Polydactyly means extra digits – in the hand or foot. Broadly speaking, there are three types of polydactyly
- Postaxial or Ulnar
- Central
- Preaxial or Radial
Postaxial or Ulnar
It is the most common type of polydactyly where the extra digit is on the ulnar side of the hand [side of the little finger].
Most commonly, the extra finger is rudimentary, consisting of an end phalanx with a nail, and connected to the hand with a small skin pedicle.
In case of a fully developed extra finger, the duplication usually presents itself at the level of the metacarpophalangeal joint. Triplication of the little finger is very rare.
In about 14% of the cases, this type of polydactyly is hereditary.
It is further of three types.
- Type I includes nubbins or floating little fingers
- Type II includes duplications at the metacarpophalangeal joint.
- Type III includes duplications of the entire ray
Preaxial or Radial
Preaxial polydactyly or extra thumbs are the common, occurring incidence of the deformity is 0.08 per 1000.
It ranges from a small fleshly webbing on the radial border of the hand to triplication. There are seven types of duplicate thumbs.
Type I – The distal phalanx is bifid
Type II– The distal phalanx is duplicated
Type III – The proximal phalanx is bifid but the distal phalanx is duplicated
Type IV – Both the proximal and distal phalanges of the thumb are duplicated
Type V – The metacarpal of the thumb is bifid, the proximal and distal phalanges are duplicated
Type VI – The thumb metacarpal and both proximal and distal phalanges are duplicated (4 percent) and
Type VII – The thumb is triphalangeal
Preaxial polydactyly may be associated with syndactyly, it is inherited as an autosomal dominant trait and is termed as polysyndactyly.
In thumb duplication, circulation may be anomalous, being supplied by one artery instead of two. Often one of the thumbs is dominant while the other is underdeveloped; sometimes, however, both thumbs are of equal size, posing a problem as to which one to ablate.
Thumb polydactyly is usually sporadic, though if associated with triphalangeal thumb it may be familial.
Preaxial polydactyly may be associated with vertebral anomalies, the absence of the tibia, cleft palate, and imperforate anus. It may also be seen in a number of syndromes.
They may be of special clinical importance are Down’s syndrome, Fanconi pancytopenia, and acrocephalosyndactyly.
Central
Duplication of the index, long, and ring fingers is referred to as axial or central polydactyly. Often the extra digit of a long or ring finger is concealed in a web between adjoining normal digits.
The tendons, nerves, and vessels of the supernumerary digits are usually abnormal, as are the epiphyses of the extra digit.
The epiphysis of the extra digit usually does not lie in the normal line of growth. As a result, its phalanges diverge from the longitudinal axis into ulnar or radial deviation and distort adjacent digits.
Duplication of the index finger is very rare, representing about 3.5 percent of all cases of polydactyly.
This anomaly should not be confused with the triphalangeal thumb. The extra index finger may consist of a pedunculated soft-tissue mass or it may have normal bony and soft-tissue components. It may be associated with congenital radioulnar synostosis, and occasionally the duplicated index finger may be fused to the long finger.
Treatment of Polydactyly
If the duplicated small finger is hypoplastic, rudimentary, and attached to the hand by a narrow pedicle it can be removed in the newborn.
The fully developed and complete extra little finger needs to be excised and can be done at a later date.
Operative treatment for preaxial type is more complicated.
The important considerations are
- To maintain size and stability
- To provide adequate motor control and strength
- To establish anatomic alignment.
The type of treatment varies according to the type of thumb duplication.
If one of the two thumbs is significantly smaller or if only one deviates from the anatomic axis, the smaller accessory thumb is ablated.
However, at skeletal maturity, the thumb would be smaller than the opposite thumb.
hi, my brother met by accident and lost his 3middle fingers, can you help me out were can go for his fingers replacement, in original or artificial or by plastic surgery, pls help me.
my contact details +919341201490 / 9845889600
thanx,
najeeb khan
Hi, my one year old infant having seven toe in his left leg. there is a some curve in his left leg too. Please let me know about treatent & doctor.
Thanks,
Sushil Dwivedi
Sushil,
You should consult an orthopaedician preferably a paediatric orthopaedician.
Treatement is surgical removal of the extra toes depending on type of polydactyly.
I hope that helps.
i had two tiny thumbs ,similar to a thumb with nails, growing on my thumb nail from beneath the skin. I had them removed by a doctor.
after a few months they have grown again. they are flexible and are sensitive to touch and pain.the size is about 2mm in breadth and 3 mm in length.pls tell me what to do and what is it.
Anand,
Why do you say they are thumbs?
What was your initial diagnosis?
Have you consulted your physician for the recurrrence of the problem?
i have a duplication of distal phalanx .Rest of thumb is normal except distal part in which two nails are there ..ican use both tips as both are functional ..my age is 20 and i want to remove them now..is it possible now? help me plz.
Yes they can be removed. You need to see an orthopaedic surgeon/Hand surgeon for that.
I hope that helps.
If I have rightly interpreted, your brother has lost four of his toes of right foot. I have never seen people using it but I found two links for you that could be helpful
http://www.hrp.greenwood.net/CustomProducts/NNcus…
http://www.artechlab-prosthetics.com/descriptions…
I hope that helps.
Hi,
I have Type I post-axial poldactyly on both fingers. They are nubs of flesh on bith pinkies that used to be longer but I had suture ligation done as a baby. They obviously didnt do it close enough, and I wanted the rest removed. Who should I go to? Thanks.
@Tammie,
In our medical system, orthopedist/hand surgeon or plastic surgeon can deal with this problem.
I think it should be same in yours too.
I hope that helps.
Hi doc,my 3month old daughter has six fully grown fingers on both hands,diagonised as thumb duplication.my worry is will they grow again after operation and whats the best age to be operated on?
@Rose,
Generally they do not. Discuss with your orthopedic surgeon and he would be able to guide you better about the course of the treatment.
She is quite young for the surgery. Usually the surgery is deferred till the child is 9-10 months old.
hi there,i dont know who else to talk to.My younger brother had a nasty accident at work which resulted in him losing all his fingers on his right hand.It's totally consumed everything and we want to know what his options are other than taking his toes to make fingers.We are desperate for some knowledge into what options he has.Many thanks for reading this and i hoe to hear from you.
@vicky,
What kinds of options you are looking for?
Dear Gentlemen,
One of my friend lost her right hand ring finger when she was probably 1 or 2 years old accidentally. The complete ring finger is lost/removed from the palm area (I donot know how to call it, might be root of the finger). Now she is 25 years old. She is thinking of any chances of getting her finger viz. through plastic surgery, prothesis, finger duplication, amputation. She's is very much worried about her chances of getting married due to this reason as people (potential prospects) may reject her because of she does not has the finger.
I request, please help her informing any chances she can regain/re attach the lost finger. Please provide such details. Kindly help her.
Many Thanks in advance. My contact number is [Moderated].
@Mr. Chidambar Rao Bhukya,
Only option is a prosthesis. You would need to see an orthotist/prosthetist in your area to proceed.
My fingers are not straight they are crooked…. And when I walk they look too ugly. Cam anything be done for this & why are my fingers like this…???????pls help
@Keerthi,
Would you please elaborate.