Radiographic features of Wu et al. type A2 congenital thumb duplication and implications for management: new subtypes and surgical strategies
ObjectiveThis study aimed to assess the radiographic features of patients diagnosed with congenital thumb duplication (CTD) type A2 based on the Wu et al. classification, describe the different subtypes of duplications and propose a classification system that permits identifying various surgical str...
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Frontiers Media S.A.
2025-03-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2025.1536872/full |
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| author | JianPing Wu ShiJie Liao YuQuan Li FuLong Xu Hai Zhao ChenYang Li YanHan Liu XinWang Zhi HongHong Lin ZheHui Tu LiLi Shu JingChun Li YiQiang Li Federico Canavese Federico Canavese HongWen Xu YuanZhong Liu |
| author_facet | JianPing Wu ShiJie Liao YuQuan Li FuLong Xu Hai Zhao ChenYang Li YanHan Liu XinWang Zhi HongHong Lin ZheHui Tu LiLi Shu JingChun Li YiQiang Li Federico Canavese Federico Canavese HongWen Xu YuanZhong Liu |
| author_sort | JianPing Wu |
| collection | DOAJ |
| description | ObjectiveThis study aimed to assess the radiographic features of patients diagnosed with congenital thumb duplication (CTD) type A2 based on the Wu et al. classification, describe the different subtypes of duplications and propose a classification system that permits identifying various surgical strategies.MethodsWe evaluated 665 patients (680 thumbs) diagnosed with type A2 CTDs by examining the alignment of the interphalangeal (IP) and metacarpophalangeal (MP) joints of the primary thumb on posteroanterior (PA) radiographs. The classification system has four types: Type I (no deviation); Type II (ulnar deviation); Type III (hypertrophic epiphysis); and Type IV (convergent). Types I-IV were compared to Hung et al.'s system Type A-D (Hypoplastic, Ulnar Deviation, Divergent, and Convergent).ResultsOf the 680 fingers, 436 (64.1%) were determined to be Wassel type IV while 244 (35.9%) were classified as Wassel type VII. All of the 436 fingers could be categorized according to the subtypes of the Hung et al. system; in particular, 369 (84.6%) were identified as type B, 52 (11.9%) as type D, and 15 cases (3.4%) as type C. The proposed classification system worked effectively for all CTDs (n = 680). 494 cases were classified as type II (72.6%), while 75 cases were classified as type I (11.0%). The remaining 111 cases were further classified as either type IV (9.3%) or type III (7.1%). The Wu et al. systems showed excellent intra-rater (0.881) and inter-rater (0.873) reliability compared to the Hung et al. systems (0.842 and 0.823, respectively).ConclusionsThe proposed radiographic pathoanatomical system has the potential to improve communication and guide optimal procedure selection for different subtypes of CTD depending on the attachment of the extra digit to the main thumb and the alignment of the interphalangeal and metacarpophalangeal joints of the primary thumb (Wu et al. type A2).Level of evidenceIII |
| format | Article |
| id | doaj-art-a6c3179034cb4bf994fa5e1b1bc7b67a |
| institution | DOAJ |
| issn | 2296-2360 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj-art-a6c3179034cb4bf994fa5e1b1bc7b67a2025-08-20T02:47:04ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602025-03-011310.3389/fped.2025.15368721536872Radiographic features of Wu et al. type A2 congenital thumb duplication and implications for management: new subtypes and surgical strategiesJianPing Wu0ShiJie Liao1YuQuan Li2FuLong Xu3Hai Zhao4ChenYang Li5YanHan Liu6XinWang Zhi7HongHong Lin8ZheHui Tu9LiLi Shu10JingChun Li11YiQiang Li12Federico Canavese13Federico Canavese14HongWen Xu15YuanZhong Liu16Department of Pediatric Orthopaedics, GuangZhou Women and Children’s Medical Center, Guangdong Provincial Clinical Research Center for Child Health, GuangZhou Medical University, GuangZhou, ChinaDepartment of Orthopedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, ChinaDepartment of Orthopedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, ChinaDepartment of Pediatric Orthopaedics, GuangZhou Women and Children’s Medical Center, Guangdong Provincial Clinical Research Center for Child Health, GuangZhou Medical University, GuangZhou, ChinaDepartment of Pediatric Orthopedic, ChenZhou No.1 People’s Hospital, ChenZhou, ChinaDepartment of Orthopedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, ChinaDepartment of Pediatric Orthopaedics, GuangZhou Women and Children’s Medical Center, Guangdong Provincial Clinical Research Center for Child Health, GuangZhou Medical University, GuangZhou, ChinaDepartment of Pediatric Orthopaedics, GuangZhou Women and Children’s Medical Center, Guangdong Provincial Clinical Research Center for Child Health, GuangZhou Medical University, GuangZhou, ChinaDepartment of Pediatric Orthopaedics, GuangZhou Women and Children’s Medical Center, Guangdong Provincial Clinical Research Center for Child Health, GuangZhou Medical University, GuangZhou, ChinaDepartment of Pediatric Orthopaedics, GuangZhou Women and Children’s Medical