Management

The management of symbrachydactyly depends upon the severity of the deficit.

Most short finger forms require no treatment other than hand therapy for stiffness and occasionally, syndactyly release if this is present as an associated finding.

For oligodactylic symbrachydactyly (type 4) - the classical atypical cleft hand with suppressed central digits - the remaining digits may have anatomic features which limit prehension. The little finger can lack a middle phalanx and is frequently deviated in a radial direction. The thumb may have a limited range of motion at the carpometacarpal joint and a single phalanx. Treatment may entail augmentation of existing digits with a free phalangeal transfer from the foot, distraction lengthening of existing bones or the fusion of components of existing digits (an 'on-top plasty'). Alternatively, an existing digit can be transposed into a more radial position to allow pinch grips.

The monodactylous form (type 5) has only a thumb that is often hypoplastic and again has a poor CMCJ. Type 6 and 7 with short peromelic limbs have only nubbins with or without nail remnants on a truncated limb. Augmentation of existing rays may have a minor role to play in these more severe forms eg a free phalangeal transfer if a reasonable thumb metacarpal is present. However, it is more likely that the child will need at least one free microvascular toe transfer. The second toe is usually harvested. If there is a complete absence of functional digits, two toe transfers may be required, one for the thumb and one for a finger ray to allow opposition.