INTRODUCTION
Syndactyly is the fusion or reduction of adjacent
digits, more common between toes than fingers. The
extent of this fusion varies from a fusion of the
soft tissues only (cutaneous syndactyly) to fusion
of the bone (synostosis or osseous syndactyly). Syndactyly
can be isolated or occur as part of a syndrome such
as acrocephalosyndactyly (e.g. Apert syndrome) or
triploidy. Some families are affected by an autosomal
dominant isolated syndactyly. A severe form is lobster
claw or split hand/foot syndrome (ectrodactyly).
Polydactyly is the presence of extra digits on
the hands or feet. The extent can vary from a fleshy
protrusion to complete duplication of a digit. Polydactyly
can be isolated; an autosomal dominant form exists
in some families, or occur as part of a syndrome
such as short rib-polydactyly syndrome. There are
many sub-classifications of this anomaly but the
two major subgroups are preaxial and postaxial. Pre-axial
polydactyly occurs on the side of the thumb or big
toe. Post-axial polydactyly is relatively more common
and occurs on the side of the little finger or lateral
side the foot and in association with trisomy 13.
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ANTENATAL
Syndactyly and polydactyly are potentially both
visible on ultrasound, although good views depend
both upon the position of the fetus and the volume
of liquor, with reduced liquor severely limiting
the ability to see the extremities well. The best
view to detect these anomalies is by examining a
fully splayed hand but this may not always be possible.
Plantar views of the foot or a section across the
hand in axial plane may be diagnostic. Because both
defects occur as part of other syndromes, the detection
by ultrasound of syndactyly or polydactyly should
be followed by a detailed scan for other malformations.
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POSTNATAL
The cosmetic and functional outcomes for syndactyly
depend on the extent of the skeletal anomaly. If
the digits are normal, separation with skin grafts
takes place in childhood, however if a short finger
is distorting a long finger earlier surgical intervention
may be necessary. If other skeletal anomalies are
present, separation should only be undertaken if
a good functional result can be achieved.
Simple fleshy additional digits can be excised
early providing a good cosmetic outcome. If the digit
is fixed with tendons, the hand or foot must be adequately
grown to allow dissection and reconstruction without
affecting the growth or function of the remaining
digits.
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WEST MIDLANDS
DATA
To be added
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