On-Top Plasty in Post-Axial Polydactyly: A Case Report and Recommendation to Modify the Classifications.

Post-axial polydactyly (PAP) is almost always treated by ablation of the sixth ray since the ulnar duplicate is universally inadequate and the radial one is normal. We report a patient with bilateral PAP with skeletal abnormalities in both radial and ulnar duplicates. This unusual presentation cannot be classified according to previous classifications of PAP and precludes simple ablation as the treatment of choice. Both hands of this patient were treated by on-top plasty with excellent functional and cosmetic results. A modification of the previous classifications is recommended at the end of this article. Level of Evidence: Level V (Therapeutic).

Is Carpal Tunnel Release an Effective Treatment for Patients with Suspected Concurrent Carpal Tunnel and Pronator Syndrome?

Background: Some patients with a confirmed diagnosis of carpal tunnel syndrome (CTS) on clinical examination and electrodiagnostic testing (EDX) may also have one or more clinical features of pronator syndrome (PS). However, the EDX is negative for PS. We label these patients as suspected concurrent carpal tunnel and pronator syndrome (CCPS). We suspect that this is a presentation of reverse double crush syndrome that occurs when a symptomatic distal compression neuropathy converts an asymptomatic proximal compression into a symptomatic one. We believe both compressions can be relieved by decompressing the median nerve only at the wrist. The aim of our study is to determine whether carpal tunnel release (CTR) is an effective treatment for patients suffering from CCPS. Methods: This is a prospective, cohort study of the outcomes of CTR in two matched groups with 37 patients in each group. Group A included patients with suspected CCPS and group B included patients with isolated CTS. All patients were evaluated pre-operatively and 1 year after surgery using the Boston Carpal Tunnel Questionnaire (BCTQ). At one year, patients were also assessed for residual symptoms and positive provocative tests. Results: A significant improvement in the symptom and functional severity scales (SSS and FSS) of the BCTQ was noted in both groups. The degree of improvement in SSS was similar in both groups; however, group A showed a greater improvement in FSS. This could be attributed to higher pre-operative values in some items of FSS in group A. No patients in either group had residual symptoms severe enough to necessitate further treatment. Conclusion: The outcomes of CTR are similar in patients with isolated CTS and suspected CCPS and a CTR may be sufficient to address symptoms of CTS and PS in patients with CCPS. Level of Evidence: Level II (Therapeutic).