Arch Hand Microsurg.  2024 Sep;29(3):187-190. 10.12790/ahm.24.0025.

Tetrapolydactyly: a rare presentation and review of the literature

• Seo D
• Ishii R
• Tada K
• Horiuchi K
• Kawashima K

• KMID: 2558743
• DOI: http://doi.org/10.12790/ahm.24.0025

Abstract

Polydactyly is a common congenital anomaly characterized by the presence of extra digits on the hands and/or feet, potentially involving all four limbs simultaneously. The terminology used to describe polydactyly involving all four limbs varies in the literature, with terms such as “tetrapolydactyly,” “polydactyly 24,” and “hexadactyly of all limbs” being used interchangeably. We encountered a case of tetrapolydactyly in a female neonate with postaxial polydactyly involving all four limbs. Our patient had an extra digit on the ulnar side with a bony component on the left hand and a similar extra digit without a bony articulation at the base of the right hand. The right foot showed postaxial polydactyly, and the left foot exhibited both preaxial polysyndactyly and postaxial polydactyly. A review of the literature shows that this combination of anomalies is extremely rare. A family history is present in approximately 30% of cases, asymmetric patterns are rarer than symmetric patterns, and heptadactyly is particularly uncommon. This report summarizes the information on tetrapolydactyly in the literature and discusses the clinical implications as well as management strategies.

Keyword

Tetrapolydactyly; Polydactyly 24; Crossed polydactyly

Figure

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  Fig. 1. Clinical photograph and radiograph of the left hand at 9 months of age. The images show polydactyly on the ulnar side with an additional finger containing two phalanges articulating at the metacarpal head and budding from the fifth metacarpal bone. The abductor digiti minimi was inserted into the additional finger, and it was reconstructed as the base of the fifth proximal phalanx.

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  Fig. 2. Clinical photograph and radiograph of the right hand at 9 months of age. The additional finger on ulnar side was the floating type.

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  Fig. 3. Clinical photograph and radiograph of the left foot at 9 months of age. The left foot showed both preaxial and postaxial polydactyly. The preaxial toe and the first toe had an incompletely divided metatarsal bone, with the additional toe articulating with this metatarsal bone. The postaxial toe was articulated to a metatarsal bone, with a Y-shaped configuration.

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  Fig. 4. Clinical photograph and radiograph of the right foot at 9 months of age. The right foot showed postaxial polydactyly, demonstrating an asymmetric pattern of polydactyly.

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