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Case Reports
. 2024 Jan 31;16(1):e53285.
doi: 10.7759/cureus.53285. eCollection 2024 Jan.

On-Top Osteotomy of the Phalanx Base Combined With Modified Bilhaut: Cloquet Procedure for Atypical Radial Polydactyly

Akira Kodama  1 , Shigeki Ishibashi  1 , Masaru Munemori  1 , Kentarou Tsuji  1 , Nobuo Adachi  1
Affiliations
Case Reports

On-Top Osteotomy of the Phalanx Base Combined With Modified Bilhaut: Cloquet Procedure for Atypical Radial Polydactyly

Akira Kodama et al. Cureus. .

Abstract

In this report, we present the combination of on-top plasty with a modified Bilhaut-Cloquet procedure for treating atypical radial polydactyly with duplication at the metacarpophalangeal (MP) joint and triphalangism of the radial and ulnar phalanges, hypoplastic middle phalanx of the radial thumb, and hypoplastic phalanx base of the ulnar thumb. To preserve the stable MP and interphalangeal joints of the radial and ulnar thumbs, respectively, on-top plasty involved osteotomizing the middle phalanx and transferring the distal end of the middle phalanx of the ulnar finger to the phalanx base of the radial thumb. A modified Bilhaut-Cloquet procedure was used to combine the tips and nails of both thumbs. Twelve months postoperatively, good joint alignment and thumb tip appearance were achieved. On-top plasties effectively combined the desirable parts of both thumbs. The modified Bilhaut-Cloquet technique is particularly well-suited for atypical cases, such as the present case.

Keywords: congenital hand; duplicated thumb; modified bilhaut–cloquet procedure; on-top osteotomy; radial polydactyly; triphalangeal thumb.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Appearance of polydactyly of the radial and ulnar triphalangeal thumbs
Figure 2
Figure 2. Radiographic image obtained before surgery
Figure 3
Figure 3. Pre-operative photograph to mark the skin incision (Palmar side)
Figure 4
Figure 4. Pre-operative photograph to mark the skin incision (Dorsal side)
Figure 5
Figure 5. Intraoperative photograph after the excision of the proximal part of the proximal and extra phalanx of the ulnar thumb
The white arrow indicates the excised part of the radial thumb, including the distal part of the proximal and extra phalanx and the ulnar 2/3 of the distal phalanx.
Figure 6
Figure 6. Illustrated diagram showing the excised part and the preserved part
The excised part is colored orange, and the preserved part is colored blue. The red dotted lines indicate the osteotomy line.
Figure 7
Figure 7. Intraoperative photograph after transferring the ulnar thumb to the radial thumb
The white arrow indicates the preserved part of the distal phalanx of the radial thumb
Figure 8
Figure 8. Final intraoperative appearance (Palmar side)
Figure 9
Figure 9. Final intraoperative appearance (Dorsal side)
Figure 10
Figure 10. Radiographic image after the surgery
Figure 11
Figure 11. Appearance of the thumb a year after surgery
Figure 12
Figure 12. Radiographic image obtained 12 months after surgery
See this image and copyright information in PMC

References

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