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The Informed Parent


by Shanna R. Cox, M.D., F.A.A.P.
Published on Feb. 09, 2009

Recently, I had the pleasure of walking into one of my examination rooms and being greeted by a family with a new baby. Tightly bundled and sleeping against dad’s chest, the newborn was seemingly the picture of health. The parents calmly answered my questions about the pregnancy, delivery, and days at the hospital. But, as we moved toward the examining table I could sense some hesitation. Unwrapping the baby and putting her on the table, they shared the concern they had by grabbing the baby’s hand and lifting it up. They said, “Well, there is this.”

Standing on the far side of the table, at first I wasn’t sure what “this” meant. As I looked toward the far edge of the hand I noticed a small string of skin with what looked like a mini pinky finger, absent of nail, attached. This was in addition to the baby’s otherwise completely normally formed hand. The baby’s routine examination was also normal. I explained to the parents that “this” is described as polydactyly. Usually it is an isolated finding in a normal examination.

This particular type of polydactyly is called ulnar polydactyly, describing its location on the ulnar side of the hand or foot. It may be an autosomal recessive condition. Therefore, other members in the family may have had a similar occurrence. There can be syndromes associated with polydactyly. If any other findings or physical characteristics suggest more whole body involvement, a genetics referral should be completed.

Polydactyly may also involve the thumb side of the hand or foot, called radial polydactyly, or the middle of the hand or foot, which is called central polydactyly.

I quickly assured the family that the extra partial digit could be removed and should not cause any distress for themselves or for their daughter. In a simple, isolated ulnar polydactyly of the hand case, it is usually accomplished with a fine suture ligation which will cause the extra digit to fall off. Other types of polydactyly may require orthopedic or plastic surgery evaluations. Eventual surgical treatment may follow to remove full extra digits of the thumb or toes. These are more complex procedures that likely would not be completed until the infant becomes older than nine months. The family let out a big sigh of relief and smiled as they happily rebundled their new perfect baby.

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