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• A large proportion
is isolated
• May be associated
with
Post-axial
polydactyly
Post-axial polydactyly
• Can be bilateral
• Prevalence in African
Americans estimated to be 1
in 143 live births (and 1 in
1339 live births in white)
12 year-old with bilateral polydactyly and
left long-ring finger syndactyly
Post-axial polydactyly
• Postaxial polydactyly in a
white person is often
indicative of an underlying
syndrome (e.g., chondro-
ectodermal dysplasia or Ellis-
van Creveld syndrome)
Classification of post-axial
polydactyly
• Rare
• Isolation or part of a
syndrome (e.g, Grebes’
chondro-dysplasia)
Central polydactyly
• May be hidden within a
concomitant syndactyly
(i.e., synpolydactyly)
• Fully formed digit and normal function does not require removal
• Classification according to
Wassel, type IV representing
almost 50% of cases (type II
15% second most common)
This classification had some
limitations
• Tri-phalangism can involve
the radial, the ulnar or both
split thumb
• Suggested by abduction of
affected digit + absence of IP
joint crease
• Holt-Oram syndrome
• Fanconi’s anemia
• Blackfan-Diamond anemia
• Imperforate anus
• Cleft palate
• Tibial defects
Pre-op workup
• Nail widening ?
• MCP stability ?
• Intrinsic reconstruction.
• Same principles
Larsen M, Nicolai JP. Long-term follow-up of surgical treatment for thumb duplication. J Hand
Surg [Br] 2005;30(3):276–81.