Surgical treatment of radial polydactyly: a review of the Congenital Upper Limb Differences (CoULD) registry

INTRODUCTION: This study aims to explore the types of surgeries performed for radial polydactyly, complications and their associations with Wassel-Flatt classification types using a multi-centre prospective paediatric hand surgery registry. METHODS: Patients with radial polydactyly in the Congenital Upper Limb Differences (CoULD) Registry who underwent surgery were reviewed for Wassel-Flatt classification, types of surgeries performed and complications. RESULTS: A total of 247 extremities with radial polydactyly in 230 patients underwent surgical treatment at an average age of 1.4 years (ranging from 24 days to 8.4 years) for the index operation. The most common primary procedure was excision of the radial thumb with reconstruction of the dominant ulnar thumb (87%), followed by simple excision (7%). Thumbs classified as the hypoplastic subtype were more likely to undergo simple excision. The most common ancillary procedure was ligament reconstruction. Fifteen patients (7%) experienced 17 total complications including five thumbs requiring revision at an average of 3.6 years (range 2.5-4.3 years) after the first surgery. CONCLUSIONS: Excision of the radial thumb with reconstruction of the ulnar thumb is the most common procedure for patients undergoing surgical treatment for radial polydactyly, followed by simple excision of a hypoplastic polydactylous digit. Surgical complication rates for radial polydactyly surgery are low (7%) with a 2% reoperation rate at the 3 year follow-up. LEVEL OF EVIDENCE: IV.