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J Bone Joint Surg Am. 2017 Jul 5;99(13):1119-1128. doi: 10.2106/JBJS.16.01283.

Functional Assessment of Children and Adolescents with Symbrachydactyly: A Unilateral Hand Malformation.

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1Department of Public Health Sciences, Division of Biostatistics (S.L.T), Department of Orthopaedic Surgery (M.A.J.), University of California, Davis, School of Medicine (P.B.G.), Sacramento, California 2Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts 3Harvard Medical School, Boston, Massachusetts 4Charles E. Seay, Jr. Hand Center, Texas Scottish Rite Hospital for Children, Dallas, Texas 5Department of Clinical Science and Education (M.A.), Department of Molecular Medicine and Surgery (T.L.), and Center of Molecular Medicine (T.L.), Karolinska Institutet, Stockholm, Sweden 6Department of Hand Surgery (M.A. and T.L.), Södersjukhuset, Stockholm, Sweden 7Department of Orthopaedic Surgery, Shriners Hospitals for Children-Northern California, Sacramento, California.



We studied children and adolescents with symbrachydactyly to determine whether hand function depends on digit opposability and whether scores for function and quality-of-life measures differ from population norms.


Participants were grouped on the basis of hand morphology: Group A lacked opposable digits, and Group B had ≥2 digits that were opposable. The groups were compared with each other and with norms with respect to pinch strength, the performance of bimanual activities and in-hand manipulation, and questionnaires regarding psychosocial status and the ability to perform activities of daily living (ADLs). Participants and parents also rated the appearance and function of the hand.


Pinch strength was higher for participants in Group B (4.1 compared with 2.4 kg; p = 0.008), but the groups did not differ with respect to the proportion of participants outside of pinch norms. Participants in Group B were more likely to actively use their affected hand to perform bimanual activities (p ≤ 0.0009), and to use normal or supination strategies to accomplish in-hand manipulation (p = 0.031). The groups did not differ in the proportion of ADLs rated "difficult" or "impossible," and both groups tested within normal limits for psychosocial function. Participants from both groups and their parents rated their satisfaction with hand appearance and function similarly high.


Participants with ≥2 opposable digits incorporated their hand better in bimanual activities and used more effective strategies to accomplish in-hand manipulation than those who did not. These groups reported no difference in the ability to perform ADLs or with psychosocial function, which was within the normal range. Children and adolescents with symbrachydactyly demonstrated and reported a high level of function in all domains of validated function tests. This study provides information to help parents of children with a unilateral hand malformation understand their child's potential function, and assist surgeons with recommending treatment.


Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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