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Saturday, May 3, 2014

The woman with triplicate thumbs


Polydactyly is a congenital physical anomaly where patients have supernumerary fingers or toes. It can occur in humans, as well as cats and dogs. The extra digit is usually a small piece of soft tissue that can be removed. Occasionally it contains bone without joints; rarely it may be a complete, functioning digit. 


The most common type is postaxial polydactyly, where the extra digit is situated on the side of the little finger. A less common situation is preaxial polydactyly, where the extra digit is situated on the side of the thumb or big toe. Central polydactyly, where the extra digit is on the ring, middle or index finger, is very rare.

Jafari et al. have described the unique case of a female patient who came to a hospital in Tehran, Iran, seeking advice because of triplicate thumbs on both hands. Such an extreme presentation of preaxial polydactyly is very unusual; no similar cases have been described in medical literature. The woman, a 22-year-old housewife, sought to improve the appearance and functionality of her hands. 


Photographs of the patient's right and left hand clearly show her unique congenital anomaly, without precedence in medical literature - triplicate thumbs on both hands. Note that all the supernumerary digits have separate nail beds; however, on the left hand the three thumbs are completely fused together. The rest of the hand is normal.

The patient's family history was positive for congenital anomalies of the hand. She has four sisters and two brothers. One of her sisters, one of her brothers, a grandmother and a grandfather had a history of congenital hand anomalies. Except for deformity of the hands, the patient had no other anomalies and was in all other respects normal. Examination of the upper limbs showed no abnormalities of the shoulders, elbows, forearms or wrists.


An X-ray of the patient's right hand shows the bones of the supernumerary digits.

Surgical correction of preaxial polydactyly is almost always indicated, not only to improve appearance, but also for better function. Surgical reconstruction is generally performed when the child is about 18 months old, but no later than 5 years old if possible. The patient described here was not at a good age for surgery; however, surgical reconstruction was the only option to improve her condition. The right hand was operated first, and a year later, the left one. The surgeons managed to save the metacarpophalangeal joint on the right side, but had to fuse the left one; then, the two extra thumbs were excised bilaterally. Recovery was uneventful.

After surgical correction, the appearance and function of the patient's hands have dramatically improved. (All images from: Jafari et al. 2013)




Literature:

Jafari D, Shariatzade H, Mazhar FN, Abbasgholizadeh B, Dashtebozorgh A. (2013) An unusual case of preaxial polydactyly of the hand (triplication of the thumbs). Med J Islam Repub Iran. 27(2): 91–94.

Wikipedia: Polydactyly


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