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Duplication of proximal phalanx

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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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