{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T23:19:56Z","timestamp":1787527196585,"version":"build-2736575974"},"reference-count":36,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Hand Surg Eur Vol"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Radial polydactyly is often underestimated in its complexity. While many cases can be managed by excision and reconstruction of a dominant thumb, suboptimal outcomes persist when soft-tissue imbalance or bony deviation is not fully addressed. Expectations for aesthetic symmetry have also increased, placing greater demands on surgical precision and judgement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Limitations of current approaches and classifications:<\/jats:title>\n                    <jats:p>In cases where both duplicates are small (typically &lt;70% of the contralateral thumb), achieving adequate thumb girth and a satisfactory nail complex frequently requires augmentation or combined procedures. Traditional techniques such as the Bilhaut\u2013Cloquet procedure, although conceptually elegant, may result in split nail deformity, joint stiffness, and excessive bulk. Likewise, the Wassel\u2013Flatt classification, despite its widespread use, does not adequately capture soft-tissue anomalies, axial deviation, or triphalangeal components, limiting its value for operative planning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>A proposed classification and surgical philosophy:<\/jats:title>\n                    <jats:p>We present a simplified, two-group classification derived from decades of cumulative clinical experience. This framework integrates key anatomical and morphological factors, including size discrepancy, axis deviation, soft-tissue quality and nail deformity, to guide surgical strategy. It incorporates both transverse (modified Bilhaut\u2013Cloquet) and longitudinal (on-top plasty) reconstructive concepts, as well as combinations of these techniques where required. This approach also recogizes the need for a comprehensive surgical skillset, including paediatric orthoplastic and microsurgical expertise for optimal refinement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This pragmatic classification aims to address at least 95% of cases with radial polydactyly configurations, while remaining intuitive for clinical use. It provides a structured approach to surgical planning, communication, and outcome assessment, and should be applicable. By aligning anatomical complexity with tailored reconstruction, it supports more consistent functional and aesthetic outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence:<\/jats:title>\n                    <jats:p>V<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17531934261455208","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T08:34:42Z","timestamp":1782722082000},"page":"978-991","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Radial polydactyly: towards a unifying approach for surgical management"],"prefix":"10.1177","volume":"51","author":[{"given":"Tian","family":"Xiaofei","sequence":"first","affiliation":[{"name":"Department of Burns and Plastic Surgery, Children\u2019s Hospital of Chongqing Medical University, China"},{"name":"National Clinical Research Center for Children and Adolescents\u2019 Health and Diseases, Ministry of Education Key Laboratory of Child Development and Disorders, China"},{"name":"Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1986-2116","authenticated-orcid":false,"given":"Wee L","family":"Lam","sequence":"additional","affiliation":[{"name":"Hand and Reconstructive Microsurgery, Singapore General Hospital, KK Women\u2019s and Children\u2019s Hospital, Singapore"},{"name":"Honorary Clinical Senior Lecturer, University of Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3344-333X","authenticated-orcid":false,"given":"Shanlin","family":"Chen","sequence":"additional","affiliation":[{"name":"Peiking University and Capital Medical University, China"},{"name":"Department of Hand Surgery, Beijing Jishuitan Hospital, Capital Medical University, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"e_1_3_2_2_1","article-title":"Modified Bilhaut\u2013Cloquet procedure for zigzag thumb polydactyly types III and IV","volume":"5","author":"Al-Qattan MM","year":"2017","unstructured":"Al-Qattan MM, Kattan AE, Al-Lazzam A, Gelidan AG. Modified Bilhaut\u2013Cloquet procedure for zigzag thumb polydactyly types III and IV. Plast Reconstr Surg Glob Open. 2017, 5: e1589.","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200703000-00010"},{"key":"e_1_3_2_4_1","article-title":"Gu\u00e9rison d\u2019un pouce bifide par un nouveau proc\u00e9d\u00e9 op\u00e9ratoire","author":"Bilhaut M.","year":"1889","unstructured":"Bilhaut M. Gu\u00e9rison d\u2019un pouce bifide par un nouveau proc\u00e9d\u00e9 op\u00e9ratoire. 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