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Polydactyly of Fingers

  • Overview

    Combining training in adult and pediatric orthopedics, hand surgery, plastic surgery and microsurgery allows our surgeons to provide a comprehensive level of care unmatched in most other hospital settings.

    --Donald S. Bae, MD, associate in Orthopedic Surgery, Boston Children's Hospital; Brian I. Labow, MD, principal investigator, Plastic Surgery, Boston Children's Hospital

    Please note: these pages focus primarily on polydactyly of the fingers. For details on polydactyly of the thumb, see thumb duplication.

    If your baby or child has been born with one or more extra fingers (polydactyly), we know that you and your family are concerned. So, please know that at Children’s Hospital Boston, we will approach your child’s treatment and care with sensitivity and support—for your child and your whole family.   

    If your child has polydactyly, it means that he has extra fingers and/or toes.

    • Polydactyly is a fairly common congenital defect that often runs in families. At Children’s, it’s the most common congenital hand problem that we see.
    • If your child has an extra finger, it may occur in any of three places of his hand:
      • on the small finger side—most common (ulnar)
      • on the thumb side, also called thumb duplication—less common (radial)
      • in the middle of the hand—least common (central)
    • The extra fingers are usually smaller than his other fingers and are abnormally developed.
    • Your child’s extra finger can be made up of:
      • skin and soft tissue (most easily removed)
      • skin, soft tissue and bone (no joint—more challenging to remove/remodel)
      • skin, soft tissue and bone with joint (closer to a fully-formed finger—most challenging to remove/remodel)
    • Polydactyly can sometimes be detected by prenatal ultrasound, and is apparent at birth; the underlying structure of the finger and the course for treatment are determined with x-ray.
    • In the United States, polydactyly occurs in one out of 500 to 1,000 newborns. Boys and girls are affected about equally.
    • African-American children are more likely to have polydactyly of on the little finger side; Asians and Caucasians, on the thumb side.
    • Most forms of polydactyly are treated surgically. Surgery is usually done when the child is between 1 and 2 years old and can range from fairly simple to highly complex. Some mild cases can be treated non-surgically.

     

    How Children’s Hospital Boston approaches polydactyly

    You can have peace of mind knowing that the skilled experts in our Orthopedic Center’s Hand and Orthopedic Upper Extremity Program and our Plastic Surgery Department’s Hand and Microsurgery Reconstructive Program have treated thousands of babies and children with hand problems, ranging from the simple to the highly complex. So we can provide your child with expert diagnosis, treatment and care—as well as the benefits of some of the most advanced clinical and scientific research in the world.

    Our Orthopedic Center is nationally known as the preeminent center for the care of children and young adults with a wide range of developmental, congenital, neuromuscular, sports related, traumatic and post-traumatic problems of the musculoskeletal system.

    As one of the largest pediatric plastic surgery centers in the United States, our Department of Pediatric Plastic Surgery provides comprehensive care and treatment for a wide variety of congenital and acquired conditions, including hand deformities.

     

    Polydactyly: Reviewed by Donald Bae, MD, Brian Labow, MD, and Amir Taghinia, MD
    © Children’s Hospital Boston, 2011

    The Hand and Orthopedic Upper Extremity Program provides comprehensive care involving occupational and physical therapy, splinting, casting and reconstructive surgeries for infants, children and adolescents with complex congenital, neuromuscular, sports-related oncologic and traumatic upper limb conditions.
    Boston Children's Hospital
    300 Longwood Avenue
    Fegan 2
    Boston MA 02115

     617-355-6021
     fax: 617-739-1093

    Boston Children's Hospital at Waltham
    9 Hope Avenue
    Waltham MA 02453

     617-355-6021


    Boston Children's North
    10 Centennial Drive
    Peabody MA 01960

     617-355-6021



    The specialists in the Hand and Reconstructive Microsurgery Program at Children's are experts in the management of congenital and acquired hand deformities. We recognize the social elements involved in pediatric hand surgery, so an essential part of these operations has been making the child's hand as symmetrical as possible with his unaffected hand.
    Boston Children's Hospital 
    300 Longwood Avenue
    Hunnewell 1
    Boston MA 02115
     617-355-7252

  • In-Depth

    At Boston Children’s Hospital, our orthopedic and plastic surgery teams know that you’re concerned about your baby’s hand deformity. It might help put your mind at ease to know that we’ve developed innovative surgical and non-surgical treatments for children with all degrees of severity of polydactyly. Learning more about this condition may help you feel more confident and informed as we treat—and work toward—healing your child.


