title: Soft tissue reconstruction for type IV-D duplicated thumb: a new surgical technique.
abstract: Type IV-D duplicated thumb has the most complex anomalies and difficulties for treatment among polydatyly. Double osteotomy is usually recommended to gain the best cosmetic and functional outcome. However, 4 cases of type IV-D duplicated thumb were treated only by soft tissue procedure in this study. At operation, a conjoined A2 pulley was routinely identified, and the flexor pollicis longus (FPL) was found bifurcated distal to the conjoined pulley in every of these cases. Instead of double osteotomy, a soft tissue procedure that included centralization of FPL and A2 pulley reconstruction was pursued to correct these special anomalies. The overall clinical results were evaluated by a modification of the Tada scoring system based on the range of motion, joint stability, alignment of the remaining thumb, and subjective opinion regarding the reconstructed thumb after an average follow-up of 3.3 years (range, 2.5-4.7 years). According to the scoring system, the results were rated as good in 3 cases and fair in 1 case. From the results, the A2 pulley reconstruction and FPL centralization could prove to be an effective method for the treatment of type IV-D duplicated thumb and could efficiently avoid the residual angular deformities. Therefore, we recommend this soft tissue procedure as an alternative surgical technique to the double-osteotomy procedure for treating a type IV-D duplicated thumb in a very young child, whose bone is still not mature enough for holding the fixing pins.
authors.affiliation: Department of Orthopedics, Kaohsiung Medical University, Fooyin University, Kaohsiung, Taiwan. d740113@kmu.edu.tw
authors.forename: Yin-Chun
authors.initials: YC
authors.lastname: Tien
authors.forename: Tsai-Tung
authors.initials: TT
authors.lastname: Chih
authors.forename: Tai-Lung
authors.initials: TL
authors.lastname: Wang
authors.forename: Yin-Chih
authors.initials: YC
authors.lastname: Fu
authors.forename: Jian-Chih
authors.initials: JC
authors.lastname: Chen
mesh_terms: D062109:Dermatologic Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D008662:Metacarpophalangeal Joint / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery; D018482:Muscle, Skeletal / Q000601:surgery*; D019637:Orthopedic Procedures / Q000379:methods*; D017689:Polydactyly / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods*; D013933:Thumb / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome