Syndactyly is a congenital pathology of the newborn, which manifests itself in the fused fingers of a child. This disease is quite rare; boys are more susceptible to the pathology than girls. Syndactyly creates a clear cosmetic defect and requires treatment. In addition, fused toes can cause foot deformities in the future, so surgery to separate the toes is still recommended. In some cases, the operation is not performed, since the fused fingers do not threaten the normal development of the child.
Kinds
Fused toes can be of several types:
- Zygodactyly is a webbed fusion of the second and third toes, in some cases the third and fourth toes are fused, and in more rare cases 3 or more toes are fused.
- The second type is called synpolydactyly and is characterized by the bifurcation of the little toe and fusion with the fourth toe. In this case, disturbances occur in the skin of the sole and anomalies of the middle phalanges of the feet.
- The third type occurs when the fingers grow together.
- The fourth type, or Gaza syndactyly, affects only the hands, in which case complete fusion of the fingers occurs.
- The fifth type is characterized by skin fusion of the second and third toes, and the fingers may also be affected.
Additionally, the area that connects the fused toes may be webbed, skin, or bone. Bone adhesions are a more severe condition than cutaneous and membranous adhesions.
Fusion of fingers Also, fusion of fingers can be incomplete or complete. By incomplete we mean a condition when the fingers are not completely fused, but when fully fused, all phalanges are affected up to the nail plates. Incomplete pathology is divided into basal and terminal. in the first case, the skin grows together in the area of the joints, and in the second, the terminal phalanges of the fingers grow together.
How does the defect develop?
Why do the toes have fused toes, and how can we explain this development of the limbs? The formation of the unborn child’s foot occurs in the 5th week of intrauterine development. It is at this time that the fetus can develop physiological syndactyly.
In the absence of a defect, fingers are formed already in the 7th week. This occurs due to the growth of the digital rays and the slowing down of the development of the interdigital spaces. If the reduction of the interdigital septa is impaired, then the phalanges do not separate, that is, syndactyly occurs.
Causes
Fused toes are associated with a disorder in embryonic development. In the embryo, all the fingers are fused, but over time they form correctly and separate, then the child is born healthy with normal fingers. But in some cases, the separation of the fingers does not proceed correctly and some of them remain fused. As a rule, such an anomaly is associated with a number of negative factors affecting the fetus. This may be a hereditary predisposition, maternal infections, medication, poor nutrition. It is impossible to name the exact cause of the pathology, but it was noted that the risk of syndactyly increases significantly if the mother underwent fluoroscopy in the early stages of pregnancy, and was also exposed to harmful toxic substances or suffered from infectious diseases in the first trimester. Taking drugs during pregnancy plays an important role, since such substances disrupt the development of the fetus, causing a slowdown in the formation of arms, legs, and internal organs. In this case, the fusion of the fingers can be very severe, flipper-like and accompanied by deformation of the limbs.
Why is the development of fetal limbs impaired?
The content of the article
There are many reasons for the appearance of children with such deformities:
- Hereditary factors
. Diseases that cause skeletal deformities are hereditary. An example is achondroplasia - dwarfism caused by underdevelopment and shortening of the legs and arms. In popular programs about the Roloff family, a typical case is shown when people with achondroplasia first have a son, and then a grandson with such a deviation. - Genetic malfunctions
that arose during the process of fertilization or in the first stages of the baby’s development. The cause of deviations can be infections, even common flu, TORH infections - rubella, herpes, cytomegalovirus, toxoplasmosis. It is especially dangerous if the expectant mother had an infection at the beginning of pregnancy. - Taking certain medications.
The most striking example is the thalidomide disaster - the birth in Europe in 1959-1962. 12 thousand children with underdevelopment of limbs. Their mothers were prescribed the anti-anxiety drug thalidomide during pregnancy. Such drugs include antidepressants, drugs that affect blood clotting, some antibiotics, and retinoids used to treat acne. Tragedy happens when an expectant mother takes medication without knowing that she is pregnant or the doctor prescribes a drug that is contraindicated for pregnant women. - Bad habits and harmful working conditions that
affect heredity. Substances that cause deformities are called teratogenic. These include compounds of arsenic, lithium and lead. Radiation exposure also leads to congenital anomalies. Children with abnormal bone development are born to mothers who abuse alcohol and use drugs. Since hazardous substances and radiation affect the eggs in a woman's body, problems may arise in women who once worked in hazardous industries.
Patients belonging to these groups require careful ultrasound monitoring throughout pregnancy.