    What is polydactyly?

    Polydactyly is a deformity in which the hand has one or more extra fingers in any of three places of the hand:

    • on the small finger side—most common (ulnar)
    • on the thumb side, also called thumb duplication—less common (radial)
    • in the middle of the hand—least common (central)


    In polydactyly, are there different forms and different degrees of severity?

    The extra fingers are usually smaller and abnormally developed than normal and can be made up of:

    • skin and soft tissue—the simplest to remove
    • skin, soft tissue and bone but no joint—more challenging to remove/remodel
    • skin, soft tissue and bone with joint (closer to a fully-formed finger—most challenging to remove/remodel)


    Are certain ethnic groups predisposed to have a certain type of polydactyly?

    Yes, African-American children are more likely to have an extra little finger, while Asians and Caucasians are more likely to have an extra thumb.
     

    What causes polydactyly?

    During normal embryonic development (while the baby is still in the womb), the hand initially forms in the shape of a paddle, and then—at about the sixth or seventh week of gestation—splits into separate fingers. Polydactyly results if there’s an irregularity in this process: An extra finger forms when a single finger splits in two.

    The vast majority of occurrences of polydactyly are sporadic, meaning that the condition occurs without an apparent cause—but some may be due to a genetic defect or underlying hereditary syndrome. African-Americans are more likely to inherit the condition than other ethnic groups.


    How common is polydactyly?

    Polydactyly is one of the most common congenital hand defects, affecting about one out of every 500 to 1,000 babies. Usually, only one of a child’s hands is affected.
     

    Does polydactyly cause the baby pain?

    No, an extra finger isn’t usually painful.
     

    How is polydactyly diagnosed?

    Polydactyly can be seen by ultrasound prenatally, and by eye at birth. Your doctor will use x-rays to assess the underlying structure of your baby’s finger and determine a course of treatment.
     

    How is polydactyly treated, and at what age?

    Children’s orthopedic surgeons and plastic surgeons usually treat polydactyly by surgically removing the extra finger—typically, when the child is between 1 and 2 years old, young enough that he won’t miss developmental milestones such as grasping (prehension), but late enough that he can tolerate anesthesia and surgery well.

    For details, see Treatment & Care.
     

    What’s the prognosis for my child after surgery for polydactyly?

    The outlook for your child after removal of his extra digit is excellent if it occurs in isolation. Our orthopedic and plastic surgeons have vast experience treating children with polydactyly. If the condition occurs in association with a genetic syndrome, your child’s outlook depends to a large extent on the nature and severity of the syndrome.
     

    Can there be complications after polydactyly surgery?

    Complications after surgery are common but are often minor. Such minor complications include scar formation, stiffness, instability, and late deformity. Most cosmetic or functional deformities can be addressed in later corrective surgery.
     

    Will my child be OK?

    The good news is that after surgery, most of our young patients have full hand function and an improved appearance of their hand. If needed, your child’s team will work with you and your child to learn home exercises that are important to his recovery. He may need to wear a cast in some circumstances. It is possible that in a severe case, your child may need additional reconstructive surgery(ies) to recover full function and improve the hand’s appearance.


    FAQ
     

    Q: What is polydactyly?
    A:
    Polydactyly isa deformity in which a child’s hand has one or more extra fingers in any of three places of the hand:

    • on the small finger side—most common (ulnar)
    • on the thumb side, also called thumb duplication—less common (radial)
    • in the middle of the hand—least common (central)

    Q: What are the signs and symptoms of polydactyly?
    A:
    Polydactyly is visible at birth. It is also usually visible in utero by fetal ultrasound.
     

