At Boston Children's Hospital, experts in our Orthopedic Center's Hand and Orthopedic Upper Extremity Program and our Plastic and Oral Surgery Department's Hand and Reconstructive Microsurgery Program provide comprehensive care for symbrachydactyly—including diagnosis, surgery and follow-up care.
How is symbrachydactyly treated?
Many forms of symbrachydactyly are treated surgically. Initial surgery is usually done when the child is between 6 and 18 months old. Sometimes, a series of additional surgeries need to be performed over a period of years.
What happens during surgery?
Treatment of symbrachydactyly varies from child to child.
- In some cases, no surgery or only minor skin and soft-tissue corrections are needed.
- If your child has a more serious case, he may need to have bones transferred, usually from the toes, to add length to the affected fingers.
- In some cases, a toe or multiple toes are transplanted to the affected hand (a process called toe transfer or toe-to-hand transfer) so that your child will eventually be able to pinch, pick up and hold objects.
Complications after surgery
Complications right after surgery are uncommon and usually minor. But medium- to longer-term complications can include:
- Poor bone healing
- Stiff knuckle joints
- Finger dislocation
Caring for your child after surgery
After surgery, your child is usually placed in an above-elbow cast for three weeks to help immobilize and protect the hand. Once the cast is removed, a splint that slides in between the fingers and keeps them apart is used for an additional six weeks. During this time, your child's doctor may recommend occupational or physical therapy to help reduce scarring, stiffness and swelling and improve function.
What is the follow-up treatment plan?
Doctors will want to see your child for follow-up visits to ensure that healing is proceeding well and function has returned. In some cases, follow-up will continue for years to evaluate whether additional surgery is needed to improve the function or appearance of your child's hand.
Surgery can be very successful in helping the use and appearance of the hand. If your child's case is severe, he may need additional reconstructive surgery(ies) to achieve greater function and improve his hand's appearance. But to some extent, the hand will always look different and function differently. As he grows, your child may use prosthetics for some sports and activities.
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: additional procedures often needed to deepen the web space between fingers using skin grafts
Coping and support
At Boston Children's Hospital, we want 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 Boston Children's
- 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 symbrachydactyly. Boston 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.
- Parent-to-parent: Want to talk with someone whose child has been treated for symbrachydactyly? 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 Boston 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.
- Emotional support: 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.