Recent Advancements and Outcomes of Syndactyly and Polydactyly, Experience from over 2300 Cases

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Background: Polydactyly and syndactyly are the two most common congenital limb differences. Previous reports contain small sample sizes and/or report single surgeon outcomes. Using data from a large cohort, this study aimed to give an overview of the clinical characteristics and surgical outcomes of these congenital conditions to guide current practice. Methods: A large retrospective database was created to analyze outcomes of polydactyly and syndactyly from 2007-2023 at a large children’s hospital. Patients aged 0-17 years with either polydactyly or syndactyly were included. Demographics, classifications, and postoperative complications were recorded. Descriptive statistics, chi-square tests, and logistic regressions were used. Results: 1621 duplicated digits from 1071 patients and 684 web spaces from 318 syndactyly patients were analyzed. In the polydactyly cohort, 2.3% of digits experienced early and 7.3% late complications, with post-axial cases having the lowest complication rates. For the syndactyly cohort, 12.3% had early and 25.7% late complications, with web-creep incidence of 8.8%. In polydactyly, predictors of late postoperative complications included ligament reconstruction, pinning, and osteotomy. For simple dangling postaxial polydactyly, procedures performed in the OR were 4.74X more likely to develop early complications than clinic procedures (p=.002). In a subgroup analysis of simple syndactyly cases, web-creep and hypertrophic scarring were significantly higher in cases reconstructed with skin grafts compared to cases that utilized a skin graftless dorsal metacarpal VY island flap technique. Conclusions: This study provides the largest cohort of polydactyly and syndactyly cases to date, providing an updated overview of demographics, presentations, and outcomes of its treatment.

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