Uncommon variant of pre-axial polydactyly and its surgical management: a case report

Alejandro Quiroga-Garza, Kouatzin Aguilar-Morales, Fabian Contreras-Gonzalez, Rodrigo Enrique Elizondo-Omaña, Santos Guzmán-López


We report the case of an adult patient with thumb polydactyly. The pre-axial thumb is in a non-functional flexion, while the 1st thumb maintains normal function. X-ray of the hand reveals a “T” shape 1st metacarpus bone, giving origin to the pre-axial polydactyly. Although this variation is not specifically described in the Wassel classification, we classify it as a type V of the Rotterdam´s classification. Patient is managed surgically, using a dynamic incision for polydactyly amputation. The polydactyly thumb has no identifiable muscle/tendon structures responsible of this unique deformation. The procedure results in good post-operative evolution with aesthetic scaring, and integral thumb function.


Polydactyly, Pre-axial, Duplicated thumb, Anatomy, Radiology

Full Text:



de Oliveira R, Ribak S, Irisarri C. Polidactilias del pulgar. Tratamiento quirúrgico. Rev Iberoam Cirugía la Mano. 2016;44(02):118-30.

Pacheco YD, Lorca-García C, Berenguer B, De Tomás E. Preaxial polydactyly of the hand: 15 years of experience. Cir Pediatr. 2015;28(4):188-92.

Umair M, Ahmad F, Bilal M, Ahmad W, Alfadhel M. Clinical Genetics of Polydactyly: An Updated Review. Front Genet. 2018: 1-9.

Van Wyhe RD, Trost JG, Koshy JC, Pederson WC. The duplicated thumb: A review. Semin Plast Surg. 2016;30(4):181-7.

Chung MS, Baek GH, Gong HS, Lee HJ, Kim J, Rhee SH. Radial polydactyly: Proposal for a new classification system based on the 159 duplicated thumbs. J Pediatr Orthop. 2013;33(2):190-6.

Dijkman RR, Van Nieuwenhoven CA, Selles RW, Habenicht R, Hovius SER. A multicenter comparative study of two classification systems for radial polydactyly. Plast Reconstr Surg. 2014;134(5):991-1001.

Wassel H. The results of surgery for polydactyly of the thumb. A review. Clin Orthop Relat Res. 1969;64:175-93.

Zuidam JM, Selles RW, Ananta M, Runia J, Hovius SER. A Classification System of Radial Polydactyly: Inclusion of Triphalangeal Thumb and Triplication. J Hand Surg Am. 2008;33(3):373-7.

Netscher DT, Baumholtz MA. Treatment of congenital upper extremity problems. Plast Reconstr Surg. 2007;119(5):101e-129e.

Abu-Amero KK, Kondkar AA, Hellani AM, Bosley TM, Khan AO. Chromosome 6 microdeletion in a patient with syndromic congenital cranial dysinnervation disorder. Neurosciences. 2016;21(1):72-4.

Jia ZW, Bai DM, Long JT, Guo XS, Tian Y, Zhang LQ, et al. Optimal surgical timing and treatment of thumb duplication in children. Zhonghua Zheng Xing Wai Ke Za Zhi. 2013;29.5:336-40.