EC Paediatrics

Objective: To evaluate the clinical and functional outcomes of surgical treatment of type IV bifid thumb in children.

Materials and Methods: A retrospective study was conducted from January 1995 to December 2022. Clinical and radiographic evaluations were performed according to the Wassel classification. Patients were operated on by transferring a segment of the epiphyseal cartilage of the proximal phalanx with insertion of the abductor pollicis brevis tendon into the radial aspect of the proximal phalanx of the ulnar finger. The patients were evaluated both functionally and cosmetically according to the modified Tada scoring system of Tien.

Results: This study included 164 patients (102 women, 62 men). The MPJ joint was stable in 170 thumbs, 15 thumbs had radial instability, 10 thumbs had collateral ligament augmentation, and 27 thumbs had collateral ligament augmentation. The mean follow-up period was 10 years 2 months (range: 4 years 5 months to 21 years 6 months). Overall, we achieved good results in 140 thumbs (75.7%), fair results in 36 thumbs (19.4%), and poor results in nine thumbs (4.9%).

Conclusion: We recommend the use of a proximal phalanx fragment with a short thumb abductor tendon attached to the radial aspect of the proximal phalanx of the ulnar finger and to restore the anatomical attachment of the abductor pollicis brevis muscle. This technique is simple, safe, and effective for thumb abduction in the treatment of type IV bifid thumb in children.

 Keywords: Thumb; Congenital Diplopia; Polydactyly; Thumb Duplication; Thumb Abduction

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