Amniotic Constriction Band Central Deficiency (cleft hand) Fixators Symbrachydactyly

Finger Lengthening

Lengthening a finger or thumb may be a good treatment option for a number of conditions including symbrachydactyly, constriction band syndrome, and ulnar deficiency.  Essentially any congenital or traumatic condition that leads to a shortened digit (or digits) may interfere with function.  If lengthening that digit will help pinch or large object grasp (i.e., soda can), then the procedure is considered.  Typically it is one metacarpal or one phalanx bone that is lengthened although it can be done for more than one digit.  Typically we lengthen the most distal bone (i.e., the farthest bone out) if it is long enough to allow the fixator to be safely placed (more later). 
I believe in lengthening for function.  It can really make a huge difference because it will simply increase the number of activities that the child can accomplish with the affected hand.  I do NOT believe in lengthening for appearance.  There is some information on the web and some things I have heard from patients about “growing” new fingers.  This does not make a lot of sense to me for a lot of reasons.  I use lengthening devices for 1 or 2 digits with a specific functional goal in mind.
The procedure has some risks, the most common being skin infection.  Most kids treated with a lengthener will have a skin infection but usually it can be treated with antibiotics by mouth.  Some have more serious infections.  The next most common issue is that the bone may not form as fast as we would like or as fully as we would like and additional surgeries may be required to help this process.
Fixators are not just used for fingers and we commonly use them in the forearm for radial deficiency https://congenitalhand.wustl.edu/2012/05/fixator-for-radial-longitudinal.htmland sometimes for ulnar deficiency https://congenitalhand.wustl.edu/search/label/Fixators.  
The idea is that we can place a fixator on a short bone and then slowly grow that bone.  Typically less than 1mm a day.  A family member turns a dial 3-4x/ day to gradually make the bone longer.  We have to carefully watch the xrays to make sure the body is responding by growing bone.  This process is painless and if the child is having pain, something is usually wrong.  We grow the bone as long as possible to help function.  The fixator is on during the lengthening process (may be months but depends on how much bone we grow) and then stays on a bit longer while the bone truly heals (after we stop turning the dial).  More information is always available through our website at http://ortho.wustl.edu/content/Patient-Care/3220/SERVICES/Hand-Wrist/Congenital-Hand-Disorders.aspx

 
 Here is one example.
This is an unusual form of cleft hand (central deficiency).  There is no thumb except the floppy “nubbin.”

Another picture of unusual cleft hand with absent thumb
This is the xray.  Notice the lack of the thumb.  The thumb metacarpal measures 22mm- good enough to support a fixator.

We have placed the fixator to allow a gradual lengthening of the bone.
Another view of fixator for cleft hand lengthening of a thumb.

41 Comments

  1. You say you don't believe in lengthening for appearance, well for most with such abnormalities, appearance is a huge part of it as well.

    For those that have normal hands, they don't even have to think about them throughout the day, when waving, picking up a cup, shaking hands etc, or even just walking with them by your side. Its difficult to understand.

    Function is important, but appearance does have a huge mental and emotional impact as well.

  2. Thank you for your comment. I couldn't agree with you more- appearance is very important and I should clarify my comment above.

    In most cases, in my opinion, lengthening a finger does NOT make a better looking finger for 2 reasons. First, because we can't create joints to allow the finger to bend, the finger sits straight. This does not appear natural. And second, when we stretch a finger, it becomes even more narrow and tapered in appearance. For both these reasons, a lengthened finger may look worse.

    So, I agree that finger and hand appearance are "huge." The best surgeries for patients with birth abnormalities of the hand are those that improve both function and appearance.

  3. I have really short pinky fingers in both hands. The middle bone on each pinky finger seems to be the culprit. Many things slip out of my hands because of this condition and playing guitar and piano has its issues….even I love doing both….my range is hampered quite a bit…I wonder how much would it cost to lengthen both fingers and how long would it take…

  4. Robby- thanks for writing. It is often the case that the middle bone (the middle phalanx) is the problem. It can just be short or can be short and angled (causing clinodactyly). Unfortunately, lengthening the pinky is a challenge and can lead to stiffness. While I won't say it is impossible, surgery would have challenges. Cost and time depend on many factors- sorry I can't be more specific. I hope that helps.

