1. Preaxial duplication R. Sh. Kamrani 90/2/20

2.  Incidence  1-2% of neonate with congenital anomaly  10% with upper extremity anomaly

4.  Incidence  Most common polyductyly in Whites and Asians  Second common anomaly in hand  1/3000 birth  Usually  Unilateral  Sporadic  Without other syndromes

5. Preaxial (bifid thumb)Postaxial polyductylyCentral poltductyly Most commonLess common More common in Caucasian Most common in African50% relationship parents Classification

6.  Classification  Wassel

7.  Clinical  Widening of the tip to two complete thumb rays  Hypoplasia (radial side more hypoplastic)  Convergent or divergent  Flat hand  Deviate or delta phalanx

8.  Treatment  Surgery  Indication  Cosmetic  Function  Age of surgery  6-12-18 m.  <5 y.  8-10 y. for revision  Kinds of surgery

9.  Treatment  Preoperative splinting  Kinds of surgery  Simple excision  Bilhaut-Cloquet  Excision and lig. Reconstruction

10. B-QE-LR Normal width+_ Lig stability+_ Mobility_+ Growth plate injurycommonuncommon Indication1-2>=3

11.  Treatment  Bilaut-Cloquet  Meticulous physeal rearrangement

13.  Excision and reconstruction  Which thumb

20.  Steps of reconstruction

25.  ???