    Q: How is polydactyly usually diagnosed?
    A:
    Polydactyly can sometimes be seen by ultrasound prenatally, and by eye at birth. Your doctor will use x-rays to assess the underlying structure of the baby’s finger and determine a course of treatment.
     

    Q: How does Children’s treat polydactyly?
    A:
    Except in very mild cases, at Children’s we usually treat this condition by removing the extra digit surgically.

    For treatment details, see Treatment & Care.
     

    Q: If my child has surgery for polydactyly, will he be OK?
    A:
    Most of our young patients have full hand function and an improved appearance of the hand. If needed, your child’s team will work with you and your child to learn home exercises that are important to his recovery. He may need to wear a cast in some circumstances. It is possible that in a severe case, your child may need additional reconstructive surgery(ies) to recover full function and improve the hand’s appearance.

    Q: What is Children’s experience treating polydactyly?
    A:
    The experts in our Orthopedic Center’s Hand and Orthopedic Upper Extremity Program and our Plastic Surgery Department’s Hand and Microsurgery Reconstructive Program have treated thousands of babies and children with hand problems ranging from the simple to the highly complex. So, we can provide your child with expert diagnosis, treatment and care—as well as the benefits of some of the most advanced clinical and scientific research in the world
     

    Causes/risks

    During normal embryonic development (while the baby is still in the womb), the hand initially forms in the shape of a paddle, and then eventually—in about the sixth or seventh week of gestation—splits into separate fingers. Polydactyly results if there’s an irregularity in this process: An extra finger forms when a single finger splits in two.

    The vast majority of occurrences of polydactyly are sporadic, meaning that the condition occurs without an apparent cause—while some may be due to a genetic defect or underlying hereditary syndrome. African-Americans are more likely to inherit the condition than other ethnic groups.


    Signs and symptoms

    Polydactyly is visible at birth. It is also sometimes visible in utero by fetal ultrasound.
     

    When to see a specialist

    Your child’s doctor will know by sight that your baby’s hand has an extra digit. The doctor will refer you to a hand specialist, who will guide you to a more detailed diagnosis and treatment plan.
     

    Questions to ask your doctor

    If your child is diagnosed with polydactyly, you may feel overwhelmed with information. It can be easy to lose track of the questions that occur to you. Lots of parents find it helpful to jot down questions as they arise—that way, when you talk to your child’s doctors, you can be sure that all of your concerns are addressed.

    Some of the questions you may want to ask include:

    • What is happening to my child, and why?
    • What will x-rays reveal?
    • What actions might you take after you review my child’s x-rays?
    • Is surgery necessary? Are there alternative therapies?
    • Will my child be OK after surgery?
    • Will there be restrictions on his activities or capabilities?
    • What will be the long-term effects?
    • What can we do at home?


    Complications

    Complications after surgery are common but often minor. Most remaining cosmetic or functional deformities can be addressed in later corrective surgery.
     

    Long-term outlook

    Most of our young patients recover full hand function and an improved appearance of the hand. If needed, your child’s team will work with you and your child to learn home exercises that are important to his recovery. He may need to wear a cast or splint in some circumstances. It is possible that in a severe case, your child may need additional reconstructive surgery(ies) to recover full function and improve the hand’s appearance.

    Your child may need to be followed for a number of months or years to:

    • ensure that the healing has gone well
    • check that function has returned to your child’s hand
    • determine whether additional surgery is needed to improve the function or appearance of the hand as your child grows
       

    For parents

    It’s natural for parents whose babies are born with polydactyly to feel concern. Your child’s treatment and recovery may be fairly easy. Or, the journey may be more complicated—requiring more than one surgery for your child.

    Even though you understand the importance of surgery and therapy for your child, you still might experience his treatment and recovery as a stressful time. If you feel frustrated or depressed, speak to your doctor or counselor to get help. Professionals in Children’s Center for Families can provide you with important resources and referrals.
     

