The Journal of Bone and Joint Surgery (American). 2008;90:74-86.
doi:10.2106/JBJS.G.01104
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Modified Bilhaut-Cloquet Procedure for Wassel Type-II and III Polydactyly of the Thumb

Surgical Technique

Goo Hyun Baek, MD1, Hyun Sik Gong, MD1, Moon Sang Chung, MD1, Joo Han Oh, MD1, Young Ho Lee, MD1 and Sang Ki Lee, MD1

1 Department of Orthopedic Surgery, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, South Korea. E-mail address for G.H. Baek: ghbaek{at}snu.ac.kr

Investigation performed at the Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea

The original scientific article in which the surgical technique was presented was published in JBJS Vol. 89-A, pp. 534-41, March 2007

DISCLOSURE: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

The line drawings in this article are the work of Jennifer Fairman (jfairman{at}fairmanstudios.com).

BACKGROUND: The Bilhaut-Cloquet operation is a combined surgical procedure for the treatment of a symmetric bifid thumb. Although this procedure can obtain a normal-sized thumb with a stable interphalangeal joint, it has limitations, such as the technical difficulty of combining all segments of a duplicated thumb, possible later physeal growth arrest, joint stiffness, and nail plate deformity. We reviewed the results of our modification of this procedure for the treatment of Wassel type-II and III polydactyly of the thumb.

METHODS: Seven patients, two with type-II and five with type-III polydactyly of the thumb, underwent this modified Bilhaut-Cloquet procedure and were followed for an average of fifty-two months. Cosmetic and functional assessments were made.

RESULTS: All patients and parents were satisfied with the cosmetic and functional results. Compared with the preoperative motion, the postoperative range of motion of the interphalangeal joint was preserved in thumbs with type-III deformity and was increased in those with type-II deformity. No nail deformity or growth arrest occurred, and remodeling and hypertrophy of the distal phalanx occurred with time.

CONCLUSIONS: Our modification of the Bilhaut-Cloquet procedure for the treatment of type-II and III thumb polydactyly is effective in preserving interphalangeal joint motion, minimizing nail deformity, and preventing growth arrest.

LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

ORIGINAL ABSTRACT CITATION: "Modified Bilhaut-Cloquet Procedure for Wassel Type-II and III Polydactyly of the Thumb" (2007;89:534-41).


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