Treatment of duplicated thumb using a ligamentous/periosteal flap

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Abstract

Since 1975, 22 duplicated thumbs in 21 children were treated by ablation of one of the digits, elevation of a ligament and periosteal flap from the proximal bone, reduction osteotomy to narrow the widened proximal bone, centralization of the retained thumb, and stabilization of the joint by reattaching the ligament and periosteal flap. In addition to improving the cosmetic appearance by centralizing the retained thumb on the narrowed proximal bone, good joint stability was provided. Three patients had subsequent joint arthrodesis because of laxity of the contralateral collateral ligament. The procedure is preferred to the reconstruction of a single digit by using component parts of both duplicated thumbs because the described procedure is technically simpler and does not potentially interfere with physeal growth or leave a nail matrix defect.

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    Citation Excerpt :

    Surgical methods for the cases of polydactyly consisted of excision of the fifth or sixth toe in consideration of the appearance and radiographic alignment of the toe, resection of excess cartilage and bone from the widened articular surface with shaving of the joint cartilage to align the joint, and transfer of the abductor digiti minimi muscle from the sixth to fifth toe (3). Restoration of ligamentous stability was performed using a modification of Manske's technique for thumb polydactyly (3,6). Briefly, the collateral ligament of the excised toe was carefully detached from its distal insertion in continuity with the adjacent periosteum.

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Presented in part at the combined American Society for Surgery of the Hand/British Society for Surgery of the Hand Meeting in Killarney, Ireland, May 20, 1988.

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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