Treatment Trends in Symbrachydactyly: Surgical Management in Milder Cases and Nonoperative Treatment in Severe Ones.

Introduction: Symbrachydactyly is a unilateral hand abnormality characterized by incomplete finger formation and rudimentary nubbins containing nail plate, bone, and cartilage. Surgical intervention typically targets web space contractures, digit instability, and pincer dysfunction. This study examines the relationship between the severity of symbrachydactyly and the choice of operative or nonoperative approaches.

Methods: A retrospective comparative analysis was conducted on patients diagnosed with symbrachydactyly at a pediatric referral center from 2005 to 2024. Collected data included demographics (age, sex, laterality), familial factors (congenital malformations, miscarriage history), medical history (associated syndromes, pregnancy complications), clinical and radiologic details of hand abnormalities (side, Blauth and Foucher classifications), and treatment modalities. Descriptive, comparative, and correlation analyses were performed across treatment groups.

Results: A total of 80 patients were analyzed (median age: 5.32 y, IQR: 1.8 to 8.8), including 47 males (58.8%) and 52 patients (65.0%) with left-sided involvement. Nonoperative treatment was provided to 61 patients (76.3%), while 19 (23.8%) underwent surgical interventions. Among the nonoperatively treated patients, 9 (14.8%) received prostheses. Prosthesis use was significantly associated with higher severity in the Blauth and Foucher classifications ( P <0.001). No significant differences in the Blauth ( P =0.14) and Foucher ( P =0.22) classifications were observed between nonoperative and surgical groups. The Blauth and Foucher classifications showed no significant associations with syndromic involvement, pregnancy complications, miscarriage history, or in vitro fertilization ( P >0.05). A correlation analysis showed that more severe involvement in both classifications was statistically associated with a higher likelihood of nonoperative management: Blauth (r=-0.253, P =0.031) and Foucher (r=-0.243, P =0.038).

Conclusions: This study demonstrates that surgical interventions benefit patients with milder forms of symbrachydactyly, while patients with more severe manifestations typically receive nonoperative management, including prosthetic solutions.

Level of evidence: Level III-retrospective comparative study.