Surgical treatment of polydactyly and syndactyly during the 4th century AD.

INTRODUCTION: Polydactyly, or polydactylism, is a common congenital disorder of the limbs, consisting of any digit duplication beyond the normal five. The term syndactyly refers to fused digits. We herein present a thorough description of these diseases together with their surgical treatment, provided by Oribasius, a Byzantine physician of the 4th century. To our knowledge, this is the earliest description of supernumerary and fused fingers and their surgical management. MATERIAL AND METHODS: We conducted a thorough study of Oribasius' work. RESULTS: The 15th chapter of the 47th book of Oribasius' work is devoted to finger abnormalities (i.e. polydactyly and syndactyly) and their surgical treatment. DISCUSSION: With regard to the extensive medical knowledge of the 4th century as survived in Oribasius' work, these descriptions comprise, to the best of our knowledge, the earliest written references to the surgical treatment of polydactyly and syndactyly.

Prehistoric polydactylism: Biological evidence and rock art representation from the Atacama Desert in northern Chile.

A review of the bioarchaeological collections from the site Morro de Arica in northern Chile allowed the identification of two cases of human polydactyly. Both cases are from the Chinchorro culture, hunters, fishers, and gatherers with a maritime orientation who inhabited the coast of the Atacama Desert (9000-3400 BP). Additionally, the analyses of 75 rock art sites in the area, from the Formative to Late Intermediate Periods (3000-550 BP), allowed the identification of hands and feet with six digits. Given the bioarchaeological record of polydactyly, it is highly probable that the rock art images were based on real individuals with polydactyly. However, the Sr chemical signal in a juvenile with polydactyly is the same as the Sr chemical signal in the rest of the individuals buried in the same site, proving that all the individuals were born and lived on the coast. We discuss the idea that, although these anomalies could have been the result of genetic mutations, endogamy and exposition to ecotoxic environments could also be at play within the Chinchorro groups.

Polydactyly suggesting local husbandry of Pre-Columbian camelids: A case from Castillo de Huarmey archaeological site, northern coast of Peru.

Three camelid metapodials with polydactyly (additional digits) were found at the Wari culture archaeological site (dated to the Middle Horizon) of Castillo de Huarmey. The anomalous bones were excavated among numerous remains, and presumably represent animals that were sacrificed within the principal mortuary mausoleum. The bones derive from at least two individuals. The etiology of the deformities remains unknown, but the most probable causes include low genetic diversity in the herd or unintended effect of selective breeding. The likelihood of impaired locomotion suggests birth and rearing within the site vicinity. The animals were juvenile, apparently killed around the age of sexual maturity, when they would have attained maximum body mass. Purposeful funerary proceedings with deformed animals suggest (at least) a locally developed camelid husbandry.

Paul of Aegina (ca 625-690 AD), and his orthopaedic surgical reconstruction of the preternatural fingers.

Paul of Aegina lived in a era when the preservation of the ancient Greek tradition was for him almost a necessity. Eager to follow the dogma of "oρθoπo(ε)δώ" (orthopodo: pace with no malformation), he introduced a series of surgical operations of reconstructive-cosmetic-plastic-orthopaedic nature to confront any disfiguration of the human body. The aim of our study is to present the atmosphere of the era concerning the congenital malformations, describe briefly Paul's contribution on classic orthopaedics and present his views on the preternatural fingers. Our methodology mainly included the indexing of Paul's treatise, as published by the Sydenham Society during the nineteenth century, while references from the ancient Greek scholars were added to compose a better understanding of Paul's views. Inside his seven book treatise "Medical Compendium", he dedicated a separate chapter "On preternatural fingers, and on persons having six fingers", to introduce a detailed description of the extremities' additional digits and propose surgical treatment for their correction. He classified polydactylism according both to the presence of bones and to the anatomical origin of each additional finger. Paul marked the beginning of a new era for orthopaedics.

