Syndactyly is fusion of two digits and occurs due to failure of differentiation between adjacent digits. Syndactyly is the most common congenital anomaly of the hand, occurring once in every 2000 births. Involvement is bilateral and symmetrical in about 50 percent of cases.
Syndactyly occurs in all fingers. An incidence of occurrence in decreasing order of frequency is given below
- Between the middle and ring fingers (57 percent)
- Lttle and ring fingers (27 percent)
- Middle and index fingers (14 percent)
- Thumb and index fingers (3 percent)
Males are affected twice as often as females.
Inheritance
Syndactyly is sporadic, occurring spontaneously in about 80 percent of cases. In the familial cases, especially with fusion between the long and ring fingers, the trait appears to be autosomal dominant.
Classification
Syndactyly is classified according to the degree of webbing and the presence or absence of bony fusion.
In complete syndactyly the skin interconnection extends to the tips of the involved digits. The fingernail may be common to both.
In incomplete syndactyly the web does not reach the fingertip, stopping at any point between the normal commissure and the finger ends.
Syndactyly may be simple or complex.
In simple syndactyly the web contains only skin and soft tissue; there is no bony fusion.
In complex syndactyly there is osseous connection between the digits to a varying degree.
In complex syndactyly there may be abnormalities of nerves, vessels, and tendons.
Syndactyly may be associated with a multitude of other malformations and syndromes.
Treatment
The objective of surgery is to separate the webbed fingers so that they can be spread normally and to improve function and appearance.
The timing of surgery is important and depends on the fingers involved and the degree of completeness and complexity of syndactyly.
Fingers of unequal length, such as thumb and index fingers or little and ring fingers, should be separated early in life because the longer finger will develop lateral deviation and flexion contracture.
As a rule, thumb-index finger syndactyly should be separated by six months of age, and ring-little finger syndactyly before one year of age.
It is best to separate the index and middle fingers at about one year of age.
The middle and ring fingers are almost even in length and one can wait until the child is two or three years of age.
While awaiting the appropriate age for surgery, parents are instructed to perform massage and stretching exercises to widen the skin web between the digits and maintain range of motion of the interphalangeal joints.
When there is syndacyly of three digits, one should stage the operations and separate the webbed fingers at different sessions, preferably at intervals of three months.
This is done to avoid circulatory insult to the finger which is in the middle.
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