Thumbs Up! A Novel Use of the Acutrak Screw Fixation System for the Management of Triphalangeal Thumb

Objective: The management of triphalangism provides the age-old problem of marrying maximal functional benefit with acceptable cosmesis. The objective was to discuss the rare abnormality of bilateral triphalangeal thumb, the surgical existing surgical approaches, and to present a case in a pediatric patient who had a good result with a relatively simple and straightforward method of surgically managing the deformity. Method: We present the case of a 16-year-old girl with isolated bilateral triphalangism of the thumbs. Her primary concern was the cosmetic deformity conferred by a delta middle phalanx, resulting in ulnar deviation of the thumb, in addition to the consequent reduced function of the thumb. Our approach to this problem was to perform a wedge osteotomy of the delta phalanx and a shave osteotomy of the articular surface of the distal phalanx, before using the Acutrak screw system to perform an arthrodesis. We present the first reported case in the literature. Results: This resulted in a near-anatomical correction of the deformity and consequent improvement of the cosmesis with a short anesthetic time, quick postoperative recovery, and very satisfied patient. Conclusion: We acknowledge that superior techniques exist; however, we also recognize that every case is unique and therefore, in this case the use of the Acutrak screw fixation system was the best option. It offers a noncomplex method of managing a complex condition. Short, safe, and effective surgery is always the best practice in managing pediatric patients.