Case 59 Syndactyly
59.1 Description
Simple, complete syndactyly involving the ring and small fingers of the left hand
59.2 Work-Up
59.2.1 History
Gestational history and issues during pregnancy
Medical comorbidities and any previous medical work-up
Family history of syndactyly (autosomal dominant with variable expressivity and incomplete penetrance) or associated syndromes (e.g., Poland or Apert syndromes)
Patient’s current handedness and hand function
59.2.2 Physical Examination
Perform total body examination
Evaluate for any craniofacial or chest wall anomalies
Examine feet and contralateral upper extremity to rule out additional syndactylies
Complete upper extremity examination
Assess for extent and location of webbing as well as the number of digits involved
Look for other concurrent deformities (i.e., polydactyly, clinodactyly, brachydactyly, and symphalangism)
Examine contralateral hand for comparison
In children, assess for hand function by evaluating the patient during play
Classification
Simple/Complex
Simple syndactyly: No bony fusion
Complex syndactyly: Bony fusion
Complete/Incomplete
Complete syndactyly: Fused web space extends to fingertips
Incomplete syndactyly: Web space involvement but fingertip and nail are spared
Complicated: Associated with a syndrome
59.2.3 Pertinent Imaging or Diagnostic Studies
Hand three-view X-rays: Image bilateral hands to assess for underlying bony fusion and additional anomalies
59.3 Consultations
Occupational therapy
If indicated: Genetics and cardiology
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