Hernández-Ortiz JA, Sánchez-Knupflemacher D, Rivera-Baena SE, Sánchez-Ramírez EL

Language: Spanish
References: 18
Page: 149-155
PDF size: 964.15 Kb.

ABSTRACT

Thumb duplication is the most common form of preaxial polydactyly. The optimal surgical approach remains controversial due to persistent postoperative complications and reinterventions. The main techniques include resection with ligament and tendon reconstruction, the Bilhaut-Cloquet procedure, and the on-top plasty technique, each with specific advantages and limitations. The aim of this study was to analyze, through a meta-analysis, complication and reintervention rates associated with the most commonly used surgical approaches in pediatric thumb duplication. A systematic search was conducted in PubMed, Embase, Scopus, and LILACS (up to May 2025). Observational studies with ≥ 10 patients, ≥ 12 month-follow-ups, and reports of complications and/or reinterventions were included. A random-effect model (DerSimonian-Laird) was applied, with heterogeneity estimation using the I² statistic and subgroup analysis according to the surgical technique. Publication bias was assessed using funnel plots and Egger's test. The protocol was not registered in PROSPERO. Eighteen studies were included, totaling 1,082 pediatric patients. The pooled complication rate was 21% (95%CI 17-25; I² = 62%) and the reintervention rate was 9% (95%CI 7-12; I² = 48%). Regarding technique, complication rates were: resection with reconstruction 17% (95%CI 13-22), Bilhaut-Cloquet 28% (95%CI 21-36), and on-top plasty 24% (95%CI 16-33). Subgroup comparison showed significant differences (p = 0.03). No meaningful publication bias was observed (Egger's test, p > 0.05). Pediatric thumb duplication presents relevant rates of complications and reintervention. Resection with reconstruction shows the best overall outcomes, followed by on-top plasty and Bilhaut-Cloquet. These findings support the standardization of surgical criteria and the development of prospective multicenter studies to strengthen the available evidence.

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