I: Polydactyly: the most common congenital deformity of the hands and feet
1.What is polydactyly?
Multifinger (toe) deformity is a superfluous finger (toe) or twin finger (toe) deformity other than the normal finger (toe), which can be a finger (toe) finger (toe) bone superfluous, or simply soft tissue component superfluous, or accompanied by metacarpal (metatarsal) bone superfluous.
Simply put, there are more than 5 fingers or toes on one hand or one foot, which is the most common congenital deformity of the hand (foot), and can coexist with parallel fingers (toes).
2.What are the risks? Does it have any effect on other organs?
Polydactyly mainly affects the shape and function of the hands and feet, but has no effect on other organs.
Most polydactyly does not affect the function of the hands (feet) much, but mainly the appearance is different and not good for wearing shoes.
In a few specific types, the function of the thumb can be severely affected.
In rare cases, polydactyly may be one of the manifestations of certain syndromes or chromosomal anomalies, and may be combined with malformations of other organs.
3.What are the causative factors of polydactyly?
The causative factors of polydactyly are not clear.
Most polydactyly (toe) is disseminated, simple, and related to genetic and environmental factors.
In a few cases, it is familial and is associated with genetic factors.
There are patients with syndromes of polydactyly (toe), which are related to genetic factors.
4.The first baby is polydactyly, will the second baby also be polydactyly?
Simple polydactyly is usually disseminated, unless it is familial. Therefore, if there is no family history of polydactyly, the probability of having a second child with polydactyly is low.
5. Can the offspring of patients with polydactyly also get the disease?
Solitary polydactyly is usually disseminated, unless it is familial. Therefore, if there is no family history, the probability of offspring developing polydactyly is low.
If a non-familial patient develops a genetic variation that can be passed on to offspring, then familial polydactyly occurs.
6.Does polydactyly need to be treated? What are the effects of not treating it?
Polydactyly mainly affects the appearance and function of the hands and feet. Evolutionarily speaking, some polydactyly may be beneficial.
A few specific types, which severely affect the function of the thumb, require treatment to improve the function of the hand.
Most types of polydactyly (toe), although function may be minimally affected, require surgical treatment in order to integrate into society and restore as normal an appearance and function as possible.
The effects of not treating the deformity are primarily cosmetic and functional. Abnormalities in appearance can have a significant psychological impact on the affected child. Sometimes, parents feel self-conscious as a result. The main functional impact is on fine motor movements, with some patients experiencing compensations, and life is usually not significantly limited, but sometimes limited in terms of occupation.
Second: how to do the post-operative orthopedic deformity of polydactyly?
1. Can polydactyly excision and correction be completed in one operation? Is it necessary to perform polydactyly excision first and then correct it in the second surgery?
The excision and correction of polydactyly can usually be completed in one operation. It is usually not necessary to remove the polydactyly first and then perform a second orthopedic surgery.
In rare cases, such as when a child has scoliosis of the interphalangeal joint, the distal phalanges are wedge-shaped epiphyses. The epiphyseal osteotomy may damage the epiphyseal line (growth plate), so a phase I surgery can be used to remove the polydactyly, the interphalangeal joint lateral flexion manipulation correction + plaster fixation + brace maintenance, if the effect is not good, and then phase II surgery to correct.
2.How to correct the deformity of polydactyly after excision? Can the deformed finger be corrected by splinting?
The residual deformity after the removal of polydactyly is usually due to the initial surgery only to remove the polydactyly without correcting the deformity of the preserved finger, or only to correct part of the deformity of the preserved finger, and the deformity recurs after the surgery. This usually requires a second surgery to correct the deformity.
If the factors causing the deformity are not removed, it is difficult to correct the deformed fingers with splints alone.
3.Why is it possible to have deformity even after the surgery of polydactyly (toe)? What deformities may occur?
There are four main reasons for deformities to occur after polydactyly surgery.
① The cause of the deformity of the preserved finger (toe) was not properly treated, such as the scoliosis of the interphalangeal joint of the crab finger.
② The bones were not properly treated, the resected finger epiphysis was not removed or completely removed and continued to grow after surgery, or the distal roof-like articular surface of the metacarpal bone was not treated and locally protruded, and the preserved finger was deflected to the ulnar side.
③ The lateral collateral ligaments and joint capsule on the side of the excised finger (toe) were not repaired or loosened, resulting in deflection of the preserved finger.
④ Lack of incision design, or postoperative infection and scar contracture, resulting in lateral curvature or lateral flexion.
4.When can I have a second surgery if the finger is still deformed after surgical excision?
If the finger is still deformed after surgery, a second surgery can usually be decided after 3 months depending on the specific situation.
