title: Two-stage reconstruction of apert acrosyndactyly.
abstract: This report retrospectively reviews presenting radiographs and surgical treatment of 28 hands in 14 children with Apert acrosyndactyly with the purpose of developing a classification system to describe the decision-making process used to determine the type and staging of hand reconstruction. The average patient age at last follow-up evaluation was 7 years (range, 3-17 years). Type I deformities (7 hands) had little or no angular deformity at the metacarpophalangeal (MP) joint; two-stage reconstruction created a four-fingered hand. Type IIA deformities (11 hands) had mild MP joint angular deformity and a more proximal complex syndactyly of the middle three digits; two-stage reconstruction created a three-fingered hand with ray resection of the third digit. Type IIB deformities (7 hands) had pronation of digit 2 superimposed on the thumb and radial angulation at the MP joint of digit 2; two-stage reconstruction created a three-fingered hand with ray resection of the second digit. Type IIC deformities (3 hands) had supination of digit 4 superimposed on digit 5 with ulnar angulation at the MP joint of digits 4 and 5; two-stage reconstruction created a three-fingered hand with ray resection of the fourth digit. This report presents a classification system and four different treatment strategies based on presenting radiographs.
authors.affiliation: Department of Orthopedic Surgery, Gillette Children's Hospital, Minneapolis, MN, USA.
authors.forename: A E
authors.initials: AE
authors.lastname: Van Heest
authors.forename: J H
authors.initials: JH
authors.lastname: House
authors.forename: W C
authors.initials: WC
authors.lastname: Reckling
mesh_terms: D000168:Acrocephalosyndactylia / Q000601:surgery*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003657:Decision Making; D005385:Fingers / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008662:Metacarpophalangeal Joint / Q000002:abnormalities / Q000601:surgery; D011403:Pronation; D011859:Radiography; D012189:Retrospective Studies; D013484:Supination; D013576:Syndactyly / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D013933:Thumb / Q000002:abnormalities / Q000601:surgery; D014457:Ulna / Q000473:pathology