.7-16.6 out of 20). The Wassel classification category, age, and surgical procedures were found to have no prognostic value with regard to the Tada score and presence of complications. Conclusion. Surgery on thumb polydactyly is rewarding. The Wassel classification category can be used as a guide for treatment, although it fails to predict the occurrence of postoperative complications or Tada scores. Our patients' results can serve as guidelines of expected outcomes after reconstructive procedures in different sub-types of thumb polydactyly.

Prognostic value of age and Wassel classification in the reconstruction of thumb duplication

“…The Wassel classification helps to determine the optimal surgical technique with which to achieve these aims [1,6,9,11].…”

“…It was mainly used in type II (proximal phalanx chondroplasty, 9 patients, 16 %) and type IV (metacarpal head chondroplasty, 36 patients, 67 %) [1]. Nevertheless, it might be useful in other Wassel types when joint congruency is not achieved.…”

“…For Yen et al [1], the most common complication was instability (69 %). In contrast, in our study, instability was present in only 8 % of patients.…”

“…All current publications about this pathology are retrospective [1,[7][8][9], as is ours. Our group comprised 99 patients, a number very similar to that in reviews by Wassel [10] and Ogino et al [14].…”

“…Exceptionally, only one author group, Tada et al, recommends operating at 6 months [16]. Yen et al [1] postpone surgery and operate at a mean age of Results were 91 % good (4 and 5), 8 % fair (3 and 2), and none poor. Despite the good outcomes overall, there was a tendency toward more patients with 4 points in group III and more fair results in group IV 33 months.…”