Outcomes of 1,621 Polydactyly Reconstructions from the Polydactyly at the Childrenâ€™s Hospital of Philadelphia Database
Sarah L. Struble, BS1, Niki K. Patel, MD, MSc1, Eliza Buttrick, BA1, Sarah L Barnett, BA1, John R. Vaile, BS1, Benjamin Chang, MD2, Apurva S. Shah, MD MBA2 and Shaun D. Mendenhall, MD1, (1)The Children's Hospital of Philadelphia, Philadelphia, PA, (2)Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
Polydactyly, one of the most common congenital limb differences, is divided into three categoriesâ€” preaxial (radial), central, and postaxial (ulnar) polydactyly. Using data from a large cohort, we hypothesize patient demographics and polydactyly presentations would resemble findings of previous reports. Additionally, patients with disadvantaged backgrounds and complex presentations would be predictive of early and late postoperative complications.
After IRB approval, retrospective analysis identified polydactyly cases from 2011-2022 at a large childrenâ€™s hospital. Patients 0-17 years of age at presentation with congenital hand polydactyly who underwent treatment were included. Outcomes of interest included early (30-day) postoperative complications and late postoperative complications including pathologic scar formation, angulation/rotational deformity, and functional deficits. Frequencies, proportions, chi-square tests, and multinomial logistic regressions were used to analyze findings.
In total, 1621 duplicated digits from 1071 patients were analyzed. (Table 1) Thirty cases (1.9%) experienced early complications and 119 cases (7.3%) experienced a late complication. Within preaxial polydactyly, 23 (9.2%) experienced an early complication including unplanned cast changes and infection. The incidence of late complications was 86 (34.7%) including angulation deformity (n=48, 19.4%). Of the 19 central polydactyly cases, 1 (5.3%) experienced an early complication (dehiscence) and 10 (52.6%) had late complications; however, 14 cases (74.7%) were noted to be synpolydactyly. Of the 1357 postaxial polydactyly cases, 8 (0.6%) experienced early complications and 23 (1.7%) experienced late complications including neuroma formation (n=11, 0.8%) and hypertrophic scarring (n=6, 0.4%). (Table 2)
On chi-square analysis, Asian race and Wassel-Flatt types III and VII in preaxial cases were associated with late complications (p<0.05, p<0.001, p<0.001, respectively). Synpolydactyly cases were associated with a higher late complication rate (p=0.011). In postaxial polydactyly, syndromic cases were associated with early complications (p=0.006) and Hispanic ethnicity with late complications (p=0.01). On regression analysis, predictors of late complications included Wassel-Flatt type in preaxial polydactyly (p=0.017) and socioeconomic status in postaxial polydactyly (p=0.002); there were no predictors of early or late complications in central polydactyly.
This study provides the largest cohort of polydactyly outcomes in the literature, which demonstrates an overall acceptable complication profile but may be impacted by demographic and socioeconomic factors.
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