Surgical Outcomes and Complications of Hand and Foot Polydactyly in Children: A Systematic Review

Yousefli, Fatemeh; Nourmohammadi, Jalal; Sarshar, Mohammadreza

doi:10.22038/jpp.2026.98325.5726

Surgical Outcomes and Complications of Hand and Foot Polydactyly in Children: A Systematic Review

Document Type : systematic review

Authors

Fatemeh Yousefli ¹

Jalal Nourmohammadi ²

Mohammadreza Sarshar ³

¹ Department of Nursing and Midwifery, MMS.C., Islamic Azad University, Mashhad, Iran.

² Student Research Committee, Faculty of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran.

³ Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

10.22038/jpp.2026.98325.5726

Abstract

Background: Polydactyly is a heterogeneous congenital limb anomaly in children affecting the hand or foot. Surgical management aims to restore function, alignment, stability, and acceptable appearance, but outcomes may vary according to anatomical subtype and reconstructive complexity. This systematic review evaluated surgical outcomes and complications of pediatric hand and foot polydactyly.
Methods: PubMed, Scopus, Web of Science, Embase, and Google Scholar were searched for studies published from January 2010 through January 2026. Eligible studies included original clinical research involving children with congenital hand and/or foot polydactyly undergoing surgical treatment and reporting functional, aesthetic, or complication-related outcomes. Two reviewers independently extracted data and assessed methodological quality using design-appropriate tools. Due to substantial clinical and methodological heterogeneity, findings were synthesized narratively.
Results: The search identified 2,123 records. After duplicate removal and screening, 96 articles underwent full-text assessment, of which 84 were excluded. Twelve studies were included in the qualitative synthesis. Overall, surgical correction generally resulted in favorable functional and aesthetic outcomes. However, residual or recurrent deformity, malalignment, instability, stiffness, scar-related problems, wound complications, infection, pain, and neurovascular symptoms were reported. Some patients required secondary corrective surgery. Outcomes appeared to be influenced by anatomical subtype, reconstructive complexity, relative development of duplicated digits or rays, and surgical technique. Hand and foot procedures demonstrated distinct functional priorities, limiting direct comparison of outcomes.
Conclusions: Surgical treatment generally provides favorable outcomes in children with hand and foot polydactyly, but residual deformity and postoperative complications remain clinically relevant. An individualized, anatomy-based reconstructive strategy is preferable to a universal operative approach. Prospective multicenter studies with standardized outcome measures and long-term follow-up are needed.

Keywords

Foot Polydactyly

Hand Polydactyly

Polydactyly

Pediatric Surgery

Surgical Outcomes

Subjects

Orthopedics

1. Wessel LE, Daluiski A, Trehan SK. Polydactyly a review and update of a common congenital hand difference. Current opinion in pediatrics. 2020 Feb 1;32(1):120-4.

2. Kyriazis Z, Kollia P, Grivea I, Stefanou N, Sotiriou S, Dailiana ZH. Polydactyly: clinical and molecular manifestations. World Journal of Orthopedics. 2023 Jan 18;14(1):13.

3. Lee HJ, Lee KS, Chung SH, Kim HJ, Park KH, Kim PT, et al. Mid-term to long-term follow-up results of reconstruction for thumb radial polydactyly. Journal of Pediatric Orthopaedics. 2022 Sep 1;42(8):439-42.

4. Shin YH, Yoon JO, Kim SS, Joo HS, Al-Dhafer BA, Kim JK. Reoperation after primary operation for pre-axial polydactyly of the hand: a 12-year experience at a single institute. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2022 Aug 1;75(8):2658-63.

5. Kim JK, Yoon JO, Shin YH, Lee SH. Modified Wassel-Flatt type III radial polydactyly: subtypes and their outcomes. The Journal of Hand Surgery. 2024 Jan 1;49(1):60-e1.

6. Breidung D, Megas IF, Dittrich Y, Reichert B, Nöth U, Habild G. Experience with management of radial polydactyly: the multicenter analysis of 28 surgical procedures with follow-up. InHealthcare 2023 Nov 26 (Vol. 11, No. 23, p. 3045). MDPI.

7. Hovius SE, Kruit AS. Complications after radial polydactyly surgery: analysis, prevention and management. Journal of Hand Surgery (European Volume). 2024 Feb;49(2):226-39.

8. Cordray H, Shah AS, Buttrick E, Chang B, Little KJ, Al-Muhtaseb T, et al. Postoperative and long-term patient-reported outcomes of type A ulnar polydactyly. Plastic & Reconstructive Surgery. 2025 Oct;156(4):521e-33e.

9. Chung MS, Baek GH, Gong HS, Lee HJ, Kim J, Rhee SH. Radial polydactyly: proposal for a new classification system based on the 159 duplicated thumbs. Journal of Pediatric Orthopaedics. 2013 Mar 1;33(2):190-6.

10. Dijkman R, Selles R, van Rosmalen J, Hülsemann W, Mann M, Habenicht R, et al. A clinically weighted approach to outcome assessment in radial polydactyly. Journal of Hand Surgery (European Volume). 2016 Mar;41(3):265-74.

11. Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. bmj. 2021 Mar 29;372.

12 Chopan M, Sayadi L, Chim H, Buchanan PJ. To tie or not to tie: a systematic review of postaxial polydactyly and outcomes of suture ligation versus surgical excision. Hand. 2020 May;15(3):303-10.

