By:

Fauziah
( C 111 06 089)
ADVISORS:
Dr. A. Sirfa
Dr. Nasrah

Department of Orthopedic and Traumatology

Faculty of Medicine Hasanuddin University
Introduction
 Polydactyly is the most common congenital digital
anomaly of the hand and foot.
 It may appear in isolation or in association with other
birth defects.
 Isolated polydactyly is often autosomal dominant
 Syndromic polydactyly is commonly autosomal
recessive
Pathophysiology

 Polydactyly should not be considered as a single

mendelian trait but rather multifactorial.
 Early theories for polydactyly concerned disorders in
the programmed cell death cycle of fetal limb
development.
 Current theories focus on mutations in specific genetic
locations that cause limb development to go awry.
 Mutations in the HOXD13 gene . As limb growth in
utero progresses along a preset time line, elongation of
the limb, development of soft tissue, and
differentiation of digits progresses.
Classification
Preaxial polydactyly (thumb duplication)
 Preaxial (involving thumb or great toe, Wassel
classification ):
 I: Bifid distal phalanx
 II: Duplicated distal phalanx
 III: Bifid proximal phalanx
 IV: Duplicated proximal phalanx  most common
 V: Bifid metacarpal
 VI: Duplicated metacarpal
 VII:Triphalangia
Preoperative photograph of a 1-year- Preaxial polydactyly of the
old child with preaxial polydactyly and right hand.
significant varus of the duplicated toe.
Classification
 Central
Postaxial (involving small finger or toe):
 Type A: Complete duplication with bony attachment to an
adjacent digit
 Type B: Rudimentary, incomplete duplication of the
phalanges
Epidemiology
 Preaxial form is more common in whites than in other
races and most cases are sporadic
 No significant difference in reported occurrence
between the genders
 Postaxial hand polydactyly is a common isolated
disorder in African black and African American
children, and autosomal dominant transmission is
suspected.
 Central polydactyly is uncommon compared with
border polydactyly.
Clinical Manifestation
Signs and Symptoms
 Duplicated fingers or toes
Physical Exam
 Check for active and passive movement at each joint.
 Assess the stability of the digit.
 Look for an angular deformity at each joint.
 Look at the skin coverage and webbing.
 All these factors are important in determining surgical
treatment.
Imaging
Plain film radiography is indicated

Left foot with postaxial Left hand with mid-ray duplicatio

polydactyly of 5th ray
TREATMENT
 Preaxial polydactyly  The best possible thumb is
reconstructed from the available anatomic structures.
When duplicate thumbs of equal size are present, the
radial thumb is removed. Reconstruction of all
componens is usually performed in one stage.
 Axial  The tendons, nerves, and vessels may be
shared to the point that only one finger from three
skeletons may be obtainable.
TREATMENT
Postaxial polydactyly
- Type A  Requires operative ablation with transfer of
any important parts to the adjacent finger.
 Type B postaxial polydactyly  in newborn tie off the
digit if it has no underlying skeletal connection. In the
presence of a skeletal connection, the extra digit•
should be electively removed surgically after 6 months
of age.
Complications
 Small skin tag at the site of the polydactyly removal
(rare)
 Angular deformity possible after complex polydactyly
reconstructions; possible deformity after thumb
reconstruction
THANK YOU