The preliminary outcome of syndactyly management in children with a new external separation device

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Abstract

To introduce a new external fixation device for the management of syndactyly in children. To evaluate its preliminary clinical result. From January 2011 to June 2012, 12 cases with cutaneous syndactyly of the middle/ring finger were managed with a new external fixator designed by our department. There were eight cases on the right side and four on the left side. The web space and soft tissue were stretched gradually using the new device. A Z-plasty of syndactylies was performed when the web space has reached the width that we required. The results were evaluated according to the clinical appearance and function of the fingers. Twelve cases had been followed up, with an average time of 16 months (range, 12–27 months). The web space and soft tissue in all the cases were stretched successfully using the new device. Skin grafting was not necessary in the reconstruction of syndactyly. In the last follow-up, the Vancouver Score averaged 0.6 (range, 0–2). Three cases had grade 1 web creep, whereas the other nine cases had grade 0 web creep. The total active motion averaged 130.4° for all affected fingers: 130.8° for the middle and 130.0° for the ring finger. Stiffness in the PIP joint preoperatively in two cases did not improve postoperatively. In 12 affected middle fingers, three cases had a supination deformity averaging 10.6° (range, 5°–15°) and one case had a pronation deformity of 5°. In 12 affected ring fingers, one case had a supination deformity of 18° and two cases had a pronation deformity averaging 7.5° (range, 5°–10°). The middle finger was not pronated in any patient. Among all the ring fingers, two had radial deviation of 8°and 25° and 1 had ulnar deviation of 10°. The surgeon-provided visual analog scale score for esthetics averaged 1.8 (range, 0–5). The parent-provided visual analog scale score was 2.7 (range, 1–5) for pain, 1.3 (range, 0–5) for appearance, and 1.3 (range, 0–5) for function. Displacement of the nail bed during distraction was found in two cases, which was resolved by the Winograd technique in the second surgery of syndactyly release. The clinical appearance and function were excellent. When we use the new external fixation device in the management of syndactyly, we can achieve a satisfactory outcome with little scar of the fingers. There was no need for skin grafting. However, the long-term result should be studied further.

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