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American Association for Hand Surgery

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Long-Term Outcomes after Treatment for Type B Ulnar Polydactyly
Gunnar Goebel, BS1, Steven Dawson, BA1, Scott Nathan Loewenstein, MD2 and Joshua M Adkinson, MD1, (1)Indiana University School of Medicine, Indianapolis, IN, (2)Division of Plastic Surgery, Medical College of Wisconsin, Wauwatosa, WI

Introduction:
Type B ulnar polydactyly is one of the most common congenital hand differences and can be treated with either ligation or surgical excision. There is a paucity of literature, however, evaluating long-term patient reported outcomes of these treatments. The purpose of this study was to compare the long-term outcomes after ligation and surgical excision for the management of type B ulnar polydactyly.
Materials and Methods:
We created a database of patients who underwent treatment for type B ulnar polydactyly at a single pediatric health system from 2005 to 2014. We administered the Patient Reported Outcomes Measurement Information System (PROMIS) Pediatric Upper Extremity survey to patients via telephone and assessed for their satisfaction. We evaluated for differences between treatment cohorts using Student t-tests and a significance level of 0.05.
Results:
We successfully contacted and collected outcomes from 69 of 173 eligible patients treated in infancy (40% response rate). The mean follow-up was 11.1 (± 2.5) years, and the average age of the participant at the time of the survey was 11.7 (± 2.6) years of age. Twenty-four patients were treated with in-office ligation and 45 underwent formal surgical excision. Ten patients who were initially treated with ligation required future treatment with surgery due to symptomatic neuroma stump or persistent polydactyly (42%). Patients who were treated with surgical excision rated significantly higher satisfaction with their treatment than those who underwent ligation (p = 0.003). Patients in both cohorts rated similar satisfaction with the aesthetic appearance of their hand (p = 0.07). There was no significant difference in PROMIS-rated hand function between the ligation and surgical cohort (p = 0.765) and treated adolescents PROMIS scores were not statistically different than age-matched controls without polydactyly.
Conclusion:
While ligation and surgical excision result in similar function and aesthetics, patient satisfaction is higher after surgery. Furthermore, a significant portion of patients fail ligation and ultimately request surgery for symptomatic neuroma or persistent polydactyly. Counseling parents of patients with type B ulnar polydactyly should include these considerations in order to assist them in selecting the best treatment for their child.


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