    Polydactyly glossary

    • The Center for Families at Children’s: dedicated to helping families find the information, services and resources they need to understand their child’s medical condition and take part in their care
    • central polydactyly: an extra finger in the middle of the hand
    • congenital: present at birth
    • embryonic development: development of the fetus in the womb
    • in utero: in the womb (uterus)
    • MRI (magnetic resonance imaging): produces detailed images of organs and structures within the body; does not use ionizing radiation
    • occupational and physical therapy: services offered by trained professionals to help restore function or (re)teach basic life skills, like walking or grasping objects
    • orthopedics: the medical specialty concerned with diagnosing, treating, rehabilitating and preventing disorders and injuries to the spine, skeletal system and associated muscles, joints and ligaments
    • orthopedic surgeon, orthopedist: a physician specializing in surgical and non-surgical treatment of the spine, skeletal system and associated muscles, joins and ligaments
    • prenatal (fetal) ultrasound: ultrasound performed at several stages of pregnancy; can detect polydactyly in the fetus
    • polydactyly: a deformity in which the hand has one or more extra fingers
    • post-operative (post-op): occurring after surgery
    • pre-operative (pre-op): occurring before surgery
    • range of motion (ROM) exercises:physical therapy exercises designed to improve or restore flexion and extension of joints
    • radial (pre-axial) polydactyly: an extra thumb; thumb duplication
    • reconstructive surgery: surgery performed to repair and/or restore a body part to normal or as near normal as possible
    • sporadic: occurring without apparent genetic cause
    • ulnar (post-axial) polydactyly: an extra little finger
    • x-rays: a diagnostic test that uses invisible ionizing radiation to produce images of internal tissues, bones, and organs onto film
  • Tests

    At Children’s Hospital Boston, we understand that the first step to treating your child is obtaining an accurate, timely and thorough diagnosis.

    Polydactyly can sometimes be seen by ultrasound prenatally, and is apparent at birth. Your doctor will use x-rays to assess the underlying structure of your baby’s finger and determine a course of treatment.
     

    Our Orthopedic Clinical Effectiveness Research Center (CERC)

    Children’s Orthopedic Clinical Effectiveness Research Center (CERC) was established by our Orthopedic Center to improve the quality of life for children with musculoskeletal disorders. This collaborative clinical research program is unique in the nation and is playing an instrumental role in establishing, for the first time, evidence-based standards of care for pediatric orthopedic patients throughout the world.
     

    Children’s Hand and Reconstructive Microsurgery Program

    The doctors and staff in the Hand and Microsurgery Reconstructive Program at Children's are recognized experts in the management of congenital and acquired hand deformities.

  • At Boston Children's Hospital, experts in our Orthopedic Center's Hand and Orthopedic Upper Extremity Program and our Plastic Surgery Department's Hand and Microsurgery Reconstructive Program provide comprehensive care—including evaluation, diagnosis, consultation, surgery, non-surgical therapies and follow-up care.

    Our orthopedic surgeons and plastic surgeons usually treat children with polydactyly by surgically removing the extra finger—typically, when the child is between 1 and 2 years old—young enough that he won't miss developmental milestones such as grasping (prehension), but late enough that he can tolerate anesthesia and surgery well.

    • Removing an extra little finger (ulnar polydactyly) can be fairly simple if the extra finger is attached by a narrow “stalk” or “nub” of soft tissue. The extra finger can be removed with a minor procedure or even by tying off (ligating) the nub in the nursery.
    • Removing an extra thumb (radial polydactyly, thumb duplication) can be complex. The thumb is of primary importance in hand function, and radial polydactyly can negatively impact thumb position (angle), shape and function. Removing the extra thumb is sometimes not enough—the procedure can also require remodeling of the remaining thumb, with care and attention to soft tissues, tendons, joints and ligaments. And even after treatment, the reconstructed thumb may be smaller than normal.

      Read more about treatment and care for thumb duplication.
    • Removing an extra central finger (central polydactyly) is typically complex, involving significant reconstruction of the hand, and also taking care with soft tissues, tendons, joints and ligaments. Sometimes more than one surgery is needed.

     

    Complications after surgery

    Complications after surgery are common but often minor. Most remaining cosmetic or functional deformities can be addressed in later corrective surgery.

