Synpolydactyly: Analysis of Classification and Treatment
Valeriy Shubinets, MD; Benjamin Chang, MD; Ines C Lin, MD, FACS
Children's Hospital of Philadelphia, Philadelphia, PA
Introduction: Synpolydactyly is a rare congenital anomaly characterized by syndactyly and polydactyly in the central hand. Few studies exist on clinical presentation, classification, and treatment of this complex condition. We aim to better characterize synpolydactyly hands and describe our evolution of management over the past 12 years.
Materials and Methods: A retrospective chart review of synpolydactyly patients treated by two senior authors was conducted.
Results: Ten patients with synpolydactyly were identified. Nine patients (90%) had bilateral involvement, which allowed analysis of 19 hands. The majority of hands (15/19) could be categorized according to the recently described classification by Wall et al. Of these, 7 hands had additional features such as 2nd or 4th webspace syndactyly or presence of delta phalanx in non-ring finger P1. Some hands (4/19) could not be assigned a classification type either due to one hand having features of two classification types or not being able to tell where the duplication begins (metacarpal vs. P1). Average number of surgeries for each patient was 2.1, with first surgery usually occurring between 7 and 12 months of age. In four patients, major complications developed consisting of flexion or angulation joint deformities in the digits (greater than 40 degrees). Three patients underwent reoperations to address these complications, including osteotomies or soft-tissue procedures with or without K-wire fixation. In order to mitigate these complications, we changed our approach to involve less aggressive removal of polydactylous components during the initial surgery. In a recent patient, an osteotomy was chosen instead to decrease the width of the digit and improve contour without completely removing the duplicated portion.
Conclusions: Synpolydactyly is a rare congenital hand anomaly with a significant degree of variability in clinical presentation. Following initial operation, complications are common, including joint flexion and angulation deformities in the digits. It is not clear at this time to what degree these complications can be prevented, and we currently favor less aggressive bony resection at the time of syndactyly repair in order to hopefully achieve greater joint stability in the long run. Long-term follow-up and more patients are needed for future study.
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