5.Why is it necessary to fix the finger externally with a plaster cast even though it was fixed internally with a kyphosis pin during surgery?
After waking up from anesthesia, the child’s hands and feet start to move and are very strong when they are irritable and crying. The Kirschner pin is round and smooth, with the advantage that there is little tissue damage and thus it can pass through the epiphyseal plate, but the disadvantage is that it is poorly stable and easily loosened. The Kirschner pins used in infants and children are very thin, 0.6 mm, 0.8 mm and 1.0 mm in diameter, and can loosen or even break when fixed with Kirschner pins alone, so an auxiliary external fixation support, such as a cast, is needed to protect the fixation effect of the Kirschner pins.
In addition, the external use of plaster after fixation, help to protect the wound to avoid damage and pain.
6.What is the effect on the movement of the fingers (toes) when fixation is performed with a Kirschner needle? What do I need to pay attention to?
When fixing the Kirschner pin, it is usually protected by a cast, so the movement of the fingers (toes) is limited. Usually, the Kristen pin is left in place for 3-4 weeks, and longer for those buried under the skin. After removal of the Kirschner needle and removal of the cast protection, the infant’s fingers (toes) can quickly resume movement.
When the Kirschner needle is fixed, the end of the needle is exposed, and care should be taken to avoid infection of the needle tract, which may cause local soft tissue infection or even osteomyelitis. If there is a needle tract infection, it should be detected in time. Early treatment, infection can be controlled.
7.When can I pull out the klebsiar needle for children who use klebsiar needle for internal fixation to correct finger deformity?
For polydactyly (toe) surgery, the main purpose of using Kristen pins is 2.
① To immobilize the joint and limit movement to facilitate the healing of soft tissues such as the reconstructed joint capsule, collateral ligaments and tendons. The healing time for these soft tissues is 3 weeks, so usually after 3 weeks, the kerf pins can be removed.
② Fix the osteotomy end to facilitate bone healing and avoid deformed healing, delayed healing or non-healing. The bones of infants and young children have good healing ability and usually heal in 3-4 weeks, which can be judged by X-rays. Usually the kyphoscope pin is removed after 3-4 weeks of skeletal healing. If the bones are not healing well, removal of the Kirschner needle can be delayed, usually no more than 6 weeks, to avoid infection of the needle tract. Occasionally, the pin may be removed and immobilized with an external fixation device, such as a cast.
If, during the fixation process, a needle tract infection develops that cannot be controlled, the Kirschner pin needs to be removed earlier. In this case, the need to use external fixation support, such as plaster.
8.When can the child start to move his fingers (toes) after the stitches are removed after surgery for polydactyly? Will the flexibility of the fingers (toes) be worse than that of ordinary people?
If you use fast-absorbing sutures, you do not need to remove the sutures after surgery; after 2 weeks, the part of the sutures in the body has dissolved and absorbed, and the scabs can be removed with gentle flicking. With normal absorbable sutures, the sutures can also be dissolved and loosened after about 1 month.
If non-absorbable or normal absorbable thread is used, the skin sutures are usually removed 2 weeks after polydactyly surgery, and whether the child can start moving around varies from case to case. If the deformity is a soft tissue deformity, or if there is no reconstruction of bones, joint capsule, collateral ligaments, tendons, etc., the sutures can be removed and the child can begin to move. If reconstruction of bones, joint capsule, collateral ligaments, tendons, etc. was performed during the surgery, you may not be able to start moving after the stitches are removed, and you will have to wait for the above-mentioned tissues to heal for about 3-4 weeks before you can start moving.
The flexibility of the fingers (toes) depends mainly on the severity of the polydactyly and the effectiveness of the surgical orthopedics. If the preserved fingers are well developed, the child’s fingers (toes) will be as flexible or more flexible than the average person’s through careful and standardized surgery. If the preserved fingers are not well developed and have deformities, the child’s fingers (toes) may be less flexible if the surgery is not standardized or if post-operative complications arise.
9.Will the deformity of the fingers occur again after correction?
There are many factors that influence whether the fingers will be deformed again after correction.
① The cause of the retained finger (toe) deformity is not properly handled, such as the scoliosis of the interphalangeal joint of the crab finger.
②Improper skeletal treatment, failure to remove or complete removal of the multifidus epiphysis, continued growth after surgery, or failure to treat the distal roof-like articular surface of the metacarpal bone, local protrusion, and deflection of the preserved finger to the ulnar side.
③The lateral collateral ligament and joint capsule on the side of the excised finger (toe) were not repaired or loosened, resulting in the deflection of the preserved finger.
(iv) Lack of incision design, or postoperative infection and scar contracture, resulting in lateral curvature or lateral flexion.