The Journal of Bone and Joint Surgery, Vol 65, Issue 5 584-598, Copyright © 1983 by Journal of Bone and Joint Surgery, Inc
Duplication of the thumb. A retrospective review of two hundred and thirty-seven cases
K Tada, K Yonenobu, Y Tsuyuguchi, H Kawai and T Egawa
Over a twenty-two-year period, 237 patients (261 hands) with duplication of
the thumb were seen in the Hand Clinic of Osaka University Hospital. Two
groups were identified: Group A, 141 patients without previous surgical
treatment, and Group B, ninety-six patients with residual deformity despite
previous surgical treatment. Using a modification of Wassel's
classification, seven types of deformity were defined. In Group A these
types were identified on the basis of the observed duplications of bone and
soft tissue. In all but ten of the Group-B patients preoperative
roentgenograms were not available and the type of deformity had to be
deduced from the residual duplicated bone, the surgical scar, and the
residual deformity. Surgery, performed on 193 hands (125 in Group A and
sixty-eight in Group B), attempted to restore normal anatomical
relationships. The results could be evaluated in 130 hands according to the
range of motion, joint stability, and alignment of the remaining thumb
after an average follow-up of 35.0 months. According to the rating system
described, the results were rated as good in 75.5 per cent, fair in 20.2
per cent, and poor in 4.3 per cent of the ninety-four hands in Group-A
patients who were followed. In the thirty-six hands of Group-B patients who
could be followed, the preoperative and postoperative scores were compared.
Thirteen were not improved while the other twenty-three, sixteen improved
from fair to good and seven improved from poor to fair, to give a good
result in 63.9 per cent of the Group-B patients who were followed. The
results in these 130 Group-A and B hands emphasize the importance of
providing muscle balance and, in young patients, of performing an
arthroplasty of the interphalangeal or metacarpophalangeal joint when
indicated, although arthrodesis was indicated as a salvage operation for
Group-B patients who were more than fifteen years old.
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