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What is cleft hand?

Cleft hand is a rare condition in which the center of a child’s hand is missing a finger or fingers. Cleft hand makes up less than 5 percent of all congenital hand differences. Approximately one in 50,000 to one in 100,000 babies are born with cleft hand.

Cleft hand occurs when a child’s hand doesn’t develop properly during pregnancy. The condition can sometimes be detected on a routine prenatal ultrasound. After the baby is born, the deformity is visible.

Although cleft hand usually affects both hands, it can also occur in only one hand. Children born with cleft hand may also have cleft foot. All affected children, except those with very mild cases, need one or more surgeries, usually starting in their first year of life.

Typically, a cleft hand is missing a finger or fingers in the middle of the hand and has a pronounced V-shaped cleft in that space. But not all cleft hands look the same. Cleft hands may exhibit a variety of differences such as missing bones and transverse bones. In some cases, the cleft occurs on the thumb side or pinkie side of the hand.

Cleft Hand | Symptoms & Causes

What are the symptoms of cleft hand?

Not all cleft hands look the same. Typically, the center portion of the hand is missing a finger or fingers and there’s a V-shaped cleft in that space. Less often, clefts occur on the thumb side or the little finger side of the hand.

In the majority of children with cleft hand, the condition is an isolated occurrence that affects only the hands. Your child’s doctor will check for other associated differences or syndromes, including cleft foot, cleft lip, and cleft palate.

What causes cleft hand?

Cleft hand is congenital, meaning babies are born with the condition. It develops during pregnancy when the bones of the hand are forming. The exact cause is unknown, but scientists and doctors are learning more and more about the possible genetic causes (passed from parent to child).

Cleft Hand | Diagnosis & Treatments

How is cleft hand diagnosed?

Cleft hand is diagnosed by your child’s doctor after a careful physical examination. As part of the diagnosis, your child will have an x-ray to look for related problems with the bones of the fingers and hand.

Your child’s doctor may also check for other conditions that are sometimes associated with cleft hand. These include:

  • cleft foot
  • cleft lip and palate
  • ectrodactyly (split hand-split foot malformation)
  • encephalocele (protrusion of brain membrane)
  • conditions affecting the heart and digestive systems
  • deafness (rare)

How is cleft hand treated?

Not all children need surgery for a cleft hand, particularly if the condition is not too severe and they have good use of their hand. However, if your child's hand has significant functional or cosmetic problems, their doctor may recommend surgery.

There are many different surgical options to repair a cleft hand. The timing and sequence of procedures will vary from child to child. In general, the first procedure is usually done when a child is 1 year old.

The goals of surgery are to:

  • close the cleft and make sure your child can use their hand effectively
  • create a good working space between the thumb and index finger to allow for fine motor function
  • reorganize the skin and soft tissue around the fingers
  • stabilize or transfer the bones of the hand
  • correct any deformities of the fingers or thumb

After surgery, your child will wear a long-arm cast stabilized by pins for about four to six weeks.

After the cast is removed, your child will wear a splint to bed for several weeks to maintain alignment and help reduce scarring. Occupational therapy will help your child achieve supple motion and developmentally appropriate use of the hand. Your child’s doctor will monitor their progress regularly throughout their follow-up treatment.

What is the long-term outlook for children with cleft hand?

The quality of the reconstruction of your child's fingers depends to a large extent on how severe the original difference was. As a result of surgery, you can expect your child will be able to grasp, pinch, and release objects with their fingers. Their hand should also look better and their fingers should be more aligned.

As your child grows, it’s possible gaps and deformities may recur even after they were corrected by the original surgery. If this is happens, your child may need additional procedures.

How we care for cleft hand at Boston Children’s Hospital

The Orthopedic Center’s Hand and Orthopedic Upper Extremity Program and our Department of Plastic and Oral Surgery’s Hand and Reconstructive Microsurgery Program have treated thousands of babies and children with cleft hand and other hand problems. We are experienced treating conditions that range from routine to highly complex, and can provide your child with expert diagnosis, treatment, and care. We also offer 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.

Our Department of Plastic and Oral Surgery is one of the largest and most experienced pediatric plastic and oral surgery centers anywhere in the world. We provide comprehensive care and treatment for a wide variety of congenital and acquired conditions, including hand deformities.

Cleft Hand | Programs & Services