Treatment of Bilateral Preaxial Polydactyly with Second Digit Ray Amputation and
Medial Cuneiform Open Wedge Osteotomy
Tolgay Satana and Fulya Doktorlar*
Clinic of Orthopaedic, Turkey
*Corresponding Author: Fulya Doktorlar, Clinic of Orthopaedic, Turkey.
March 28, 2022; Published: July 26, 2022
Introduction: Congenital polydactyly is an autosomal dominant deformity inherited by one generation from anotherd the most commonly cited classification scheme by Wessel which, does not include this particular anomaly (tarsal coalition). In addition, there has been only reference to this type of polydactyly with coalition in hand in the literature. We could classify our case in main type VI but propose subdivision A- not tarsal coalition B-With tarsal coalition.
Medial finger might be halluxs even if it is hypoplastic, may disrupt the plantigrade structure of the foot and cause ulcers in the plantar region caused by pressure changes. Tarsal coalitions are frequently seen in preaxial.
Material and Method: The patient was admitted to the outpatient clinic with a complaint of inability to put on shoes. His both feet had six toes each. In his radiological examination, extra second digit sprouting from preaxial, arising from medial cuneiform and hallux varus deformity were found in medial. Duplicated thumbs are almost similar, medial thumb was smaller or hipoplastic. Medial finger decided to as Hallux after radiologic and functional investigation.
The treatment is planed that second digit ray amputation and residual hallux varus deformation realigned to normal anatomic relationship with medial cuneiform open wedge osteotomy while the 1st intermatatarsal Linsfranc joint relation was restored. Supero-lateral part of medial cuneiform was continue second digit metatarsal bone than ray amputation extended to medial cuneiofrom. Open wedge osteotomy performed on medial cuneiform and first ray realigned, reduced to angel and linsfranc level metatarsal widening reduced. Moreover, soft tissue procedure was performed (transfer of the adductor and flexor attached tendon to the distal of the 1st metatarsus and with lateral capsuloraphy. (Plantar facia and protected foot incised only dorsally and plantar ragion as an intact. Foot incised only dorsally was fixed with one cortical screw and short leg was fixed in plaster for six weeks. At week six, plaster was removed.
Conclusion: Treatment of congenital deformities like polydactyly at an early age may not always provide positive outcomes. A better clinical-radiological assessment should be made for such deformities. Moreover, They should be treated with a very good preoperative planning before reconstruction. It may be useful to wait for the adolescence period or completion of bone development in these cases like the one in our study.
In this study we describe a method of to make right decision to choose right finger amputation in order foot biomechanics, anatomical relationship of joints. The choice of amputation order in pre- axial polydactyly, as well as the advantages of ray amputation over pre-axial or post-axial ray amputation are discussed. The presence of tarsal coalition could be affecting this decision indicates the presence of a new deformity not found in the existing classifications, and a new classification item has been proposed.
Keywords: Polydactyly; Ray Amputation Foot; Tarsal Coalition
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