Journal of the American Academy of Orthopaedic Surgeons
Author: Robert C. Kramer, MD, David H. Hildreth, MD, Marke R. Brinker, MD, James B. Bennet, MD, Lori Thompson, OTR, Rober M. Lumsden, MD, and Thomas E. Cain, MD
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Congenital upper extremity syndactyly is a common feature of 28 syndromes and occurs at a rate of one per 2,000-2,500 live births (5). At least 50% of all cases are bilateral (5,6.10). Congenital syndactyly is the result of incomplete separation of digital rays during the sixth to eighth week of gestational development (2,3,5-7). Syndactyly can occur as a feature of a syndrome (syndromic syndactyly) or as an isolated eotity (idiopathic syndactyly). Idiopathic forms can be inherited as autosomal dominant traits or can occur as a result of constriction bands in utero (5,6,10). During the past 20 yea". several authors have attempted to study the function of hand, after syndactyly release (2.4.13). No studies. to Ollr knowledge. h.". addressed the functional results after syndactyl), release by using a patient's own, nonoperated-on contralateral hand as a control. Further, we found no studies that use sophisticated occupational-therapy modalities 10 assess functional outcome. This study attempts to compare functional outcome after syndactyly release in two populations: one population of patients with syndactyly as result of Poland's syndrome and one population of patients with idiopathic forms of syndactyly.
MATERIALS AND METHODS
We performed a retrospective review to determine the outcomes of children having undergone syndactyly release at the Shriners Hospital for Children, Houston Unit, between January 1983 and January 199~. Included in the study were all patients having undergone finger syndactyly release in one hand who had a nonnal contralateral upper extremity. Excluded from the study was any patient having undergone hand surgery in either hand unrelaled to syndactyly. and any patient on the waiting list for failure syndactyly releases. Twenty-seven patients met our strict inclusion criteria and were candidates for this study. Of these. 14 patients were seen and examined, and I3 patients were lost 10 follow-up. One patient was seen for follow-up but was unable to cooperate with the examination; therefore. data on 13 patients were collected and analyzed. Of the 13. six (46%) had a diagnosis of Poland's syndrome. and seven (54'k) had idiopathic forms of syndactyl),. All of the examinations were performed by one physician (R.C.K.), Demographic data were recorded from the medical record. There "ere nine boy, and four girls. All patients exhibited nonoperated-on hand dominance except one. Six patients had Poland', syndrome (symbrachydaclyly).