Analyze The Difference Between The External Appearance And The Bony Structure In The Polysyndactyly Of The Fifth Toe Fused With The Fourth Toe

Objective To investigate the toe to be excised and the clinical result of operation in the polysyndactyly of the fifth toe fused with the fourth toe based on the external appearance, the imaging manifestations in X sheet and bony structure of intraoperative findings.Methods 54 patients (65 feet) with polysyndactyly of the fifth toe fused with the fourth toe who were hospitalized in Children,s Hospital of Chongqing Medical University from January 2009 to January 2014 were included in this study. To analysis the discrepant manifestation between the external appearance and the bone and joint malalignment both in plain radiograph and intraoperative findings, and choose the extra toe to be excised. The malalignment and brachydactyly of the sixth toes were corrected simultaneously.Results In the external appearance, it was found that although the fifth toe is more straight than the sixth toe,and the sixth toe is always with deviated and short appearance in varying degrees.But in X sheet and bony structure of intraoperative findings.17 toes of the 65 feet just were neoplasitc toes without joints to proximal bons, and all the neoplastic toes were just dysplasia and have poor joint para than the sixth toe, while the 48 toes were jointed but have deviation of the two planes which were difficult to be corrected, while the sixth toe have varying degree in fibial deviation and shortness. The jointed type were divided into four subtypes which were distal phalangeal jointed, middle phalangeal jointed, distal of the proximal phalangeal jointed and proximal of the proximal phalangeal jointed, which based on the different jointed planes. So we choose the fifth toe to be excised. After 1 month to 4 years follow-up, the depth and width of toe webs were normal, and the sixth toe's mal-alignment was corrected completely and the toes were lengthened.Conclusion On the basis of analyzation and classification of the polysyndactyly of the fifth toe fused with the fourth toe according to the external appearance and the bony structure, we select the toe to be excised (usually the fifth toe) and make surgical planning in different kinds of typing, the appearance and the bony joint recovery are both improved.