Surgical management of the hand in 
Apert Syndrome: a 27-year experience.

Aims:
Complex acrosyndactyly in Apert syndrome requires nuanced planning to achieve optimal functional outcomes. This study reviewed the surgical management of hand differences in Apert syndrome over a 27-year period, at a single tertiary-care institution.




Method:
A retrospective case series reviewed all children with Apert syndrome managed by our Paediatric Hand Surgery unit between 1997 and 2024. Medical and operative records, clinical photographs and radiographic images were evaluated. The primary aims were to determine the total number, timing and techniques of hand operations. The secondary aim was to establish how many patients achieved five-fingered hands.




Results:
21 patients (12 male, 9 female) were managed by our unit. 24 hands (57.1%) were Upton type 1; 10 (23.8%) were Upton type 2; and 8 (19.0%) were Upton type 3. Three patients died prior to staged hand surgery completion.

Timing of hand surgery depended on craniofacial procedures and comorbidities. Median age at first syndactyly operation was 19 months (range: 5 months – 4 years). A five-fingered hand was achieved in 64.7%, including 71.4% of Upton type I and II hands and 33.3% of Upton type III hands. All planned webspaces were separated by a median age of 4 years 11 months (range: 2 years 11 months – 12 years 1 month), requiring an average of 5.8 operations (SD 1.57). 62 (60.8%) syndactyly releases were performed without skin grafts.




Conclusions
An individualised approach within a multi-disciplinary setting is required for Apert syndrome patients to determine the ideal operative timing, surgical technique and reconstructive goals.

Hand and Upper Extremity

PSTM 2024