Wednesday, May 7, 2014

Macrodactyly- Big fingers

Large digits are also called macrodactyly.  This uncommon condition can be quite dramatic in appearance.  I have previously blogged on the topic of macrodactyly- here is the previous Post.  I want to share a few pictures from a single case as a way to demonstrate a typical progression.

This child presented to us a 8 months of age.  He was otherwise healthy and there was no family history of any kind of of bone or joint problem.  The family was obviously concerned.

Macrodactyly on left hand.  Note the very large long finger.
Macrodactyly appearance.  The long finger is obviously too big.  The other digits are not notably different.

Macrodactyly x-ray.

One of the difficulties of this diagnosis is that the decision to the "right" surgery is a hard one.  We can be tempted to debulk or decrease the size of the finger.  The problem with this procedure is that it has to be done over and over again, subjecting the child to many surgeries.  In my opinion (and indeed in the opinion of most of us who see this kind of problem), the best surgery is an amputation of the finger or fingers that are affected.  




Macrodactyly after surgery
Macrodactyly after excision of large digit.
The hand looks much better although there is swelling in the hand.  Motion is very good and the patient is happy and the family is happy.  Over time, the index finger slowly increased in size but not to the degree that the long finger was enlarged.  We did several debulking procedures to help the finger avoid dramatic growth.

Macrodactyly after excision.  This is 7+ years later.  The index finger has slowly grown larger.

The bottom line is the macrodactyly and other overgrowth conditions are challenging for the family and for the treating physician.  There are usually no easy solutions.  We try to minimize the number of interventions while providing the best hand for long term function and appearance.  The good news is that researchers are making progress.  We believe all of these disorders like macrodactyly are related to a signaling mechanism which has malfunctioned.  A cell receptor turns on, growth increases and macrodactyly (or hemihypertrophy, or tumors) result.  Identification of the problem is the first step in fixing it.

Charles A. Goldfarb, MD
My Bio at Washington University
congenitalhand@wudosis.wustl.edu





4 comments:

  1. Hi doc, I'm Finnora from Indonesia. My son Jacob (4) also has similar case on his right index and middle finger. We are wondering what's the best option for him. If you could kindly help us to share your opinion, we will be very thankful. My email is ciskafinnora@gmail.com
    Thank you for your time doc.

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    Replies
    1. Hello Finnora. Thank you for the question. It is important to find a hand surgeon with some experience. Depending on the exact size of the fingers, the concept is to either control the growth of the fingers (through the growth plates) or amputate the fingers if dramatically too large. I realize that this advice is only somewhat helpful but there are many factors that affect this treatment decision.
      Good luck

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  2. Hello doctor,
    I am maneesh from India. My 14 months old son has similar case(look like in a picture). His little finger of left hand is big campare to other to others.he has no pain in his that finger.he is healthy. Some time his left arm above the plam is coarse camapre to right hand.
    Plz doctor suggest me what I do. Any treatment sugesst me.

    Maneesh
    Email: maneesh.Kr.singh@gmail.com
    PH. No.09808976803

    ReplyDelete
    Replies
    1. Maneesh,
      Small finger macrodactyly is very uncommon. I am glad your son is otherwise healthy and that he has no pain. I do believe that he needs to be examined by a physician or surgeon who is familiar with macrodactyly (I cannot, unfortunately, suggest any treatment).

      Good luck.

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