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Contact the Hand and Orthopedic Upper Extremity Program

Cleft Hand in Children

  • "Our chief surgical goals with cleft hand are to close the cleft, optimize the thumb's function to preserve or enhance grasping, pinching and releasing movements, and improve the hand's appearance."
    –Peter M. Waters, MD, Chief, Orthopedic Center; director, Hand & Orthopedic Upper Extremity Program; director, Brachial Plexus Program, Boston Children's Hospital

    cleft hand

    At Boston Children's Hospital, we understand how concerned you are if your baby was born with a hand deformity called cleft hand. Our Orthopedic Center’s Hand and Orthopedic Upper Extremity Program will approach your child’s condition with care and support—for your child and your whole family.

    • A diagnosis of cleft hand means that your child’s hand is missing finger(s) and may have other deformities, some of which can be classified by type. (
    • Clefts are always central (middle finger[s]) and are usually V-shaped.
    • But they can also be on the thumb (radial) side, less commonly little (ulnar) finger side, or in various combinations.
    • Cleft hands usually occur on both hands (bilateral).
    • But they can also be unilateral, and can include one or both feet.
    • The condition is present and visible at birth (congenital).
    • There’s a clear genetic basis for typical cleft hands.
    • Inheritance of cleft hand is autosomal dominant: This means that if a parent has the condition, the child has a strong chance of having it, too. In cleft hand, that chance is 50 percent.
    • A cleft hand can also occur in isolation, or as part of a genetic syndrome.
    • The condition affects between one in 10,000 and one in 90,000 babies.
    • All affected children, except those with very mild cases, need one or more surgeries, usually starting in their first year of life.
    • Surgery’s first goal is to improve hand function (the ability to grasp, pinch, and let go of objects); this requires the surgeon’s careful attention to the thumb.
    • The second goal is to improve the hand’s appearance.
    • Surgery usually is performed in the child’s first or second year of life.
    • When planning surgery, the surgeon must reconstruct not just the bones of the hand, but also the soft tissues, such as ligaments and nerves.

    How Boston Children's Hospital approaches cleft hand

    You can have peace of mind knowing that the skilled experts in our Orthopedic Center’s Hand and Orthopedic Upper Extremity Program have treated thousands of babies and children with cleft hand and many other hand problems. We provide expert diagnosis, treatment and care, and we benefit from our advanced clinical and scientific research.

    Our Orthopedic Center—one of the first of its kind in the nation—is nationally known as a premiere center for orthopedic care of children and young adults with developmental, congenital, neuromuscular, sports related, traumatic and post-traumatic musculoskeletal problems.

    Cleft hand: Reviewed by Peter M. Waters, MD
    © Boston Children's Hospital, 2012

The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
- Sandra L. Fenwick, President and CEO