Shared decision making in the treatment of type B ulnar polydactyly: a systematic review and meta-analysis on parental satisfaction and complications.

Abstract

Type B ulnar polydactyly is a common congenital hand anomaly. Treatment options include suture ligation, vascular clip ligation and excision under local or general anaesthesia. However, the optimal treatment remains unclear, and evidence on parental perspectives is limited. This review investigated treatment outcomes for type B ulnar polydactyly, in combination with parental satisfaction and preferences. A systematic search of Embase, Pubmed, Medline, Web of Science and Cochrane Central Register of Controlled Trials was conducted up to March 2025 for studies reporting parental satisfaction with treatment outcome or aesthetic appearance, parental prioritizing factors or complications. Meta-analyses were performed on pooled parent-reported satisfaction scores and complication data. Fourteen studies, comprising 885 patients with 1279 supernumerary digits, met the inclusion criteria. Overall, parental satisfaction was high across all treatments. Excision under local anaesthesia resulted in significantly greater satisfaction on both treatment outcome and aesthetic appearance compared with suture ligation and excision under general anaesthesia. No parent-reported data were available on vascular clip ligation. Parents choosing suture ligation or excision under local anaesthesia mentioned avoiding anaesthesia risks and quick treatment as priorities, while parents selecting excision under general anaesthesia prioritized pain avoidance. The pooled complication rate was lowest for excision under local anaesthesia (0.01) and highest for suture ligation (0.16). Excision under local anaesthesia showed the best results regarding treatment of type B ulnar polydactyly, with the highest parental satisfaction outcomes and lowest complication rates. However, high parental satisfaction was observed in all treatment modalities and differences in outcomes were small. Parents primarily based their treatment choice on avoiding risks (with ligation or local anaesthesia) or avoiding pain (with general anaesthesia). Our results can be used for effective decision making.