Arthrography in thumb polydactyly with bifurcation at the interphalangeal or metacarpophalangeal joints provides practical information at surgery

Abstract

We carried out arthrography in 19 thumbs of 18 patients in whom duplication was observed at the interphalangeal (Wassel type II) or metacarpophalangeal (Wassel type IV) joints on radiographs. The average age at surgery was 12.3 months and average duration of post-surgical follow-up was 21.3 months. Based on the arthrographic findings, the types of cartilaginous connections were subdivided into five groups. In group 1, there was a cartilaginous connection at the base of duplicated phalanges. In group 2, there was a cartilaginous connection of the radial digit between the distal and proximal phalanges, or between the proximal phalanx and metacarpal. In group 3, the phalanges separated at a common joint without any cartilaginous connection. In group 4, the radial digit demonstrated fibrous attachment to the capsule without any joint formation. In group 5, each joint was completely separated without any cartilaginous connection. These arthrographic findings could not be detected on radiographs. Different surgical procedures were carried out according to the form of cartilaginous connection.

Long-term outcomes after corrective cartilaginous joint resection based on arthrographic findings of duplicated thumbs

“… a Group 1: a cartilaginous connection at the base of the duplicated phalanges; Group 2: a cartilaginous connection between the distal and proximal phalanges, or between the proximal phalanx and metacarpal of the radial digit, of which the joint space was only formed at the ulnar segment (Iba et al., J Hand Surg Eur. 2013, 38: 267–71). b Only this case was rated good with the JSSH score, other five patients rated excellent.…”

“…As previously reported (Iba et al, 2013), our surgical methods for bifurcation at the IP or MP joint of a duplicated thumb consists of excision of the radial digit using a longitudinal elliptical incision. The proximally based ligament/periosteal sleeve of the ablated thumb is sutured to the cartilaginous base of the retained thumb (Manske, 1989).…”

“…We have previously reported the methods and early outcomes of corrective resection and shaving of the cartilaginous joint based on arthrographic findings to reconstruct a favourable alignment in cases of Wassel Type II and IV duplicated thumbs (Iba et al., 2013). These revealed a cartilaginous connection between the duplicated phalanges, the distal and proximal phalanges, and the proximal phalanx and metacarpal (Iba et al., 2013). The corrective resection of the cartilaginous joint connection required a large cartilage resection.…”

MR Imaging Provides Practical Information for Preoperative Assessment of Radial Polydactyly with Bifurcation at the Metacarpophalangeal Joint Level

“…Based on the previous reports, 5 , 7 , 14 , 15 the anomalistic form of the MP joints was subdivided into five types; a cartilaginous connection at the base of the two proximal phalanges, phalanges separation by a common joint, disappearance of the MP joint of the radial digit and replacement by cartilaginous connection, distal metacarpal bifurcated with two cartilaginous head to form two separate joints and attachment of radial digit with soft tissues. Their findings at surgery or arthrography are in sync with our MRI findings.…”

Polidactilias del pulgar. Tratamiento quirúrgico

“…Algunas anomalías, como un sinfalangismo del pulgar radial, no se observan en las Rx hasta una edad avanzada, superior a la edad promedio en la que es realizada la cirugía inicial. Una opción diagnóstica es la artrografía MF 31,32 , que tiene el inconveniente de ser «invasiva» y requerir una anestesia general. La ecografía puede ampliar la información sin serlo.…”