13. Stutz C, Mills J, Wheeler L, Ezaki M, Oishi S. Long-term outcomes following radial polydactyly reconstruction. The Journal of Hand Surgery. 2014 Aug 1;39(8):1549-52.

14. Rogers BH, Schmieg SL, Pehnke ME, Shah AS. Evaluation and management of preaxial polydactyly. Current Reviews in Musculoskeletal Medicine. 2020 Aug;13(4):545-51.

15. McQuillan TJ, Hawkins JE, Ladd AL. Incidence of acute complications following surgery for syndactyly and polydactyly: an analysis of the National Surgical Quality Improvement Program Database from 2012 to 2014. The Journal of Hand Surgery. 2017 Sep 1;42(9):749-e1.

16. Chen H, Wu K, Wang H, Hu Y, Wang Y. Reconstruction of radial deviation after preaxial polydactyly surgery: use of an ulnar fascial flap. Frontiers in Pediatrics. 2024 Nov 18;12:1433249.

17. Zeniya T, Iba K, Hanaka M, Takashima K, Emori M, Teramoto A. Long-term postoperative outcomes of post-axial polydactyly of the foot with an emphasis on collateral ligament reconstruction. Journal of Orthopaedic Science. 2025 Nov 13.

18. Yin F, Li J, Wang J, Gu J, Lin W. A novel revision technique in the treatment for postoperative deviation after radial polydactyly reconstruction. Journal of Orthopaedic Surgery and Research. 2025 Mar 1;20(1):217.

19. Arakgi ME, Degen RM. Approach to a failed hip arthroscopy. Current reviews in musculoskeletal medicine. 2020 Jun;13(3):233-9.

20. Yeung CM, Choi AK, Tong JW, Fok W, Chan YF, Chow YY. Long-term results of surgically treated radial polydactyly–an outcome correlation study. The Journal of Hand Surgery (Asian-Pacific Volume). 2019 Sep;24(03):264-9.

21. Tawfeeq Y, Hendry JM, Wood KS. Update of surgical treatment of polydactyly. Current Opinion in Pediatrics. 2023 Feb 1;35(1):124-30.

22. Bae DS, Canizares MF, Cook DL, Van Heest A, Steinman SE, Samora J, et al. Complications following congenital hand and upper limb surgery: lessons from the CoULD Registry. The Journal of Hand Surgery. 2026 Jan 1;51(1):62-70.

23. Woo SJ, Kim BJ, Kwon ST. Case-control study of the treatment of postaxial polysyndactyly of the foot: Comparison of surgical results after removal of the fifth or sixth toe. Archives of Plastic Surgery. 2021 Jan;48(01):91-7.

24. Monjardino MP, Carvalho M, Cardoso PS, Ling TP, Alves C. Thumb duplication surgical treatment: outcomes and results. Global Pediatric Health. 2023 Jan;10:2333794X221149828.

25. Makarov AY, Proshchenko YN, Rodionova KN. Long-term outcomes of surgical treatment in children with preaxial polydactyly of the hand: a systematic review. NN Priorov Journal of Traumatology and Orthopedics. 2026;33(1):171-81.

26. de Almeida CE. Analysis of surgical results and of residual postoperative deformities in preaxial polydactyly of the hand. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2017 Oct 1;70(10):1420-32.

27. Banala M, Struble SL, Cordray H, Chang B, Shah AS, Buttrick E, et al. Cost Effectiveness of Hand Postaxial Polydactyly Type B Excision in the Office Versus Operating Room. Journal of Hand Surgery Global Online. 2026 Jan 1;8(1):100865.

28. Burger EB, Bus SA, Hovius SE, van Nieuwenhoven CA. Lateral versus medial hallux excision in preaxial polydactyly of the foot. Foot & Ankle International. 2020 Dec;41(12):1553-62.

29. Ganju N, Mantilla-Rivas E, Martinez PF, Manrique M, Escandón JM, Shah S, et al. A retrospective review of patient-reported outcomes after postaxial polydactyly ligation and surgical excision. Plastic and Reconstructive Surgery Global Open. 2024 Jan 23;12(1):e5557.

30. Kubat O, Antičević D. Does timing of surgery influence the long-term results of foot polydactyly treatment?. Foot and Ankle Surgery. 2018 Aug 1;24(4):353-8.

31. Ko KR, Shim JS, Kang J, Park J. Surgical outcomes and predictive factors of medial toe excision for polysyndactyly of the fifth toe. Foot & Ankle International. 2021 May;42(5):562-9.

32. Kim JS, Fowler JR, Davit AJ. Operative technique and management of central foot polydactyly. JPRAS open. 2022 Jun 1;32:61-71.

33. Chocron Y, Kazan R, Abi-Rafeh J, Lessard A, Thibaudeau S. Lower extremity postaxial polydactyly: current literature status and future avenues. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2021 Nov 1;74(11):2977-92.

34. Kelly DM, Mahmoud K, Mauck BM. Polydactyly of the foot: a review. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2021 May 1;29(9):361-9.

35. Xiaofei T, Lam WL, Chen S. Radial polydactyly: towards a unifying approach for surgical management. Journal of Hand Surgery (European Volume). 2026 Jun 29:17531934261455208.

36. Young B, Smith GB, Titan AL, Kenney DE, Ladd AL. National Surgical Incidence and Sociodemographic Differences for Pediatric Polydactyly of the Hand. HAND. 2026 May 4:15589447261437827.