(A) Syndactyly

– Webbing of two or more finger.

– An abnormal connection of 2 fingers.

– Most commonly occurs between middle and ring finger.

– Webbing can involve entire fingers or just involve part of finger.

– It can involve skin or bone.

• Classification

1) Incomplete

– Webbing doesn’t extend all the way to finger tips .

2) Complete

– Webbing extends all the way to fingertips.

3) Simple

– Joined only by soft tissue

4) Complex

– Fingers joined by bone / bony cartilage, and soft tissue

• Function and appearance.

– There will be problem in grabbing large objects / grabbing circular objects.

– Hand looks different with Syndactyly and may lead to stress and decreases self esteem.

• Management

√ Surgical management

– Syndactyly involving thumb and pointer finger or king and small finger : early surgery by 6 month is done.

– Other Syndactyly : surgery is done between 12-18 months of age.

– Syndactyly is reconstructed through series of flaps .

– New skin must be bought between fingers.

– Placing bulky soft dressings until 4 weeks after surgery is important and then start the therapy.

– Importance of therapy : it will keep the scars soft and helps to regain motion.

(B) Polydactyly

– It is a condition where a person is born with an extra finger / toe on one or both of the hands and feet.

– It can be ,

√ small and raised lump of soft tissue connects no bones

√ Partially formed finger or toe containing some bones but not joints.

√ Fully functioning finger or toe with soft tissue , bone and joints.

• Types

1) Ulnar / postaxial Polydactyly / small finger duplication

– Extra finger is on outside the little finger.

– When this form of condition affects toes , it is called fibular Polydactyly.

2) Radial / Preaxial / thumb duplication

– Extra finger on outside of the thumb.

– when it affects toes called as tibial Polydactyly.

3) Central Polydactyly

– Extra finger is attached to ring , middle or most oftenly index finger.

* Polydactyly can be associated with a genetic condition / syndrome.

• Treatment

(1) Little finger duplication

– May not require treatment

– It doesn’t affect use of hand but treatment can be done for cosmetic reasons

– If an extra little finger is partially formed : it can be removed easily but if it is fully formed / functional it may require surgery.

(2) Thumb duplication.

– Treatment is complicated

– Extra thumb may affects the function of other fingers

– Surgery is needed

(3) Central Polydactyly

– Keeping additional central finger and operating in tendons and ligaments to avoid deformities

– Removing an extra central finger and reconstructing the one it is attached.

– Removing both fingers and reconstruction of one new finger.

(C) Ectrodactyly

– Formation of Split hand or split foot.

– Genetic disorder characterized by complete or partial absence of some clefts in hands or feet.

– Appearance of webbing between fingers or toes , claw like appearance can also be present.

• Types

– Lobster claw variety : Absence of third digit

– 2 nd variety of split hand deformity : Presence of only 5 th digit and no cleft.

* Typical cleft hand

– Bilateral deep ‘V’ shaped central defect.

– Partial or complete absence of middle finger.

– Thumb may be involved.

– Associated cleft lip or palate

– No chest wall involvement is seen.

– No finger nubbing.

* Atypical cleft hand

– Unilateral shallow ‘U’ shaped defect.

– No associated cleft feet.

– thumb is rarely involved .

– There is no association with cleft lip / palate.

– Finger nabbins may occur.

• Manske’s classification of cleft hand

√ Type 1 : Normal first web

√ Type 2 : A – mild narrowed web .

                 B – Severly narrowed web

√ Type 3 : Syndactylised web

√ Type 4 : merged web

√ Type 5 : Absent web.

                 A – partial supression of radial ray

               B – complete supression if radial ray.

• Treatment

– Cleft hand treatment is usually invasive and can differ each time because of heterogeneity of condition.

√ Surgical treatment

– Based on several indications

Improving function

Absent thumb

Deforming Syndactyly

Transverse bones

Narrowed first web space

Reducing deformity.




Leave a Comment

Your email address will not be published. Required fields are marked *

Scroll to Top