Symptoms
The disease has no symptoms, except for an obvious cosmetic defect - two fused toes. Most often, the pathology is observed in the area of the second and third toes, others are rarely affected, in severe cases it is even possible to affect all toes, but this is extremely rare. In some cases, the disease occurs on one leg, in others both limbs are affected symmetrically. There may also be a further disturbance in the development of the fingers, in one case they become thinner and deformed, in others they become shortened, but this does not always happen; correct and symmetrical development of fused fingers is quite possible. The function of the foot may be impaired if the toes are fused with a bone membrane; in this case, movements are impaired and the child cannot walk and develop normally. This condition can even affect speech development, and in rare cases, mental development. As a result, a person in the future has difficulties with learning and finding work due to developmental disorders. If the fusion of the fingers is cutaneous or membranous, then such complications usually do not arise, since there is no disturbance in the motor activity of the fingers, the function of the foot is not impaired, and there are no delays in the development of the child in the future. But in some cases, complications are still possible.
What malformations of the limbs are visible on ultrasound?
The baby's bones are visible in the early stages of pregnancy - the femur and humerus - from 10 weeks, the bones of the legs and forearm - from 10 weeks. At this time, you can already count the fingers, see most of the bones of the skeleton and watch how the child moves his arms and legs. It is during this period that the first fetal screenings are carried out.
At 16 weeks, just from the moment of the second screening, the length of large bones can be measured, assessing the development of the fetus. The size and shape of the limbs are taken into account. A slight curvature of the legs is not an anomaly, but severe deformation is a sign of pathology.
All other parts of the skeleton - the spine, ribs, cranial bones must be correctly developed and not deformed.
The dimensions of the child’s limb bones are shown in the table. It is worth understanding that the indicators are averaged, because Each baby develops individually. The dimensions of the limbs are assessed together with other indicators. Small children have shorter arms and legs than large children.
| Duration, weeks | Shin | Hip | Forearm | Shoulder |
| 11-12 | — | 5,6-7,3 | — | — |
| 13-14 | — | 9,4-12,4 | — | — |
| 15-16 | 15,0-18,0 | 16,3-20,0 | 12,0-15,0 | 15,0-18,0 |
| 17-18 | 21,0-24,0 | 24,0-27,0 | 18,0-20,0 | 21.0-24,0 |
| 19-20 | 27,0-30,0 | 30,0-33,0 | 23,0-26,0 | 27,0-30,0 |
| 21-22 | 33,0-35,0 | 36,0-39,0 | 20,0-30,0 | 30,0-35,0 |
| 23-24 | 38,0-40,0 | 41,0-44,0 | 30,0-35,0 | 38,0-40,0 |
| 25-26 | 44,0-46,0 | 46,0-49,0 | 37,0-39,0 | 43,0-45,0 |
| 27-28 | 47,0-49,0 | 51,0-53,0 | 41,0-43,0 | 47,0-49,0 |
| 29-30 | 51,0-53,0 | 55,0-57,0 | 43,0-44,0 | 49,0-51,0 |
| 31-32 | 55,0-56,0 | 59,0-61,0 | 48,0-49,0 | 55,0 |
| 33-34 | 58,0-60,0 | 63,0-65,0 | 50,0-52,0 | 58,0-59,0 |
| 35-36 | 61,0-63,0 | 67,0-69,0 | 54,0-55,0 | 61,0-62,0 |
| 37-38 | 64,0-65,0 | 71,0-73,0 | 55,0-56,0 | 63,0-64,0 |
| 39-40 | 66,0-67,0 | 74,0-75,0 | 57,0-58,0 | 65,0-66,0 |
Diagnostics
The disease is usually diagnosed in the maternity hospital, immediately after the birth of the child. The pathology is visible to the naked eye, so it is not difficult for a neonatologist to identify the disorder. The little patient and his mother are sent for a consultation with a geneticist to check the child for the presence of chromosomal pathologies. Next, the child will have to be constantly monitored by an orthopedist and surgeon. Doctors send the child for x-rays and ultrasound to identify the type of fusion in order to select the correct treatment tactics. Research will help to see the condition of bones and joints and prevent their destruction in the future.
Defect classification
In orthopedics, syndactyly is classified taking into account the length, type of fusion, and the condition of the fingers.
Currently there are:
- bone shape (if bone adhesion occurs);
- soft tissue form (sometimes membranous and skin).
Classification of the defect by length depends on the number of fused phalanges and the length of the fusion.
As for the condition of fused fingers, syndactyly can be complex or simple. In the latter case, fusion of normal fingers occurs, and in the first case, with anomalies of the bone, articular, tendon or ligamentous apparatus.
Treatment
The disease can only be treated surgically; no ointments or folk remedies can get rid of finger fusion; there is absolutely no point in using them. If a child has fusion of the fingers, it is necessary to visit an orthopedist and undergo an examination, and if necessary, the doctor will prescribe surgery. The following types of surgical intervention exist:
- Separation of fingers without plastic surgery;
- Separation with plastic surgery in which a skin graft may be used.
- Separation with plastic surgery in which only local skin is used.
