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Duplication of proximal phalanx

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Partial or complete duplication of the proximal phalanx of the thumb may be treated in several ways:

  • if the ulnar digit is small or there is near equality of size:
    • the radial bones are excised but the soft tissue from the radial thumb is used to create soft tissue flaps to augment the ulnar digit
    • an abnormal axis to the proximal phalanx and its joint surfaces may necessitate an osteotomy
    • tendons are typically inserted anomalously and require re-routing
    • alternatively, a Bilhaut-Cloquet procedure can be employed again but results in a relatively stiff digit
  • if the ulnar digit is dominant:
    • it is conserved
    • if completely duplicated, the flared end of the metacarpophalangeal joint will need to be reduced in size
    • the abductor pollicis brevis typically inserts into the radial side of the base of the proximal phalanx of the radial digit; it must be detached and reinserted into the base of the proximal phalanx of the ulnar digit
    • the radial collateral ligament must be reconstructed with fascia or periosteum from the removed digit
    • again, osteotomy may be required to correctly align the joints
    • if the MCPJ is not stabilised in the reconstructed thumb, a zigzag deformity may result with time

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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