Morphologic characteristic of hand and foot deformities in Apert syndrome and the treatment strategy
Author(s): TIAN Wen, ZHAO Junhui, TIAN Guanglei, HOU Chunmei, SU Yannong, LIU Bo, ZHU Zuo, YANG Yong, WU Jingheng
Pages: 324-328
Year: 2013 Issue: 6
Journal: Chinese Journal of Hand Surgery
Keyword: Abnormalities; multiple; Apert syndrome; Syndactyly; Treatment strategy;
Abstract: Objective To analyze the morphologic characteristic of hand and foot deformities in Apert syndrome and explore the treatment strategy.Methods Twelve cases with Apert syndrome diagnosed and treated from May 2007 to August 2012 were retrospectively reviewed.Based on the severity and extent of finger (toe) syndactyly,the authors extended Upton's classification.Deformities of the hand were classified into type Ⅰ,type Ⅱ,type Ⅲ,type Ⅳ and type Ⅴ,while those of the foot into type Ⅰ and type Ⅱ.Under the guidance of the new classification,separation of the digits were performed by one-stage procedure in type Ⅰ and by multi-stage procedures in type Ⅱ,type Ⅲ,type Ⅳ and type Ⅴ.Deviated thumbs were corrected by proximal phalangeal osteotomies.Digit separation and osteotomy were done simultaneously in type Ⅰ,Ⅱ and Ⅲ cases.For type Ⅳ and Ⅴ cases,osteotomy and digit separation were done in two stages.Complete separation of the digits and proximal phalangeal osteotomy of the thumb were accomplished in 4 patients of hand deformities.Six patients are still in the different stages of surgical intervention,while 2 patients remain untreated.Complete separation of the toes was accomplished in 2 patients with foot deformities.Results All separations of the digits and toes were successful without any digit (toe) necrosis.Web adhesion occurred in 3 cases.Flexion contracture of the fingers due to scar contraction occurred in 4 fingers.The 4 patients who had completed digit separation and osteotomy were able to perform basic pinch and grasp.Function of the feet was not significantly improved.Conclusion Apert syndrome is one of the most severe deformity complex that involves the hands and feet.Surgical intervention,digit separation and osteotomy,could provide aesthetic and functional improvement of the hand.The residual anomalies still need further study and treatment to gain more aesthetic and functional improvement.
Pages: 324-328
Year: 2013 Issue: 6
Journal: Chinese Journal of Hand Surgery
Keyword: Abnormalities; multiple; Apert syndrome; Syndactyly; Treatment strategy;
Abstract: Objective To analyze the morphologic characteristic of hand and foot deformities in Apert syndrome and explore the treatment strategy.Methods Twelve cases with Apert syndrome diagnosed and treated from May 2007 to August 2012 were retrospectively reviewed.Based on the severity and extent of finger (toe) syndactyly,the authors extended Upton's classification.Deformities of the hand were classified into type Ⅰ,type Ⅱ,type Ⅲ,type Ⅳ and type Ⅴ,while those of the foot into type Ⅰ and type Ⅱ.Under the guidance of the new classification,separation of the digits were performed by one-stage procedure in type Ⅰ and by multi-stage procedures in type Ⅱ,type Ⅲ,type Ⅳ and type Ⅴ.Deviated thumbs were corrected by proximal phalangeal osteotomies.Digit separation and osteotomy were done simultaneously in type Ⅰ,Ⅱ and Ⅲ cases.For type Ⅳ and Ⅴ cases,osteotomy and digit separation were done in two stages.Complete separation of the digits and proximal phalangeal osteotomy of the thumb were accomplished in 4 patients of hand deformities.Six patients are still in the different stages of surgical intervention,while 2 patients remain untreated.Complete separation of the toes was accomplished in 2 patients with foot deformities.Results All separations of the digits and toes were successful without any digit (toe) necrosis.Web adhesion occurred in 3 cases.Flexion contracture of the fingers due to scar contraction occurred in 4 fingers.The 4 patients who had completed digit separation and osteotomy were able to perform basic pinch and grasp.Function of the feet was not significantly improved.Conclusion Apert syndrome is one of the most severe deformity complex that involves the hands and feet.Surgical intervention,digit separation and osteotomy,could provide aesthetic and functional improvement of the hand.The residual anomalies still need further study and treatment to gain more aesthetic and functional improvement.
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