title: Synostosis of the ring-small finger metacarpal in Apert acrosyndactyly hands: incidence and treatment.
abstract: This study reports on the incidence of a synostosis between the ring-small metacarpal bases in patients with Apert syndrome and describes a technique to resect the synostosis and insert silicone sheets to improve hand function. Records of 9 patients (18 hands) were evaluated. Average age at follow-up was 9.5 years. Three relationships between the ring-small metacarpals were observed. Type I hands (22%) had no abnormal interconnections; type II hands (33%) possessed a synostosis since birth; type III hands (44%) did not possess a synostosis at birth, but one later developed at average age of 79 months. Total incidence of synostosis was 77%. Five patients underwent excision of the synostosis. At an average of 16 postoperative months, 4 of these patients experienced improvement in hand prehension. In patients with Apert syndrome, resection of abnormal interconnections between the ring-small metacarpals is highly recommended to improve hand prehension based on the high incidence of a synostosis in this region.
authors: Division of Hand and Microvascular Surgery, Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, California 92134-5000, U.S.A. daokd@yahoo.com
authors: K D
authors: KD
authors: Dao
authors: A Y
authors: AY
authors: Shin
authors: S
authors: S
authors: Kelley
authors: V E
authors: VE
authors: Wood
mesh_terms: D000168:Acrocephalosyndactylia / Q000150:complications*; D000293:Adolescent; D000328:Adult; D001864:Bone Wires; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength; D006801:Humans; D015994:Incidence; D008297:Male; D008663:Metacarpus; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods; D011859:Radiography; D012828:Silicones; D013580:Synostosis / Q000145:classification / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D012828:Silicones