Five cases of Wassel types III, IV and VII thumb duplication underwent a Bilhaut-Cloquet procedure. A stable and mobile metacarpophalangeal joint was achieved in all cases. Interphalangeal joint motion was limited but this joint was stable in all cases. The nail ridge in these thumbs was minimal. A strong, stable thumb of normal size and good appearance can result from the Bilhaut-Cloquet procedure. When one nail is 70% of normal width, a modified procedure using the whole of one nail will avoid the nail ridge, but the nail will still differ from normal.
"As explained in more detail in Smith et al. (2015), all human individuals with birth defects dissected by us are part of the collection of birth defects of Diogo's lab, which was obtained through the Department of Pathology of Howard's College of Medicine/Hospital (for more details, see Smith et al. 2015). Apart from taking into account the information we compiled and provided about muscle defects in humans with trisomy in Smith et al. (2015), for the specific purpose of the present paper we additionally undertook a detailed review of the scarce number of other publications providing detailed distal limb muscle data for individuals with non-pentadactyl limbs due to birth defects (Heiss, 1957; Light, 1992; Tonkin & Bulstrode, 2007; Waters & Bae, 2012; see section below). It is important to stress that our determination of the identity and homology of the muscles in the humans with both normal and abnormal phenotypes is made from an analysis of all data available (e.g. "
[Show abstract][Hide abstract] ABSTRACT: Signaling for limb bone development usually precedes that for muscle development, such that cartilage is generally present before muscle formation. It remains obscure, however, if: (i) tetrapods share a general, predictable spatial correlation between bones and muscles; and, if that is the case, if (ii) such a correlation would reflect an obligatory association between the signaling involved in skeletal and muscle morphogenesis. We address these issues here by using the results of a multidisciplinary analysis of the appendicular muscles of all major tetrapod groups integrating dissections, muscle antibody stainings, regenerative and ontogenetic analyses of fluorescently-labeled (GFP) animals, and studies of non-pentadactyl human limbs related to birth defects. Our synthesis suggests that there is a consistent, surprising anatomical pattern in both normal and abnormal phenotypes, in which the identity and attachments of distal limb muscles are mainly related to the topological position, and not to the developmental primordium (anlage) or even the homeotic identity, of the digits to which they are attached. This synthesis is therefore a starting point towards the resolution of a centuries-old question raised by authors such as Owen about the specific associations between limb bones and muscles. This question has crucial implications for evolutionary and developmental biology, and for human medicine because non-pentadactyly is the most common birth defect in human limbs. In particular, this synthesis paves the way for future developmental experimental and mechanistic studies, which are needed to clarify the processes that may be involved in the elaboration of the anatomical patterns described here, and to specifically test the hypothesis that distal limb muscle identity/attachment is mainly related to digit topology.
Journal of Anatomy 04/2015; 226. · 2.10 Impact Factor
"These principles and techniques may be applied to the one circumstance for which I believe the classical Bilhaut-Cloquet procedure retains a significant role: this being for reconstruction of more proximal thumb duplications when neither thumb distal to the metacarpal is adequate and when the surgeon believes that the reconstructive procedures will not create a satisfactory thumb of adequate mobility, stability, alignment and size (Fig. 16).15) If I judge that there is a significant risk of instability at MCP and IP joints, that deviation is impossible to avoid, and that the size of the reconstructed thumb will be significantly compromised, then the Bilhaut-Cloquet technique is a good option. "
[Show abstract][Hide abstract] ABSTRACT: Within the Oberg, Manske, Tonkin (OMT) classification, thumb duplications are a failure of formation and/or differentiation affecting the radial-ulnar axis of the hand plate. The Wassel description of seven types of thumb duplication provides a good structure from which an approach to management is based. The aim of surgical reconstruction is to obtain a stable, mobile thumb of adequate size and appropriate shape. The most common form of reconstruction is removal of the lesser digit and reconstruction of the dominant digit. Surgical techniques address the problems of deviation, instability and lack of size. The disadvantages of the Bilhaut-Cloquet procedure, these being joint stiffness and a nail ridge, may be lesser concerns when reconstruction of one digit will not create a satisfactory thumb of adequate mobility, stability, alignment and size. Complicated problems of triphalangism, triplication, ulnar dimelia and the rare circumstance in which neither of the duplicated thumbs may be adequately reconstructed present specific challenges which demand alternative techniques.
Clinics in orthopedic surgery 03/2012; 4(1):1-17. DOI:10.4055/cios.2012.4.1.1
"Thumb duplication is the most frequent thumb abnormality of the first digit  , type IV in more than 50% of cases [1—3,11]. Few homogenous series have investigated type IV thumb duplication    and even fewer type IV-D  . Ulnar thumb reconstruction after excision of the radial thumb duplicate remains the most frequently used treatment today in type IV duplications, providing good results  . "
[Show abstract][Hide abstract] ABSTRACT: In the Wassel type IV classification category, the thumb is duplicated from the metacarpophalangeal joint; this abnormality accounts for approximately 50% of the cases of thumb duplication. Type IV is divided into four subtypes in which the IV-D type, or convergent (9% of cases), is the most complex form because both thumbs are hypoplastic with a divergent metacarpophalangeal joint and a convergent interphalangeal joint. Reconstruction is prone to axis deformity and ligament laxity, whereas the Bilhaut-Cloquet technique's main pitfall is nail dystrophy. We propose a modified Bilhaut-Cloquet procedure to avoid these complications.
Orthopaedics & Traumatology Surgery & Research 09/2010; 96(5):521-4. DOI:10.1016/j.otsr.2010.01.013 · 1.26 Impact Factor
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