     

    Caring for your child after surgery

    If the surgery to remove the extra digit is fairly complex, it can also involve your child's bone, ligament and tendon. If that's the case, your child may need to wear a cast for a few weeks. Your doctor may recommend occupational or physical therapy to help reduce scarring, stiffness and swelling and improve function.

     

    Long-term outlook

    Most of our young patients recover full hand function and an improved appearance of their hand. If needed, your child's team will work with you and your child to learn home exercises that are important to his recovery. He may need to wear a cast or splint in some circumstances. It is possible that in a severe case, your child may need additional reconstructive surgery(ies) to recover full function and improve the hand's appearance.

    Your child may need to be followed for a number of months or years to:

    • ensure that the healing has gone well
    • check that function has returned to your child's hand
    • determine whether additional surgery is needed to improve the function or appearance of the hand as your child grows

    Coping and support

    At Boston Children's Hospital, we understand that a hospital visit can be difficult, and sometimes overwhelming. So, we offer many amenities to make your child's—and your own—hospital experience as pleasant as possible. Visit The Center for Families for all you need to know about:

    • getting to Children's
    • accommodations
    • navigating the hospital experience
    • resources that are available for your family

    In particular, we understand that you may have a lot of questions when your child is diagnosed with polydactyly. Will this affect my child long term? Will he be able to play sports and do regular activities? Children's can connect you with extensive resources to help you and your family through this stressful time, including:

    • patient education: From doctor's appointments to physical therapy and recovery, our nurses and physical therapists will be on hand to walk you through your child's treatment and help answer any questions you may have—Why will my child need surgery? Are there non-surgical options? How long will his recovery take? How should we manage home exercises and physical therapy? We'll help you coordinate and continue the care and support your child received while at Children's.
    • parent-to-parent: Want to talk with someone whose child has been treated for polydactyly? We can often put you in touch with other families who've been through the same process that you and your child are facing, and who will share their experiences.
    • faith-based support: If you're in need of spiritual support, we'll connect you with the Children's chaplaincy. Our program includes nearly a dozen clergy— representing Protestant, Jewish, Muslim, Roman Catholic and other faith traditions—who will listen to you, pray with you and help you observe your own faith practices during your hospital experience.
    • social work: Our social workers and mental health clinicians have helped many families in your situation. We can offer counseling and assistance with issues such as coping with your child's diagnosis, stresses relating to coping with illness and dealing with financial difficulties.


    The Experience Journal

    Designed by Children's psychiatrist-in-chief David DeMaso, MD, and members of his team, the Experience Journal is an online collection of thoughts, reflections and advice from kids, parents and other caregivers about a variety of medical experiences, including hip problems.

  • Research & Innovation

    The Orthopedic Center's Hand and Orthopedic Upper Extremity Program is dedicated to the comprehensive care of all upper limb conditions in infants, children and adolescents. Under the direction of Peter M. Waters, MD and Donald S. Bae, MD, patients with congenital, neuromuscular, sports-related, oncologic and traumatic or post-traumatic conditions of the upper extremity receive multi-disciplinary care that includes occupational and physical therapy, splinting/casting and reconstructive surgery.

    In addition, our Hand and Orthopedic Upper Extremity Program is committed in its efforts to improve clinical care through continued clinical and basic science research. The program is studying the treatment of a wide variety of upper limb conditions, including:

    • reconstruction of the congenitally deficient hand
    • the use of microsurgical techniques in reconstructive surgery for congenital upper extremity differences
    • instability of the sternoclavicular and glenohumeral joints of the shoulder
    • post-traumatic stiffness and deformity of the elbow
    • surgical correction of forearm deformity following previous fracture
    • ligament and/or cartilage injuries of the wrist
    • the use of microsurgical techniques in reconstructive surgery following limb salvage for bone and soft-tissue tumors

    Many of these investigations have resulted in national and international presentations or peer-reviewed medical publications—and all have increased our ability to provide the highest standard of patient care.
     

    Children speak about what it’s like to be a medical research subject

    View a video of a day in the life of Children’s Clinical and Translational Study Unit, through the eyes of children who are “giving back” to science.

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