Pre-axial Polydactyly: Outcome of the Surgical Treatment

Abstract

From 1988 to 1999 we operated on 22 patients for pre-axial polydactyly. We retrospectively reviewed all files and we clinically reviewed 16 patients. We report on the epidemiology, the surgical technique, the outcome and the complications. All patients were operated on by the same hand surgeon (L.D.S.) and reviewed by an independent observer (S.K.). Aesthetic and functional outcome is reported. In general the surgical treatment for pre-axial duplications gives excellent functional and good aesthetic results. According to the Egawa score, 13 patients obtained an excellent, one a fair and two a poor result. The overall satisfaction rate is very high for both patient and parents and the complication rate was low. The functional outcome seems to be related to the stability of the interphalangeal and metacarpo-phalangeal joints. The most frequent aesthetic problem is a deviation of the axis. Loss of mobility of the thumb seems to be of less importance.

Reconstruction of Radial Polydactyly

“…Others delay surgery until greater than 2 years of age because anesthesia is safer, and the thumb is larger and more ossified. 8,9 I base the timing of the surgery on the type of radial polydactyly and the desires of the family. I prefer to reconstruct most thumbs at 12 to 18 months, as I feel the size of the thumb its structures are sufficiently large to make the surgery technically more straightforward.…”

Comparison of Functional Outcome Scores in Radial Polydactyly

“…Another strength of the study was that we related the patients' satisfaction with the function and aesthetic results to the outcome assessments by the three examiners. Our findings suggest poor-to-moderate correlations between physician-rated and patient-rated outcome, which is well known 2,6,8,24,33 . Moreover, patient satisfaction is an important reason for seeking medical attention, a determining factor for performing revision surgery, and a substantial confounder in outcome evaluation after revision surgery.…”

“…The Tada score (or modified versions of this assessment system) has been applied most frequently to describe outcomes of treatment of radial polydactyly [7][8][9][10][11][12][13][14][15][16] . However, the results of our study indicate that the JSSH system is better suited for this purpose.…”

“…In addition, examiners and patients (or their caregivers) were asked to assess functional and aesthetic outcome on a VAS 2,8,24,25 . The functional VAS ranged from ''no functional thumb at all'' to ''a perfectly functioning thumb.''…”

“…A comprehensive scoring system was first introduced by Tada et al in 1983 7 . This commonly used [8][9][10][11][12] and frequently modified 13-16 system consists of scores for range of motion, joint instability, and malalignment parameters. Consequently, the definition of outcome is based solely on functional parameters in the Tada scoring system.…”