Clinical study of 459 polydactyly cases in China, 2010 to 2014.

Polydactyly is one of the most common hereditary limb malformations, involving additional digits on the hands and/or feet, which is a very attractive model to appreciate clinical and genetic heterogeneity. A high level of heterogeneity in polydactyly has been identified in different regions. However, such data of the medical literatures for Asian populations are relatively limited. This study was intended to shed light on the phenotypic manifestations of polydactyly in the recruited Chinese population and to characterize the medical literature on this condition. A total of 459 well-characterized polydactyly cases from Shanghai Children's Medical Center were recruited. Their phenotypes, inheritance patterns, and clinical heterogeneity were obtained from clinical medical records. It was found that 4.8% of cases were familial and 95.2% were sporadic. The proportions of preaxial and postaxial polydactyly types were 74.7% and 25.3%, respectively. In preaxial polydactyly, type I formed the overwhelming majority (95.9%). Among the postaxial polydactyly cases, type A was most prevalent at 69.8% and type B was witnessed in 30.2% of cases. Familial and sporadic polydactyly patients mainly had unilateral presentations. A total of 583 limbs with additional digits were recorded in the 459 subjects. Upper limb involvement was more common than lower, and right hand involvement was more common than left for preaxial polydactyly, and lower limb involvement was more common than upper in postaxial polydactyly. This cohort added useful clinical/epidemiological information to the polydactyly literature in the Chinese population and highlighted its marked clinical heterogeneity.

Foot polydactyly and bipartite medial cuneiform: A case of co-occurrence in a Celtic skeleton from Verona (Italy).

We report a case of bilateral foot polydactyly and bipartite medial cuneiform in a male individual buried in a Celtic/Roman necropolis (3rd to 1st century BCE) in the city of Verona (Italy). During the construction of an underground garage in the main courtyard of the Bishop's Seminary at Verona between 2005 and 2010, archaeologists uncovered the remains of 174 individuals (108 non-adults and 66 adults). It is thought that these graves could belong to some of the first inhabitants of the urban area of Verona. The individual presented here (US 2807) is a middle-aged male (40-50 years) in a good state of preservation. His estimated stature is 1756 mm (± 32.1 mm). This male presents congenital anomalies in the feet and dental agenesis. We believe this to be the only known archaeological case of bilateral postaxial polydactyly with forked (Y) shape, in which both fifth metatarsals are associated with complete bipartition of the left medial cuneiform and partial bipartition of the right one. Polydactyly is fairly common in modern clinical cases but bipartite medial cuneiform is relatively rare; neither of these congenital conditions is well documented archaeologically.

A review of supernumerary and absent limbs and digits of the upper limb.

For years people have been enamored by anomalies of the human limbs, particularly supernumerary and absent limbs and digits. Historically, there are a number of examples of such anomalies, including royal families of ancient Chaldea, tribes from Arabia, and examples from across nineteenth century Europe. The development of the upper limbs in a growing embryo is still being elucidated with the recent advent of homeobox genes, but researchers agree that upper limbs develop between stages 12-23 through a complex embryological process. Maternal thalidomide intake during limb development is known to cause limb reduction and subsequent amelia or phocomelia. Additionally, a number of clinical reports have illustrated different limb anomaly cases, with each situation unique in phenotype and developmental abnormality. Supernumerary and absent limbs and digits are not unique to humans, and a number of animal cases have also been reported. This review of the literature illustrates the historical, anatomical, and clinical aspects of supernumerary and absent limbs and digits for the upper limb.

[Polydactyly in the Old Testament]. / Polidactilia en el Antiguo Testamento.

The study of passage 2 Sam 21: 20-21 allows us to assert that the biblical writer registered a case of polydactyly, specifically a hexadactylia of the four limbs. The documental evidence certifies the presence of this orthopedic lesion in ancient times. It is probable that this was a case of post-axial, non crossed and non syndromic polydactyly.