- It is also possible to have an operation that combines all types of surgical interventions at once.
Usually only the fingers are separated, as they create an obvious cosmetic defect. In most cases, toes are not operated on if they do not have a negative impact on the child’s development, he walks normally, and there are no delays. In cases where syndactyly on the legs has a negative impact on the development of the child, surgical intervention is indicated. The purpose of the operation is not only to eliminate the cosmetic defect, but also to restore the function of the foot in order to prevent its further deformation. The age of the operation depends on the type of pathology; as a rule, the appointment is made by a doctor. The most optimal age for surgical treatment of fused fingers is 5 years, but when the extreme phalanges are fused, such a delay will certainly lead to secondary deformation, because the fingers grow unevenly. For this reason, surgery is prescribed before the age of one year. If you don't separate your fingers in time, the consequences will be sad. The patient will begin to experience constant pain when walking, lameness, and will constantly have to wear ugly and unfashionable orthopedic shoes in order to slightly normalize the gait and alleviate the condition.
Rehabilitation
After the operation, a rehabilitation period begins, the fingers are immobilized, and special silicone gaskets are inserted between them so that the fingers do not grow together again. The duration of immobilization can be up to 3 months.
After surgery In the first days after surgery, severe pain is observed, so the patient is prescribed painkillers. To prevent infection after surgery, antibiotics are indicated, which the doctor prescribes individually, taking into account the patient’s age. After 2 weeks, when the wounds have healed, the doctor prescribes physiotherapeutic treatment. This includes the following procedures:
- exercise therapy;
- Massage;
- Electrophoresis;
- Ultrasound treatment;
- Compresses with medicines, etc.
The patient is most often discharged from the hospital on the same day or the next day after surgery, if no complications arise. The child spends the rehabilitation course at home, during which time parents must follow all the specialist’s recommendations and give the child the necessary medications. Despite the child's complaints, it is forbidden to remove the finger separators, even at night, as the fingers may grow back together. In addition, for the first month after the operation you need to remain calm and not disturb the sore leg again. The fused leg must be taken care of, especially after surgery. It is allowed to begin active movements and physical therapy when the wounds have completely healed and the pain has passed.
Postoperative period
Immediately after recovery from anesthesia, the surgeon applies a removable plaster splint designed to immobilize the fingers on the operated limb. You need to wear it for 2-4 months.
In special cases, it may be necessary to additionally wear a finger spacer to prevent re-fusion of the sutures.
In the first few days after surgery, the baby requires special care (regular changes of bandages, application of healing ointments to the wound) and medications (antibiotics, painkillers).
4 weeks after surgery, after the wound has healed, you can begin a course of restorative treatment aimed at normalizing the functioning of the limb:
- massage of the limb by a specialist to improve tone;
- Exercise therapy with a trainer;
- ultraphonophoresis;
- electrical stimulation of muscles;
- applications on limbs of mud, paraffin, ozokerite.
Forecast
With timely treatment, the prognosis is quite favorable.
If necessary, a surgical operation is prescribed during which the function of the foot is completely restored and in adulthood the child no longer remembers the problem, nothing bothers him. If syndactyly in a particular case does not pose a danger and does not impair the function of the foot, then the operation may not be performed. In this case, no violations are observed other than a cosmetic defect. If the operation was not performed, but there is a dysfunction of the foot, the consequences can be dire. At an older age, a change in gait is observed, the child limps, the legs constantly hurt, flat feet occur, which causes the ankle, knee and hip joints to suffer in adulthood. To avoid serious complications, the child should be shown to an orthopedic surgeon while still a small child and treated according to the plan drawn up by the doctor. It is possible that no operation will be needed at all, but you must make sure of this by taking tests. Share:
Surgical approaches
The following surgical approaches may be used during surgery:
- separation of fused fingers with skin grafting using local tissues;
- separation of the membranous fusion without skin grafting;
- separation of fused fingers, which is complemented by combined skin grafting using free autografts and local tissues;
- separation of fused fingers, which is complemented by free skin grafting with a full-thickness or split skin flap;
- multi-stage interventions with tendon-muscular, skin and bone plastics.
At what age should syndactyly be operated on?
Previously, many surgeons recommended operating on syndactyly after 2 years of age; it was believed that this reduced the risk of repeated operations associated with the child’s growth. However, now there is no longer such a clear opinion about the need for surgery only after 2 years of age. It is in the period from 6 months to 2 years that the child begins to develop a stereotype of using a brush, and for further development it is desirable that the child spend as little time as possible consciously using a deformed brush. Approaches to surgery and the design of skin incisions have changed; the means of optical magnification under which hand surgeons operate have become more frequently used and more sophisticated. Therefore, a timely consultation with a hand surgeon will help you correctly determine the age at which treatment will be necessary for your baby.