title: Thumbs up! A novel use of the acutrak screw fixation system for the management of triphalangeal thumb.
abstract: OBJECTIVE
  The management of triphalangism provides the age-old problem of marrying maximal functional benefit with acceptable cosmesis. The objective was to discuss the rare abnormality of bilateral triphalangeal thumb, the surgical existing surgical approaches, and to present a case in a pediatric patient who had a good result with a relatively simple and straightforward method of surgically managing the deformity.
  
  
  METHODS
  We present the case of a 16-year-old girl with isolated bilateral triphalangism of the thumbs. Her primary concern was the cosmetic deformity conferred by a delta middle phalanx, resulting in ulnar deviation of the thumb, in addition to the consequent reduced function of the thumb. Our approach to this problem was to perform a wedge osteotomy of the delta phalanx and a shave osteotomy of the articular surface of the distal phalanx, before using the Acutrak screw system to perform an arthrodesis. We present the first reported case in the literature.
  
  
  RESULTS
  This resulted in a near-anatomical correction of the deformity and consequent improvement of the cosmesis with a short anesthetic time, quick postoperative recovery, and very satisfied patient.
  
  
  CONCLUSIONS
  We acknowledge that superior techniques exist; however, we also recognize that every case is unique and therefore, in this case the use of the Acutrak screw fixation system was the best option. It offers a noncomplex method of managing a complex condition. Short, safe, and effective surgery is always the best practice in managing pediatric patients.
authors.affiliation: Odstock Centre for Burns and Plastic & Reconstructive Surgery, Salisbury District Hospital, Salisbury, Wiltshire SP2 8BJ, United Kingdom. zeeshan.ahmad@doctors.org.uk
authors.forename: Z
authors.initials: Z
authors.lastname: Ahmad
authors.forename: C N
authors.initials: CN
authors.lastname: McGuiness