Trends in the Timing of Syndactyly Release

Introduction: Syndactyly is one of the most common hand anomalies, with no strict guidelines for timing of surgery. Generally, surgery is rarely performed before age 6 months because of digital size and anesthetic considerations. However, digital separation may be delayed until school age or beyond, depending on individual patient circumstances. This study examined the timing of surgery for syndactyly in a representative sample of pediatric population in order to highlight the trends in the age of separation over time.

Materials & Methods: We retrospectively reviewed the State Ambulatory Surgery Database (SASD) between 2005 and 2011 for the states of California and Florida. All patients aged 18 years or less with a diagnosis of Syndactyly who underwent syndactyly release were included. Demographic data including age at release as well as payer status were extracted.

Results: The analysis yielded 2280 children (68% male, 32% female) below the age of 18 years who underwent syndactyly release between the years 2005-2011. The majority were white (43%) or Hispanic (38%), with mean age of 3.60 (Median age 2.00, standard deviation 4.26). The age histogram was found to have a positive skew with the majority of cases being under age 5 versus older than 5 (1662 vs. 618 cases, respectively). For children younger than 5, mean age at syndactyly release was 2.5, stable over the study period with no established trend. We then compared children operated before the age of 5, with those operated late, at age 5 and older. More females on average were operated on in the under 5 age group compared to 5 and older (37.88% vs. 30.09%, p=0.002, respectively). Race differences between the early and late-release cohorts were statistically significant, but practically comparable.

Conclusions: According to the results of the current study, most of the syndactyly releases are performed before school age, which is considered to be the primary goal in the management of syndactyly. Interestingly, despite being a male predominant condition (2:1), more females were operated early.