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A Rare Syndrome of Five Finger Hands and Polydactyly of the Feet: A Case Report

Ahmadreza Afshar

Case report

A 22-year old man was referred from the Welfare Organization for evaluation of his hands and feet abnormalities. The family history was negative for any congenital abnormalities. The parents were non-consanguineous. It seemed that the hands and feet deformities were symmetric. The right and the left thumbs were absent (Figs. 1 and ​2). The thenar prominences were absent and the first web space was narrow on both sides. The right and left hands had five fingers. The most radial fingers were in the same plane of the other fingers and they could not be opposed to the other fingers. He had a side-to-side pinch between the most radial finger and the index finger of his hands. He was able to grasp objects with all the fingers of both hands.

Fig. 1
Dorsal view of the hands
Fig. 2
Palmar view of the hands

The arcs of wrists flexion-extension were the same on both sides and they were 70° of flexion and 45° of extension. The right elbow had a normal range of motion. The left elbow’s range of motion was 40 to 120° of flexion. The active supination-pronation arc on the right side was 100°. The active supination-pronation arc on the left side was more restricted than the right side and it was about 40°. The pronounced restricted ranges of movements on the left side might be explained by relative underdeveloped osseous structures and soft tissue abnormalities.

The patient had polydactyly of the feet (Fig. 3). Each foot had seven toes. Legs and the ankles appeared normal on the both sides. No chromosomal abnormality was found on karyotype.

Fig. 3
Polydactyly of the feet

Radiographs of the hands showed that the most radial digits had a complete metacarpal and three phalanges (Fig. 4). The skeletons of the wrist joints were abnormal. Radiograph of the right wrist showed a hypoplastic distal radius and a rudimentary scaphoid. The trapezium, trapezoid and capitate bones in the distal carpal row had coalition (Fig. 5). Radiograph of the left wrist revealed a hypoplastic distal radius and a rudimentary ossicle instead of the scaphoid. The trapezium, trapezoid and capitate bones in the distal carpal row had coalition. The lunate and triquetrum were also fused (Fig. 6).

Fig. 4
Radiography of the hands
Fig. 5
Antro-posterior radiography of the feet
Fig. 6
Radiography of the right wrist

Radiographs of the feet demonstrated seven digits and six metatarsals. The second and third medial digits were articulated with the second medial metatarsal at the metatarsophalangeal joints on both sides (Fig. 7).

Fig. 7
Radiography of the left wrist

To improve the function and aesthetic of the hands’ pollicization of the most radial fingers of the hands were considered but the patient declined surgery.