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Bartsch A, Nikkhah D, Miller R, Mende K, Hovius SER, Kaempfen A. Correction of symbrachydactyly: a systematic review of surgical options. Syst Rev 2023; 12:218. [PMID: 37974291 PMCID: PMC10652478 DOI: 10.1186/s13643-023-02362-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/29/2023] [Indexed: 11/19/2023] Open
Abstract
Symbrachydactyly is a rare congenital malformation of the hand characterized by short or even absent fingers with or without syndactyly, mostly unilaterally present. The hand condition can vary from a small hand to only nubbins on the distal forearm. This study aims to systematically review the surgical management options for symbrachydactyly and compare functional and aesthetic outcomes.The review was performed according to the PRISMA guidelines. Literature was systematically assessed searching the Cochrane Library, PubMed, Embase, and PROSPERO databases up to January 1, 2023. Studies were identified using synonyms for 'symbrachydactyly' and 'treatment'. Inclusion criteria were the report of outcomes after surgical treatment of symbrachydactyly in humans. Studies were excluded if they were written in another language than English, German, or French. Case reports, letters to the editor, studies on animals, cadaveric, in vitro studies, biomechanical reports, surgical technique description, and papers discussing traumatic or oncologic cases were excluded.Twenty-four studies published were included with 539 patients (1037 digit corrections). Only one study included and compared two surgical techniques. The quality of the included studies was assessed using the Modified Coleman Methodology Score and ranged from 25 to 47. The range of motion was the main reported outcome and demonstrated modest results in all surgical techniques. The report on aesthetics of the hand was limited in non-vascularized transfers to 2/8 studies and in vascularized transfers to 5/8 studies, both reporting satisfactory results. On average, there was a foot donor site complication rate of 22% in non-vascularized transfers, compared to 2% in vascularized transfers. The hand-related complication rate of 54% was much higher in the vascularized group than in the non-vascularized transfer with 16%.No uniform strategy to surgically improve symbrachydactyly exists. All discussed techniques show limited functional improvement with considerable complication rates, with the vascularized transfer showing relative high hand-related complications and the non-vascularized transfer showing relative high foot-related complications.There were no high-quality studies, and due to a lack of comparing studies, the data could only be analysed qualitatively. Systematic assessment of studies showed insufficient evidence to determine superiority of any procedure to treat symbrachydactyly due to inadequate study designs and comparative studies. This systematic review was registered at the National Institute for Health Research PROSPERO International Prospective Register of Systematic Reviews number: CRD42020153590 and received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.Level of evidenceI.Systematic review registrationPROSPERO CRD42020153590.
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Affiliation(s)
- A Bartsch
- Paediatric Orthopaedic Surgery, University Children's Hospital Basel, Spitalstr. 33, CH-4056, Basel, Switzerland
- Orthopaedic Surgery and Traumatology, University Hospital Basel, Spitalstr. 21, CH-4031, Basel, Switzerland
| | - D Nikkhah
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust, London, UK
| | - R Miller
- Department of Plastic and Reconstructive Surgery, St George's Hospital, Blackshaw Road, London, SW17 0QT5, UK
| | - K Mende
- Paediatric Orthopaedic Surgery, University Children's Hospital Basel, Spitalstr. 33, CH-4056, Basel, Switzerland
- Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Spitalstr. 21, CH-4031, Basel, Switzerland
| | - S E R Hovius
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - A Kaempfen
- Paediatric Orthopaedic Surgery, University Children's Hospital Basel, Spitalstr. 33, CH-4056, Basel, Switzerland.
- Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Spitalstr. 21, CH-4031, Basel, Switzerland.
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Gabor N, Satnarine T, King L, Chen Chen K, Alvarez P. Type 3A Symbrachydactyly in a Newborn Female: A Case Report. Cureus 2023; 15:e41958. [PMID: 37588332 PMCID: PMC10426809 DOI: 10.7759/cureus.41958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 08/18/2023] Open
Abstract
Symbrachydactyly is a complex and rare congenital hand deformity characterized by missing or underdeveloped fingers and rudimentary digit nubbins. This case report focuses on a newborn female with type 3A symbrachydactyly, highlighting the unique clinical presentation, diagnostic assessment, and initial management approach. The rarity of this condition underscores the need for sharing cases to enhance understanding and treatment strategies. Various classification systems exist, contributing to the challenge of accurately categorizing symbrachydactyly. Surgical interventions play a crucial role in restoring hand function and appearance, with treatment choices tailored to individual evaluation and goals. Early surgical intervention is often necessary to improve outcomes, and nonvascularized toe phalangeal transfers have shown promising results. Further research is required to uncover the underlying cause and pathogenesis of symbrachydactyly, enabling more targeted and effective treatment approaches. This case report contributes to the existing knowledge and management of this uncommon congenital anomaly, emphasizing the importance of sharing and studying such cases for improved patient care.
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Affiliation(s)
- Noah Gabor
- Pediatrics, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Travis Satnarine
- Pediatrics, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Laurent King
- Pediatrics, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Karen Chen Chen
- Pediatrics, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Patricia Alvarez
- Pediatrics, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
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Sapage R, Rosa J, Pereira EC, Silva MS, Pereira A, Silva C. Free Non-vascularized Toe Phalangeal Transfers in Symbrachydactyly: Outcome Analysis. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2020. [DOI: 10.1055/s-0040-1718456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Abstract
Introduction Free nonvascularized toe phalangeal transfer is an established surgical option for the reconstruction of hypoplastic digits. The purpose of the present study was to evaluate our experience with this procedure and to assess bone growth and digit function as well foot morbidity.
Material and Methods We retrospectively evaluated the clinical records for all children with symbrachydactyly submitted to free nonvascularized toe phalangeal transfer between 2002 and 2017. A total of 8 patients were included. We summoned the patients to an appointment to clinically assess the range of motion, the stability, and the alignment of the neo-joint. We radiographically measured the final length and the expected percentage of growth of the transferred phalanx. We also evaluated the foot for comorbidities.
Results The mean age at the time of the first surgery was 19 months (range: 8–42 months). A total of 20 phalanges were harvested: 16 total proximal phalanges, 2 middle phalanges, 1 subtotal proximal phalanx, and 1 accessory thumb phalanx. The distal part of one proximal phalanx was trimmed because the skin pocket was too tight. Two patients underwent a secondary procedure to release the syndactyly. One transfer required revision surgery due to distal tip necrosis and exposition of the transferred phalanx. In the present series, the overall clinical and radiographic outcomes were compatible to those reported in other studies.
Discussion The main limitation of the nonvascularized toe phalanx transfer is the preexisting soft tissue envelope of the finger and the limited growth potential of the transferred bone.
Conclusion Irrespective of the amount of growth achieved in the transferred phalanx, the actual transfer and growth attained should not be viewed as the end result, but rather as a means of providing a stable and functional joint.
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Affiliation(s)
- Rita Sapage
- Orthopedics and Traumatology Service, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - João Rosa
- Orthopedics and Traumatology Service, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Eva Campos Pereira
- Orthopedics and Traumatology Service, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Marta Santos Silva
- Orthopedics and Traumatology Service, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Alexandre Pereira
- Orthopedics and Traumatology Service, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - César Silva
- Orthopedics and Traumatology Service, Centro Hospitalar Universitário do Porto, Porto, Portugal
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