1021
LETTERS TO THE EDITOR
2. Zancolli E. Structural and Dynamic Bases of Hand Surgery. 2nd ed. Philadelphia, PA: Lippincott; 1979:263e283. 3. Elson RA. Rupture of the central slip of the extensor hood of the finger: a test for early diagnosis. J Bone Joint Surg Br. 1986;68(2): 229e231.
4. Harris C Jr, Rutledge GL Jr. The functional anatomy of the extensor mechanism of the finger. J Bone Joint Surg Am. 1972;54(4):713e726. 5. Schreuders TAR, Soeters JNM, Hovius SER, Stam HJ. A modification of Elson’s test for the diagnosis of an acute extensor central slip injury. Br J Hand Ther. 2006;11:112e113.
Wassel Type III Polydactyly With Symphalangism: A Rare Entity To the Editor: Polydactyly is the most common hand anomaly. It is common in white individuals, and it is also documented in high proportions in Native American and Asian populations. It was classified into 7 types by Wassel.1 The anomaly described in the current report does not fit into any type in the Wassel classification system. A 25-year-old, healthy man of Turkish ethnicity presented to our outpatient clinic with an extra finger on the right hand. The patient had no relevant family history. x-ray studies demonstrated a Wassel type IIIelike duplication with symphalangism of the interphalangeal joint of the radial thumb (Fig. 1). We performed a BilhauteCloquet reconstruction with wedge excision of the nail and skin and osteotomy to radial ray to match the size of the contralateral, normal thumb. A part of resected radial ray was used as bone graft to fill the distal phalanx. Also, we constructed a radial collateral ligament. To preserve the thumb size and enclose the exposed bone, the previously elevated proximally based flap with periosteum, overlying skin, and nailbed were sutured in the midline of reconstructed distal phalanx (Fig. 1). Eight well-documented cases of thumb duplication with symphalangism have been reported in adults.2e4 Takagi et al5 reported several pediatric cases of preaxial polydactyly with cartilaginous symphalangism. Most preaxial polydactyly cases were from Asia, specifically from Saudi Arabia and Japan, which may indicate a genetic background; in every one of them, symphalangism was observed in the radial ray. In The Netherlands, an extremely high rate of thumb triplication is seen, which is attributed to genetic pooling of ZRS mutations.
FIGURE 1: Preoperative x-ray of the thumb.
Department of Plastic and Reconstructive Surgery Haydarpasa Numune Training and Research Hospital Istanbul, Turkey http://dx.doi.org/10.1016/j.jhsa.2014.02.028 REFERENCES 1. Wassel HD. The results of surgery for polydactyly of the thumb: a review. Clin Orthop Relat Res. 1969;(64):175e193. 2. Al-Aithan B, Al-Blaihed L, Mahmoud S, et al. Thumb polydactyly with symphalangism. J Hand Surg Eur Vol. 2005;30(4): 346e349. 3. Boutros S, Weinfeld AB, Stafford J, et al. An unusual case of polydactyly of the thumb. Ann Plast Surg. 1998;41(4):434e435. 4. Al-Qattan MM. The distribution of the types of thumb polydactyly in a Middle Eastern population: a study of 228 hands. J Hand Surg Eur Vol. 2010;35(3):182e187. 5. Takagi R, Kawabata H, Matsui Y. Thumb polydactyly with symphalangism in young children. J Hand Surg Eur Vol. 2009;34(6):800e804.
N. Sinem Ciloglu, MD Alpay Duran, MD Hasan Buyukdogan, MD
J Hand Surg Am.
r
Vol. 39, May 2014
LETTERS TO THE EDITOR
2. Zancolli E. Structural and Dynamic Bases of Hand Surgery. 2nd ed. Philadelphia, PA: Lippincott; 1979:263e283. 3. Elson RA. Rupture of the central slip of the extensor hood of the finger: a test for early diagnosis. J Bone Joint Surg Br. 1986;68(2): 229e231.
4. Harris C Jr, Rutledge GL Jr. The functional anatomy of the extensor mechanism of the finger. J Bone Joint Surg Am. 1972;54(4):713e726. 5. Schreuders TAR, Soeters JNM, Hovius SER, Stam HJ. A modification of Elson’s test for the diagnosis of an acute extensor central slip injury. Br J Hand Ther. 2006;11:112e113.
Wassel Type III Polydactyly With Symphalangism: A Rare Entity To the Editor: Polydactyly is the most common hand anomaly. It is common in white individuals, and it is also documented in high proportions in Native American and Asian populations. It was classified into 7 types by Wassel.1 The anomaly described in the current report does not fit into any type in the Wassel classification system. A 25-year-old, healthy man of Turkish ethnicity presented to our outpatient clinic with an extra finger on the right hand. The patient had no relevant family history. x-ray studies demonstrated a Wassel type IIIelike duplication with symphalangism of the interphalangeal joint of the radial thumb (Fig. 1). We performed a BilhauteCloquet reconstruction with wedge excision of the nail and skin and osteotomy to radial ray to match the size of the contralateral, normal thumb. A part of resected radial ray was used as bone graft to fill the distal phalanx. Also, we constructed a radial collateral ligament. To preserve the thumb size and enclose the exposed bone, the previously elevated proximally based flap with periosteum, overlying skin, and nailbed were sutured in the midline of reconstructed distal phalanx (Fig. 1). Eight well-documented cases of thumb duplication with symphalangism have been reported in adults.2e4 Takagi et al5 reported several pediatric cases of preaxial polydactyly with cartilaginous symphalangism. Most preaxial polydactyly cases were from Asia, specifically from Saudi Arabia and Japan, which may indicate a genetic background; in every one of them, symphalangism was observed in the radial ray. In The Netherlands, an extremely high rate of thumb triplication is seen, which is attributed to genetic pooling of ZRS mutations.
FIGURE 1: Preoperative x-ray of the thumb.
Department of Plastic and Reconstructive Surgery Haydarpasa Numune Training and Research Hospital Istanbul, Turkey http://dx.doi.org/10.1016/j.jhsa.2014.02.028 REFERENCES 1. Wassel HD. The results of surgery for polydactyly of the thumb: a review. Clin Orthop Relat Res. 1969;(64):175e193. 2. Al-Aithan B, Al-Blaihed L, Mahmoud S, et al. Thumb polydactyly with symphalangism. J Hand Surg Eur Vol. 2005;30(4): 346e349. 3. Boutros S, Weinfeld AB, Stafford J, et al. An unusual case of polydactyly of the thumb. Ann Plast Surg. 1998;41(4):434e435. 4. Al-Qattan MM. The distribution of the types of thumb polydactyly in a Middle Eastern population: a study of 228 hands. J Hand Surg Eur Vol. 2010;35(3):182e187. 5. Takagi R, Kawabata H, Matsui Y. Thumb polydactyly with symphalangism in young children. J Hand Surg Eur Vol. 2009;34(6):800e804.
N. Sinem Ciloglu, MD Alpay Duran, MD Hasan Buyukdogan, MD
J Hand Surg Am.
r
Vol. 39, May 2014
