Article
Radial Polydactyly: The not so innocent floating radial duplicate
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Authors
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Lisa Ng
- Department of Plastic and Reconstructive Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Susan Stevenson
- Department of Plastic and Reconstructive Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Jane Maraka
- Department of Plastic and Reconstructive Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Helen Stark
- Department of Plastic and Reconstructive Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Victoria Lockwood
- Centre for the Advanced Study of Human Paleobiology, Department of Anthropology, The George Washington University, Washington, United States
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Rui Diogo
- Department of Anatomy, Howard University College of Medicine, Washington DC, United States
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Brid Crowley
- Department of Plastic and Reconstructive Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: In radial polydactyly radiological and clinical appearances can belie the underlying anatomical complexity. The floating radial duplicate we define as a radial duplicate with soft tissue attachment only to the ulnar duplicate. Such duplicates are often perceived to be straightforward, associated with a normal ulnar duplicate and suitable for management by simple excision. We report our experience of anatomical surgical management of radial polydactyly with floating radial duplicates.
Methods: Operative anatomical data was collected prospectively for 75 consecutive thumbs at primary surgery. Cases with floating radial duplicates were identified. Detailed schematics were constructed providing a highly visual representation of the anatomy.
Results and Conclusions: 19 thumbs with floating radial duplicates were identified. In 3 cases the ulnar duplicate was triphalangeal.
Thenar muscle: In 4/19 thumbs abductor pollicis brevis(APB) inserted on both duplicates. Anomalies included: APB inserting on the radial duplicate solely; APB inserting into the flexor and extensor mechanism at IPJ level; APB inserting distal to IPJ of ulnar duplicate; hypoplastic APB inserting on the neck of 1st metacarpal.
Extensor: 8/19 thumbs demonstrated insertion on both duplicates. Anomalies included: interconnections extensor-flexor; atrophic EPL ulnar duplicate; hypoplastic EPB ulnar duplicate; EPB inserting radial duplicate only.
Flexor: 15/19 floating radial duplicates had no flexor tendons. FPL inserted on both duplicates in 4/19. Eccentric FPL insertion and deficient pulleys in the dominant ulnar duplicate were observed.
Surgical procedures: The radial duplicate skeleton was excised in 14/19 cases. MCPjt instability in the ulnar duplicate was treated in 2 cases. 3 thumbs with a triphalangeal ulnar component underwent excision of middle phalanx. A new IP joint was formed. The radial collateral ligament of IPjt was reconstructed in 2 cases.
Tendon procedures included transfer of EPB to the dominant duplicate; division of anomalous interconnections; division of anomalous flexor slips; pulley reconstruction; division of anomalous APB insertions.
Discussion: Radial polydactyly cases with floating radial duplicates are often perceived as straightforward with "normal" ulnar duplicates. Our experience does not support this perception. We identified anomalous anatomy in both the floating radial duplicate and the dominant ulnar duplicate. A systematic anatomical approach to primary surgery is advocated.
