Thumb and index finger macrodactyly with first carpometacarpal and scaphotrapezotrapezoidal joints fusion: inevitable consequence?

To cite: Iyengar KP, Matar HE, Suraliwala K. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2016218043 DESCRIPTION Macrodactyly is a descriptive term used for a rare anomaly of disproportionately large digit noted at birth or that develops within the first years of life. The soft tissue and skeletal elements are diffusely enlarged in the affected digit or digits. 2 Most cases appear sporadically without evidence of inheritance. The anomaly is generally unilateral and may affect more than one digit, when the thumb involved, it assumes an abducted and extended attitude. The bony growth continues until physeal closure; however, soft tissue enlargement may continue into adulthood. The enlarged digits stiffen during growth, which further limits function as the enlarged digit or digits often obstruct grasp and pinch. Patients are usually initially evaluated in childhood with indications for surgery based on functional and aesthetic grounds. Macrodactyly’s management is very challenging due to its progressive and diffuse nature preventing complete correction to normal. Surgical options are either to limit ongoing growth, reduce the size of the digit or correct the deviation, as well as amputation. 3 We present very interesting clinical photographs and plain radiographs of a man aged 68 years with right hand macrodactyly of the thumb and index finger which we believe is the longest follow-up of macrodactyly to be reported in the literature. An attempt to correct his index finger deformity, during childhood, resulted in gangrene to the tip and surgical terminalisation of the index finger was undertaken (figure 1). Despite this, he has maintained full use of this dominant hand. He recently sustained a closed traumatic injury to his right hand and plain radiographs were obtained to rule out any fractures (figures 2 and 3). These demonstrate advanced degenerative changes and fusion across the base of the thumb and carpus and he retained his preinjury function with simple conservative measures.