The oblique wedge osteotomy of the metacarpal condyle for reconstructing wassel type IV thumb duplication in older children and adults

2010 ◽  
Vol 35 (8) ◽  
pp. 669-675 ◽  
Author(s):  
E. M. Chew ◽  
F. C. Yong ◽  
L. C. Teoh
Keyword(s):  
Wedge Osteotomy ◽  
Older Children ◽  
Type Iv ◽  
Thumb Duplication

Opening wedge phalangeal osteotomy for correction of Wassel type IV-D thumb duplication

2019 ◽  
Vol 52 (02) ◽  
pp. 147-150
Author(s):  
Kun Wang ◽  
Fangxin Ai ◽  
Pan Zhou ◽  
Zhiwei Liu ◽  
Zhenbing Chen ◽  
...  
Keyword(s):  
Metacarpophalangeal Joint ◽  
Suture Technique ◽  
Wedge Osteotomy ◽  
Angular Deformity ◽  
Opening Wedge ◽  
Type Iv ◽  
Pull Out ◽  
Thumb Duplication ◽  
The Right ◽  
Pull Out Suture

Abstract Background Thumb duplication is one of common anomalies of the hand. Among of Wassel type IV subtypes, type IV-D duplication with a zigzag deformity is most challenging for reconstructing. Several factors may affect the surgical outcomes. This study aimed to present an opening wedge osteotomy at proximal phalangeal neck for treating type IV-D duplication. Methods Data from 14 patients are presented in this study. Eight patients had duplication of the right thumb, and six left thumb. After removal of radial supernumerary thumb, a snug collateral ligament was repaired to correct angular deformity of metacarpophalangeal joint (MCP). Angular deformity of the interphalangeal (IP) joint was corrected by an opening wedge osteotomy at the proximal phalangeal neck. A wedge bone from ablated thumb was grafted to correct the malalignment. IP joint was further stabilized by plication of the ulnar capsule. The relocation of radial part of FPL to the center of distal phalangeal base by use of pull-out suture technique Results After surgery, the angulations of the IP joints and the MCP joints were improved. Bone union was observed in all patients. According to the Japanese Society for Surgery of the Hand evaluation form, twelve cases were rated good, 2 cases fair. Stability of IP and MCP joints was good in all cases. The active ROM of IP was less in residual thumb than in normal thumb. Small nails were observed in some patients. Conclusions Although the reconstructed thumbs were smaller than normal counterparts, they were aligned and with stable joints. The opening wedge osteotomy at proximal phalangeal neck could improve realignment of IP joint and prevent reoccurrence of deformity over time.

Causes of secondary deformity after surgery to correct Wassel type IV-D thumb duplication

2016 ◽  
Vol 41 (7) ◽  
pp. 739-744 ◽  
Author(s):  
B. He ◽  
G. Nan
Keyword(s):  
Kirschner Wire ◽  
Incomplete Resection ◽  
Flexor Pollicis Longus ◽  
Level Of Evidence ◽  
Thenar Muscle ◽  
Type Iv ◽  
Kirschner Wire Fixation ◽  
Thumb Duplication ◽  
Secondary Deformity ◽  
A2 Pulley

This study was undertaken to document the causes of secondary deformities after surgery for correction of Wassel type IV-D thumb duplication. We carefully dissected and observed the flexor pollicis longus, and bone and joint anatomy in eight patients with secondary deformities after surgical correction. We transferred the flexor pollicis longus and thenar muscle attachments, reconstructed the A2 pulley, released and tightened the joint capsule, and performed osteotomies to correct skeletal malalignment. Kirschner wire fixation was used for 4–5 weeks, followed by brace fixation for 3 months. Patients were followed up for 13–34 months (mean 20 months). According to the Tada scores, the outcomes were good in six patients, and fair and poor in one patient each. The main causes of the secondary deformities were failure to reconstruct the A2 pulley, to transfer the flexor pollicis longus and thenar muscles, and incomplete resection of the radial metacarpal head. Brace fixation after Kirschner wire removal is crucial in preventing secondary deformities. Level of evidence: IV

scholarly journals Type IV-D thumb duplication: A new reconstruction method

2010 ◽  
Vol 96 (5) ◽  
pp. 521-524 ◽  
Author(s):  
A. Abid ◽  
F. Accadbled ◽  
G. Knorr ◽  
P. Darodes ◽  
J.-P. Cahuzac ◽  
...  
Keyword(s):  
Reconstruction Method ◽  
Type Iv ◽  
Thumb Duplication

The distribution of the types of thumb polydactyly in a middle eastern population: a study of 228 hands

2009 ◽  
Vol 35 (3) ◽  
pp. 182-187 ◽  
Author(s):  
M. M. Al-Qattan
Keyword(s):  
Middle Eastern ◽  
Far East ◽  
Type I ◽  
Type Iv ◽  
The Far East ◽  
Thumb Duplication ◽  
Middle Eastern Population ◽  
Genetic Pools ◽  
Almost All ◽  
Far Eastern

Several series have reported the distribution of the types of thumb polydactyly in the Caucasian and Far Eastern populations. No data are available for the Middle East. A total of 196 Saudi patients (228 hands) with thumb polydactyly were reviewed. The most common type was Wassel type IV (33.8%) and the least common was Wassel type I (0.4%). A total of 26 hands (11.4%) did not fit into the classic Wassel types including 18 cases of rudimentary duplications, two cases of thumb triplication, and five cases of thumb duplication with symphalangism. Concurrent ipsilateral little finger triplication (one case) and contralateral thumb aplasia/hypoplasia (two cases) were seen and the developmental biology of these cases are discussed. After reviewing our results and other series in the literature, we concluded that Wassel types IV and I remain to be the most and least common types respectively in almost all races. However, the genetic pools of various races greatly affect the distribution of other non-classic duplications (unclassifiable by Wassel classification) such as rudimentary duplication in the Far East, triplication in the Southwestern region of the Netherlands, and symphalangism in Asia.

Preoperative percutaneous arthrography provides detailed information for treatment of Wassel type IV thumb duplication

2018 ◽  
Vol 71 (12) ◽  
pp. 1717-1722 ◽  
Author(s):  
Qianqian Liu ◽  
Lei Zhong ◽  
Hong Li ◽  
Jun Liu ◽  
Zhe Zhu ◽  
...  
Keyword(s):  
Type Iv ◽  
Thumb Duplication

The anatomy of Wassel type IV-D thumb duplication

2017 ◽  
Vol 42 (5) ◽  
pp. 516-522
Author(s):  
B. He ◽  
G. Liu ◽  
G. Nan
Keyword(s):  
Proximal Phalanx ◽  
Tendon Sheath ◽  
Distal Phalanx ◽  
Level Of Evidence ◽  
Type Iv ◽  
Radial Side ◽  
Thumb Duplication ◽  
Secondary Deformity ◽  
A2 Pulley ◽  
Flexor Pollicis Longus Tendon

We describe Wassel type IV-D thumb duplication anatomy after surgery on 11 affected children (12 hands, seven boys (eight hands) and four girls). We studied the structure and course of the flexor pollicis longus tendon and its action at the joint. Four patients had secondary deformity associated with an absent A2 pulley and a tendon that clung to the radial side of a small thumb. In patients with primary deformity, the flexor tendon sheath became membranous in the A2 area and attached to neighbouring sites on the opposite side of the proximal phalanx. In the proximal A2 area, the tendon divided – one division attached on the ulnar side of the distal phalanx base; the other, the base of the radial side. There was slight ulnar angulation of the distal phalanx on the radial portion of the duplication and slight ulnar angulation on the radial portion. Level of evidence: V

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