There may be a times, thankfully not often, when improving function may come at a cost of some worsening of appearance. If this is a possibility, frank discussions should be held with the family and many will eagerly proceed with an intervention for improved function.
This case is one example. The child has symbrachydactyly, the cleft type (classification is reviewed in this POST). He does well overall but has trouble grasping with the hand.
![]() |
Symbrachydactyly, cleft type, palm view |
![]() |
Symbrachydactyly, cleft type, top view |
![]() |
Symbrachydactyly, cleft type, top view with thumb held |
1. Sometimes, lengthening a digit will make sense as described HERE. But there must be sufficient bone present before we can lengthen.
2. Other times, transferring a toe or toes to the hand will be the best option to improve function. While this is a significant surgery for the patient and the whole family, it can be the best option to provide pinch and grasp in kids with few options related to limited anatomy.
3. Lastly, and perhaps counterintuitively, we can deepen the space between the thumb and pinky. This does not actually lengthen the digits but it makes them seem and act longer because bigger objects can be grasped. Again, this may be considered different than some interventions because we usually try to get rid of the cleft, but in this case we deepen it.
![]() |
This is the same patient after cleft deepening. |
![]() |
Palm view after cleft deepening. |
For this particular patient, the seemingly small amount of deepening will (and has) make a notable difference for function. And as he gets older, lengthening the bones can still be considered.
Functional improvements are always our goal in the care of kids with hand differences. In this case, a small surgery should really help.