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Polydactyly

Polydactyly. Jillian Peterson UNSOM Family Medicine. Definition of Polydactyly. Presence of one of more supernumerary digits or parts of digits Hand and/or foot. Types of Polydactyly. Postaxial Occurring on ulnar border of hand Fibular aspect of foot aka “little finger/toe side”

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Polydactyly

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  1. Polydactyly Jillian Peterson UNSOM Family Medicine

  2. Definition of Polydactyly • Presence of one of more supernumerary digits or parts of digits • Hand and/or foot

  3. Types of Polydactyly • Postaxial • Occurring on ulnar border of hand • Fibular aspect of foot • aka “little finger/toe side” • Most common • Preaxial • Occurring on radial border of hand • Tibial aspect of foot • aka “thumb/big toe side” • Central • Occurring in between fingers/toes • Least common

  4. Types of Polydactyly • Can be unilateral or bilateral • Can range from: • Skin tag • Skin + floating bone • Completely duplicated finger

  5. Hand vs. Foot Polydactyly • Considered different traits • Hand more frequent (75%) vs. foot (15%) • Hand less often found w/ other anomalies • Having both hand & foot polydactyly is rare • Highest rate of associated anomalies

  6. Inheritance • 1 in 1000 – 3000 births • Depends of type of polydactyly • No consensus on incidence • Can be isolated malformation or part of genetic syndrome

  7. Non-syndromic polydactyly • Non-syndromic polydactyly • Post-axial polydactyly can be autosomal dominant inheritance • Strong family history • Incomplete penetration

  8. Syndromic Polydactyly • 15% of children born w/ polydactyly have other associated congenital anomalies

  9. Skeletal Dysplasias Associated w/ Polydactyly

  10. Syndromes Associated with Polydactyly Syndromes Associated with Polydactyly

  11. Preaxial Polydactyly • Radial border of hand / Tibial side of foot • More common in Caucasians • Typically unilateral • Often sporadic isolated defect

  12. Preaxial Polydactyly • Seven groups based on level of bifurcation • Wassel classification

  13. Postaxial Polydactyly • Ulnar border of hand / Fibular side of foot • Often bilateral • More common in AA than other ethnic groups • Isolated presentation • When present in Caucasians often associated w/ syndromic conditions

  14. Central Polydactyly • Least common type of polydactyly • Ring finger most common > middle > index • Rarely occurs in isolation • Typically occurs w/ complex syndactyly

  15. Workup of Polydactyly • Prenatal US • Fetal finger buds can be seen on TVU reliably by 13wks • If diagnosed on prenatal US: • Thorough US evaluation of heart, limbs, kidneys, nervous system to identify potential associated syndrome Post axial polydactyly

  16. Workup of Polydactyly • X-ray • Used to determine if digit has bony component • Assists in surgical planning, if needed

  17. Treatment • Treatment depends on degree • Skin tag, skin + floating bone • Suture ligation in nursery • Complete finger duplication • Formal amputation and reconstruction • Usually performed around 1yr of age

  18. References • Campbells’ Operative Orthopaedics • Guo B, Lee S, Paksima N (2013) Polydactyly. Bulletin of the Hospital for Joint Diseases. 71 (1): 17-23. • Nelson’s textbook of Pediatrics • UpToDate • Kozin SH (2003) Upper-extremity congenital anomalies. J Bone Joint Surg Am 85:1564-76 • Castilla EE, Lugarihno da Fonseca R, da Graca Dutra M, Paz JE (1997) Hand and foot postaxial polydactyly: two different traits. Am J Med Genet 73:48-54 [Medline]

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