1, Overview: Congenital polydactyly is the most prevalent congenital disease in children, and some of them also have other systemic malformations such as cardiovascular or urinary. Polydactyly is most often seen on the lateral side of the thumb and the medial side of the little finger, and other fingers are less commonly involved. The incidence of compound thumb deformity is the highest, which has a significant impact on the appearance and function of the hand, and its diagnosis and treatment are the focus of pediatric orthopedic surgeons.
2, etiology and classification: multiple fingers and toes deformity is mostly unilateral, bilateral involvement only accounts for about 10%. The exact cause of compound bunion deformity is unknown, and most of them are disseminated, suggesting that the disease is related to environmental factors, and not much related to genetic factors. For example, the mother is affected by viral infections, drugs, radiation and other environmental factors during the early 4-8 weeks of pregnancy, when the embryonic limb buds are differentiated, resulting in impaired finger differentiation and malformation. The exception is when duplication of the thumb is accompanied by three thumbs, some of which are autosomal dominant, and the Wassel typing proposed in 1969, which classifies duplication of the thumb into seven types according to the severity of the duplication, is still widely used. It is generally believed that polydactyly of the little finger is genetically determined, and it can also be divided into three types according to the severity of repetition.
3, symptoms and hazards: children are found to have extra fingers at birth, the type and severity of deformity is diverse, some are connected to normal fingers only by narrowly wrapped vascular nerve dermatome; some have nails, bone joints, tendons and vascular nerve bundles, and have certain finger activities and sensory functions, resulting in difficulties in surgical selection; some even have serious deformities such as ” The deformity is even as severe as “crab-like”, with poor finger development, small and deviated fingers, which seriously affects the appearance and function of the hand. In addition to the physiological impact, the child and parents often have psychological problems, psychological concerns will affect the child’s psychological development, affect learning and social life, and even affect the future employment, work and marriage.
4, common associated malformations: the most common is associated with cardiovascular, neurological or urinary system malformations, such as congenital heart disease, congenital cerebral dysplasia, etc. A comprehensive and systematic physical examination should be conducted for children with suspicion.
5.Diagnosis: congenital polydactyly can be clearly diagnosed according to medical history and clinical physical examination.
6.Treatment mode and indications: Seek medical treatment in a timely manner after the discovery of the disorder, and develop a reasonable and personalized treatment plan according to the condition after the doctor-patient communication.
The treatment of congenital polydactyly varies according to the degree of the disease. Simple dermatomal polydactyly can be surgically removed in the first month after birth or postponed to the third month after birth if the safety of anesthesia is considered.
For complex polydactyly with articulated skeletal connections, surgical excision can be performed at 6 months to 3 years of age.
Treatment principles for duplicated thumb deformity: If there is a difference in the development of the two thumbs, the thumb with the poorer appearance, lack of function or three phalanges will be removed. If the difference in appearance and function between the two thumbs is not significant, removal of the lateral polydactyly is often chosen.
If the polydactyly occurs at the level of the articulation, in addition to the polydactyly resection, a portion of the corresponding proximal articular cartilage surface should be resected and blocked to effectively prevent recurrence of the polydactyly, and the joint capsule and collateral ligaments should be repaired and the tendons should be transferred and sutured.
If the thumb recurrence occurs at the level of the diaphysis combined with angular deformity, the polydactyly is resected with osteotomy orthopedic correction of the force line and internal fixation of the phalanges. For poorly developed, severely deformed (crab pincer) compound thumb, a modified Bilhaut procedure is performed early (8-12 months) to replace the skeletal consolidation with soft tissue consolidation to reduce complications such as osteochondrosis and joint ankylosis, and to maximize the reconstruction of an aesthetic and functional thumb by tendon transfer and soft tissue narrowing on the convex side. Residual deformities can be further corrected by wearing orthopedic braces or by further bony surgery at the age of 3-6 years.
It is generally recommended that surgery be performed before toddlerhood, i.e., 9-12 months after birth. Otherwise, if the abnormal force area is formed on the sole of the foot after walking, the force area will be removed or changed after surgery, thus affecting the gait.
7, precautions: multi-finger, toe deformity after surgery need to keep the wound dressing clean and tidy, to prevent wound infection; strengthen the child’s nutrition, eat more high-protein food to promote wound healing, appropriate choice of drugs to inhibit scar formation, as far as possible to give the child beautiful, functional hands and feet.
8.Prevention: strengthen health care and nutrition during pregnancy, avoid respiratory infections, gastrointestinal infections, rubella, measles, chicken pox, mumps and other viral infections during pregnancy, and avoid exposure to radiation, drugs and other possible embryonic teratogenic factors.
9, expert opinion: polydactyly, toe deformity is a common congenital malformation of children, once found that the child was born with such a problem, parents need to face the correct, neither as some parents take it lightly, they for the skin flab type of polydactyly, at home on their own with thread or hair, etc. ligature, the result of finger necrosis, wound infection septicemia, and even sepsis, to further treatment difficulties; nor should not be overly nervous, trying to solve the problem immediately. Do not try to solve the problem immediately, because newborn anesthesia has certain risks, so you can wait until the child is full-term to find an experienced doctor to diagnose once, to clarify the type and severity of the deformity, in order to decide the best time to treat and treatment plan. We hope that each child will receive reasonable and timely treatment and that each child will have a perfect life.