PMC9453009_01
Preoperative clinical photographs demonstrating preaxial polydactyly of the patient's right thumb. (a) Oblique view. (b) Dorsal view. (c) Lateral view.
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The team noted the presence of an extra digit involving her right hand, specifically preaxial polydactyly of her right thumb (Figures 1(a)-1(c)).
A 3-view X ray of the right hand showed preaxial polydactyly. (a) Duplicated proximal and distal phalanx, anterior-posterior view. (b) Subchondral sclerosis, oblique view. (c) Reactive bone formation suggestive of arthritic changes at the radial preaxial polydactyly MCP joint (Wassel type IV), lateral view.
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A 3-view X ray of the right hand showed preaxial polydactyly with a duplicated proximal phalanx, as well as subchondral sclerosis and reactive bone formation suggestive of arthritic changes at the radial preaxial polydactyly MCP joint due to being apex radial (Wassel type IV) (Figures 2(a)-2(c)).
Intraoperative photo of procedure. (a) Thenar racquet incision made with a 15 blade around the extra digit and down the radial side at the junction between the palmar and dorsal skin. (b) Disarticulated extra digit, measuring approximately 6 cm, excised after the extensor and flexor tendons were sharply released distally. (c) Radial facet of the radial thumb joint needing to be removed. Residual capsule was elevated off of the metacarpal base (origin of RCL), and a saw was then used to remove the articular surface and dorsal osteophyte. (d) Approximation of the tendinous insertion of the thenar musculature onto the dorsoradial capsule of the residual proximal phalanx using 3-0 FiberWire .
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Under tourniquet control for hemostasis, a racquet incision was made around the extra digit and down the radial side, at the junction between the palmar and dorsal skin (Figure 3(a)). The extensor and flexor tendons were sharply released distally, and the extra digit was disarticulated (Figure 3(b)). Residual capsule was elevated off of the metacarpal base, and a saw and rasp were then used to remove the articular surface and dorsal osteophyte (Figure 3(c)). The tendinous insertion of the thenar musculature was then approximated onto the dorsoradial capsule of the residual proximal phalanx using 3-0 FiberWire (Figure 3(d)).
A 3-view X ray of the right hand taken one month postoperatively. (a) Interval resection of the extra digit, dorsal view. (b) Mild degenerative osteoarthrosis of the MCP, oblique view. (c) Mild degenerative osteoarthrosis of the IP joints, lateral view.
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A 3-view X ray of the right hand demonstrated interval resection of the extra digit with stable, mild, degenerative osteoarthrosis of the first MCP (Figures 4(a)-4(c)).
Seven-week postoperative clinical photos demonstrating an attractive cosmetic result. (a) No visible scar dorsally. (b) Minimal visible scar over the volar radial aspect of the right thumb. (c) Full opposition of the right thumb to the distal fifth phalanx. (d) Twelve-week postoperative visit with minimal scar formation and satisfactory thumb abduction.
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