  5. My girlfriend's little boy, 4 months old, has his pinky and thumb on his right, but the three digits in between are just tiny. They have nails and the doctor said they would grow in proportion to the rest of his hand. Could thus treatment be used to help him lengthen those middle 3 fingers? At least enough to help him grab handle bars, hammer, etc. ?

  6. Trevor,

    Thank you for the question. By your description, your girlfriend's boy has symbrachydactyly. There is a fair amount of information on the blog about this diagnosis. I believe he has the cleft type of symbrachydactyly. The middle 3 fingers do not usually have much bony support but usually kids have pretty good use of the thumb and pinky. Sometimes efforts to improve the middle digits can make function worse by getting in the way (longer digits are stiff because the joints don't bend). Because of the lack of bony structure to the middle 3 digits and the risk of worsening function, we usually do not lengthen those short digits.

    Thank you.

  7. Hey Charles,

    I have acromesomelic dysplasia and am an adult. My fingers and arms are very short and am interested to see how I can gain more length. At the moment I need to hands to holds cups and cans.

    Could this technique be used to help me get a better grip?

  8. Thrush,
    While fingers can be lengthened, in my experience, it does not help significantly with grip. The fingers can actually be stiffer after a lengthening surgery. But if you need length to help with pinch (thumb and index finger especially), lengthening can make sense- this is my personal 'favorite' reason for surgery.

  9. Hello,

    I have clubbed thumbs; specifically, the bones in my tips of my thumbs are short and broad. Would lengthening benefit such a condition or would it be more likely to lead to decreased mobility?

  10. Lauralot,
    "Clubbed' thumbs is something we see relatively commonly although few people ever complain about it functionally. I do believe there is a strong genetic connection (not sure if family members also have it). In my patients, I have not recommended surgery for this. Good luck.

  11. My 16 month old daughter lost the tip of her right index finger in an accident about 7 months ago. It was severed at the first joint so she is missing the entire distal bone and fingernail and nail bed. The hand surgeon that did the amputation revision on her said she should not have any limitations, however I notice she favors the other hand (her left) and points with her middle finger instead of the index finger when she does use her right hand. Im not sure if she will be left handed or is favoring the left hand because of the injury that has happened on her right hand. Would this lengthening treatment be something we should consider for her?

  12. Jill,

    Thank you for the question and I am sorry to hear about your daughter's fingertip. I agree with the hand surgeon that typically this type of amputation is very well tolerated. Over time, kids typically adapt quite well to these injuries and use the hand normally. I would not recommend lengthening in this situation.
    Good luck and while it has already been 7 months, I hope and expect that over time, she will continue to improve.

  13. I have a shortened ring finger on my left hand. I have full function and no pain. I have went to my doctor and he said I should just deal with it. I will be engaged in the next year or so and am terrified to wear a ring on that finger because the part where it sits is so much shorter than the rest of my fingers. I know it sounds stupid but I could be wearing a very expensive ring with a high risk of it slipping off. It is also chubby compared to the rest. Will doctors not do surgery unless there is something wrong? It seemed that way when I talked to mine.

  14. Shannon, thank you for the question. Most importantly, you have full function and no pain. While fingers can be lengthened, there are risks in doing so and surgery could worsen your function. So while each patient and hand are considered individually, I am doubtful that lengthening makes sense in your case. Hopefully you can find a ring that fits well! Good luck.

  15. I have very short fingers for an adult. At first glance, my hands are actually rather attractive, but I can't reach more than five white keys on a piano–and even that is stretching it. My hands are not in proportion to my height at all. Would surgery help me play the piano better?

  16. Rose. Thank you for the question. While it is clearly tough for me to answer, there is chance that you have brachydactyly (short fingers), which can be isolated or can be associated with some webbing.

    If there is increased webbing between the fingers, deepening the web spaces can make a difference for the piano. I hope this helps. Good luck!

