An Unusual Pollicization Procedure

Radial polydactlyly (extra thumb) is a relatively common problem for those of us who treat kids with birth differences/ anomalies of the upper extremity.  Please see the following link for previous posts on the topic LINK.  Sometimes these can be treated by a "straightforward" procedure with excision of the extra thumb and stabilization of the primary thumb.  Other times a more complex surgery is required which can include a similar procedure + cutting and realigning the bones.  More rarely, other procedures are required.  This is one such case.  

This patient has an uncommon type of extra thumb.  There are really two issues.  First, there are really two extra thumbs.  And second, there are five fingers (including the most radial one being in the plane of the fingers).  

Unusual radial polydactyly (extra thumb)

Another view of Unusual radial polydactyly (extra thumb)

X-ray showing the extra thumb (or 2 thumbs) with 5 fingers.

Initially, we made a decision with the family to remove the extra thumbs.  Structurally, there is no 'great' thumb and creating a useful thumb would be difficulty if not impossible.  Instead, we focused on removing these thumbs and then better understanding if a second surgery would be necessary.  There was a possibility that the patient would be sufficiently function with a five finger hand.

Here is the hand after the first surgery.

View after surgery.  Now a 5- finger hand

5- finger hand after surgery 

Ultimately, we decided that additional surgery made sense for function primarily but also appearance.  This is a triphalangeal thumb that is largely in the plane of the fingers making pinch a challenge.  There are different approaches but we elected to perform the pollicization procedure and are pleased with the early results.

After pollicization surgery, 4 week visit

Another view after pollicization surgery

Another view after pollicization surgery

I believe that his new thumb to function really well.  It takes time for kids to start using the new thumb although each child is different- some start using it well at 3-4 weeks and for others, it can take 6 or more months.  Therapy is helpful, sometimes with simple actions like taping the thumb in an easy, functional position and other times with more deliberate functional assistance.

Thanks for reading,

Charles A. Goldfarb, MD              

My Bio at Washington University     

email: congenitalhand@wustl.edu

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