Center, Guangdong Provincial Clinical Research Center for Child Health, GuangZhou Medical University, GuangZhou, ChinaDepartment of Pediatric Orthopaedics, GuangZhou Women and Children’s Medical Center, Guangdong Provincial Clinical Research Center for Child Health, GuangZhou Medical University, GuangZhou, ChinaDepartment of Pediatric Orthopaedics, GuangZhou Women and Children’s Medical Center, Guangdong Provincial Clinical Research Center for Child Health, GuangZhou Medical University, GuangZhou, ChinaDepartment of Pediatric Orthopaedics, GuangZhou Women and Children’s Medical Center, Guangdong Provincial Clinical Research Center for Child Health, GuangZhou Medical University, GuangZhou, ChinaDepartment of Orthopedic and Traumatology, IRCCS Istituto Giannina Gaslini, Genoa, ItalyDISC-Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, University of Genova, Genova, ItalyDepartment of Pediatric Orthopaedics, GuangZhou Women and Children’s Medical Center, Guangdong Provincial Clinical Research Center for Child Health, GuangZhou Medical University, GuangZhou, ChinaDepartment of Pediatric Orthopaedics, GuangZhou Women and Children’s Medical Center, Guangdong Provincial Clinical Research Center for Child Health, GuangZhou Medical University, GuangZhou, ChinaObjectiveThis study aimed to assess the radiographic features of patients diagnosed with congenital thumb duplication (CTD) type A2 based on the Wu et al. classification, describe the different subtypes of duplications and propose a classification system that permits identifying various surgical strategies.MethodsWe evaluated 665 patients (680 thumbs) diagnosed with type A2 CTDs by examining the alignment of the interphalangeal (IP) and metacarpophalangeal (MP) joints of the primary thumb on posteroanterior (PA) radiographs. The classification system has four types: Type I (no deviation); Type II (ulnar deviation); Type III (hypertrophic epiphysis); and Type IV (convergent). Types I-IV were compared to Hung et al.'s system Type A-D (Hypoplastic, Ulnar Deviation, Divergent, and Convergent).ResultsOf the 680 fingers, 436 (64.1%) were determined to be Wassel type IV while 244 (35.9%) were classified as Wassel type VII. All of the 436 fingers could be categorized according to the subtypes of the Hung et al. system; in particular, 369 (84.6%) were identified as type B, 52 (11.9%) as type D, and 15 cases (3.4%) as type C. The proposed classification system worked effectively for all CTDs (n = 680). 494 cases were classified as type II (72.6%), while 75 cases were classified as type I (11.0%). The remaining 111 cases were further classified as either type IV (9.3%) or type III (7.1%). The Wu et al. systems showed excellent intra-rater (0.881) and inter-rater (0.873) reliability compared to the Hung et al. systems (0.842 and 0.823, respectively).ConclusionsThe proposed radiographic pathoanatomical system has the potential to improve communication and guide optimal procedure selection for different subtypes of CTD depending on the attachment of the extra digit to the main thumb and the alignment of the interphalangeal and metacarpophalangeal joints of the primary thumb (Wu et al. type A2).Level of evidenceIIIhttps://www.frontiersin.org/articles/10.3389/fped.2025.1536872/fullcongenital thumb duplicationWu et al. classificationanatomyinterphalangeal and metacarpophalangeal joint alignmentsurgery |
| spellingShingle | JianPing Wu ShiJie Liao YuQuan Li FuLong Xu Hai Zhao ChenYang Li YanHan Liu XinWang Zhi HongHong Lin ZheHui Tu LiLi Shu JingChun Li YiQiang Li Federico Canavese Federico Canavese HongWen Xu YuanZhong Liu Radiographic features of Wu et al. type A2 congenital thumb duplication and implications for management: new subtypes and surgical strategies Frontiers in Pediatrics congenital thumb duplication Wu et al. classification anatomy interphalangeal and metacarpophalangeal joint alignment surgery |
| title | Radiographic features of Wu et al. type A2 congenital thumb duplication and implications for management: new subtypes and surgical strategies |
| title_full | Radiographic features of Wu et al. type A2 congenital thumb duplication and implications for management: new subtypes and surgical strategies |
| title_fullStr | Radiographic features of Wu et al. type A2 congenital thumb duplication and implications for management: new subtypes and surgical strategies |
| title_full_unstemmed | Radiographic features of Wu et al. type A2 congenital thumb duplication and implications for management: new subtypes and surgical strategies |
| title_short | Radiographic features of Wu et al. type A2 congenital thumb duplication and implications for management: new subtypes and surgical strategies |
| title_sort | radiographic features of wu et al type a2 congenital thumb duplication and implications for management new subtypes and surgical strategies |
| topic | congenital thumb duplication Wu et al. classification anatomy interphalangeal and metacarpophalangeal joint alignment surgery |
| url | https://www.frontiersin.org/articles/10.3389/fped.2025.1536872/full |
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