Upper extremity anomalies in Pfeiffer syndrome and mutational correlations.
BACKGROUND
Pfeiffer syndrome is characterized by craniosynostosis and a variety of associated upper and lower extremity anomalies. The authors reviewed presentation and treatment of upper extremity anomalies in a series of genotyped patients with Pfeiffer syndrome.


METHODS
Medical records of patients with Pfeiffer syndrome seen at the authors' institution over a 16-year period were reviewed. Data on clinical presentation, genetic testing, and treatment were collected. The upper extremity anomalies were documented using plain radiographs and physical examinations by a multidisciplinary craniofacial team.


RESULTS
Of 15 patients identified as having FGFR1- or FGFR2-confirmed Pfeiffer syndrome, 12 (80 percent) presented with upper extremity anomalies, most commonly broad thumbs [n = 10 (83 percent)], radial clinodactyly (thumbs) [n = 7 (58 percent)], and symphalangism [n = 7 each (58 percent)]. All patients with upper extremity anomalies had lower extremity anomalies. Six of the 12 patients (50 percent) with upper extremity findings underwent surgical correction. FGFR1 or FGFR2 genotype did not correlate with upper extremity phenotype.


CONCLUSIONS
Although broad thumbs are common, patients with Pfeiffer syndrome often present with other upper extremity anomalies that may not require surgical intervention. Genetic and allelic heterogeneity may explain phenotypic variability in these upper extremity anomalies. Characterization of these limb differences should be made by pediatric hand surgeons as part of a craniofacial team. Treatment decisions should be individualized and dictated by the type and severity of clinical presentation.


METHODS
Risk, IV.
Boston, Mass. From the Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School.
Felecia E
FE
Cerrato
Laura C
LC
Nuzzi
Todd A
TA
Theman
Amir
A
Taghinia
Joseph
J
Upton
Brian I
BI
Labow
D000168:Acrocephalosyndactylia / Q000000981:diagnostic imaging / Q000235:genetics* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005838:Genotype; D006228:Hand Deformities, Congenital / Q000000981:diagnostic imaging / Q000235:genetics / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D009154:Mutation; D010641:Phenotype; D022821:RNA Splice Sites; D011859:Radiography; D051496:Receptor, Fibroblast Growth Factor, Type 1 / Q000235:genetics*; D051497:Receptor, Fibroblast Growth Factor, Type 2 / Q000235:genetics*; D012189:Retrospective Studies; D013580:Synostosis / Q000000981:diagnostic imaging / Q000235:genetics / Q000601:surgery; D013933:Thumb / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery
D022821:RNA Splice Sites; C496348:FGFR1 protein, human; C496353:FGFR2 protein, human; D051496:Receptor, Fibroblast Growth Factor, Type 1; D051497:Receptor, Fibroblast Growth Factor, Type 2