Polydactyly

At Children’s Hospital Boston, experts in our Orthopedic Center’s Hand and Orthopedic Upper Extremity Program and our Plastic Surgery Department’s Hand and Microsurgery Reconstructive Program provide comprehensive care—including evaluation, diagnosis, consultation, surgery, non-surgical therapies and follow-up care.

Our orthopedic surgeons and plastic surgeons usually treat children with polydactyly by surgically removing the extra finger—typically, when the child is between 1 and 2 years old—young enough that he won’t miss developmental milestones such as grasping (prehension), but late enough that he can tolerate anesthesia and surgery well.

• Removing an extra little finger (ulnar polydactyly) can be fairly simple if the extra finger is attached by a narrow “stalk” or “nub” of soft tissue. The extra finger can be removed with a minor procedure or even by tying off (ligating) the nub in the nursery.

• Removing an extra thumb (radial polydactyly, thumb duplication) can be complex. The thumb is of primary importance in hand function, and radial polydactyly can negatively impact thumb position (angle), shape and function. Removing the extra thumb is sometimes not enough—the procedure can also require remodeling of the remaining thumb, with care and attention to soft tissues, tendons, joints and ligaments. And even after treatment, the reconstructed thumb may be smaller than normal.
  
  Read more about treatment and care for thumb duplication.

• Removing an extra central finger (central polydactyly) is typically complex, involving significant reconstruction of the hand, and also taking care with soft tissues, tendons, joints and ligaments. Sometimes more than one surgery is needed.

Complications after surgery

Complications after surgery are common but often minor. Most remaining cosmetic or functional deformities can be addressed in later corrective surgery.

Caring for your child after surgery

If the surgery to remove the extra digit is fairly complex, it can also involve your child’s bone, ligament and tendon. If that’s the case, your child may need to wear a cast for a few weeks. Your doctor may recommend occupational or physical therapy to help reduce scarring, stiffness and swelling and improve function.

Long-term outlook

Most of our young patients recover full hand function and an improved appearance of their hand. If needed, your child’s team will work with you and your child to learn home exercises that are important to his recovery. He may need to wear a cast or splint in some circumstances. It is possible that in a severe case, your child may need additional reconstructive surgery(ies) to recover full function and improve the hand’s appearance.

Your child may need to be followed for a number of months or years to:

• ensure that the healing has gone well
• check that function has returned to your child’s hand
• determine whether additional surgery is needed to improve the function or appearance of the hand as your child grows

Coping and support

At Children’s Hospital Boston, we understand that a hospital visit can be difficult, and sometimes overwhelming. So, we offer many amenities to make your child’s—and your own—hospital experience as pleasant as possible. Visit The Center for Families for all you need to know about:

• getting to Children’s
• accommodations
• navigating the hospital experience
• resources that are available for your family

In particular, we understand that you may have a lot of questions when your child is diagnosed with polydactyly. Will this affect my child long term? Will he be able to play sports and do regular activities? Children’s can connect you with extensive resources to help you and your family through this stressful time, including:

• patient education: From doctor’s appointments to physical therapy and recovery, our nurses and physical therapists will be on hand to walk you through your child’s treatment and help answer any questions you may have—Why will my child need surgery? Are there non-surgical options? How long will his recovery take? How should we manage home exercises and physical therapy? We’ll help you coordinate and continue the care and support your child received while at Children’s.
• parent-to-parent: Want to talk with someone whose child has been treated for polydactyly? We can often put you in touch with other families who’ve been through the same process that you and your child are facing, and who will share their experiences.
• faith-based support: If you’re in need of spiritual support, we’ll connect you with the Children’s chaplaincy. Our program includes nearly a dozen clergy— representing Protestant, Jewish, Muslim, Roman Catholic and other faith traditions—who will listen to you, pray with you and help you observe your own faith practices during your hospital experience.
• social work: Our social workers and mental health clinicians have helped many families in your situation. We can offer counseling and assistance with issues such as coping with your child’s diagnosis, stresses relating to coping with illness and dealing with financial difficulties.

The Experience Journal

Designed by Children’s psychiatrist-in-chief David DeMaso, MD, and members of his team, the Experience Journal is an online collection of thoughts, reflections and advice from kids, parents and other caregivers about a variety of medical experiences, including hip problems.