Early surgical correction of congenital thumb duplication combined with longitudinal epiphyseal bracket: a prospective case series of 15 infants and toddlers

To evaluate the clinical efficacy of early polydactyly and longitudinal epiphyseal bracket (LEB) excision in children with congenital thumb duplication (CTD) combined with LEB, and to explore its potential value in supporting early intervention strategies. This prospective case series included 15 infants and toddlers (17 hands) with CTD combined with LEB, aged 9 months to 2.5 years (mean: 1.48 years), treated at our institution from 2019 to 2024. Surgical intervention combined polydactyly excision and LEB excision. Outcomes were assessed using the Tada scoring system (joint range of motion, deformity, instability) with follow-up from 12 to 24 months. All patients achieved successful correction with primary wound healing and no severe complications. The follow-up period ranged from 12 to 24 months, with an average of approximately 16 months. At the final follow-up, Tada scores for all patients ranged from 4 to 5, with 12 joints scoring 5 and 5 joints scoring 4, resulting in a 100% excellent outcome rate. The range of motion of the joints was between 66° and 91°, with an average of approximately 80.2°. The angular deformity ranged from 1° to 15°, with an average of approximately 6.4°. All patients demonstrated stable joint stability. The mean preoperative metacarpal I length increased from 12.75 ± 3.25 mm to 21.79 ± 3.88 mm postoperatively, while the mean Metacarpal II/I ratio decreased from 1.80 ± 0.18 preoperatively to 1.59 ± 0.14 at the final follow-up. Early thumb duplication reconstruction combined with LEB excision may help restore metacarpal growth, prevent deformity progression, and improve thumb morphology in the short term. This approach appears to be safe and feasible, and may support early intervention for children with CTD combined with LEB. Level IV—Case series.