  17. HI I'm zach from South Africa, I'm still 19y old and 175cm tall. I have really short fingers with a lowset pinky, plus I feel pain in my finger joints so I'm not sure it it's because it's so short and it never truly caught my eye until I noticed that my hand size is the same as my girlfriend's who is about half my size. Do you know what is wrong?

  18. Zachary,
    Unfortunately, I am not immediate certain what is going on with your hands. It could be a metacarpal length issue. The diagnosis may be affected by whether this is one side or both. For example, if one side only, this may represent symbrachydactyly (see blog for pictures). But certainly, a hand surgeon will be able to give you some information.

  19. Hi
    My daughter had a zip line accident about 18 months ago. She severed the top part of her finger. She has since had surgery but the finger is shorter and the nail bed grows in a direction around the finger causing her a pinching type feeling. We are wondering if this surgery is somehting we should consider to help her be more comfortable.

  20. Hello. While this blog is primarily about kids born with hand differences, I certainly treat patients with hand trauma. Its sounds like your daughter may have a hook nail based on a shortened distal phalanx. Often, if painful, surgery can be helpful. However, the usual treatment is eliminating the nail entirely. The other simple option is just to keep the nail trimmed short. I hope this is helpful.

  21. Hi Charles my 1.5yo daughter was born with symbrachtyly type 2 in two of her left Hand, she got Surgery last year she got transferred a piece of bone of her toes and they put them in both fingers to lenghten a little bit,they look much better but I would like to ask you if there is something else we could do to make them look better. Also her index finger is stiff she can't bend it, I would like you to check her case and give me some other treatment option I would really appreciate it, thanks a lot in advance.

  22. Octavio,
    It sounds like your daughter is receiving care from a surgeon with experience. Unfortunately, there is typically not another surgery to help appearance. Also stiff digits are not uncommon in the diagnosis of symbrachydactyly. I hope this is helpful. Good luck.

  23. I have small hands and short fingers in proportion to my height. I sometimes find it hard to get a grip on a baseball.
    The appearance if my fingers bothers me immensely.
    Can my fingers be lengthened even slightly? Please let me know.

  24. I know you are an expert in this field and what you say makes complete sense. I realize that each finger is made up of multiple bones and joints, but I wondered if the first bone and I assume the largest bone of a finger, could be lengthened and thus prevent the narrowing and tapering that occurs when the "final" bone, (the fingertip) is lengthened? Also, would this prevent excessive stiffening of the finger? Thank you.

  25. My experience has been that a longer finger can be an appearance improvement. But, as I state above, it can also give the appearance of a longer, thinner finger. And lengthening will definitely not improve motion and may worsen it.

  26. My thumbs' tips are abnormally short and wide, a congenital defect I've come to know as brachydactyly type D. A fairly common issue from what I've read, and definitely no where near as severe as the pictures you've posted. I actually agree with your perspective regarding appearance; the shape of my thumbs really doesn't concern me. However, I often find myself frustrated while trying to grip certain things (pens come to mind), and my thumb is so abnormally wide that it is extremely obvious that many tools are not designed for a hand this shape. Since lengthening apparently results in the finger becoming thinner, it seems like it would be a somewhat reasonable choice. However, considering the overall function of my hand is fairly normal, is it worth it to receive a treatment such as this? It's definitely not a major impact in my life; more like a minor to moderate frustration at the obvious shortcomings of my thumb design. What are the potential negative side effects of this treatment? Is there a potential for loss of functionality/dexterity in the hands due to the treatment?

    Thank you for taking your time to read.

  27. Sim,
    Thank you for the question. And I appreciate your perspective- helpful for me and I am sure for the readers. I would not push for a lengthening based on your overall description of your function and the challenging with lengthening (including stiffness). However, it is always smart to be examined and discuss the option with a hand surgeon who regularly treats kids. Good luck.

  28. Angel R,
    Thank you for question. You can lengthen the bones of the feet but usually that is only done if there is pain. We are not creating a toe, just lengthening the bones that are there. Good luck.

  29. I know that this is a few years late, but this is similar to what I had (but with short ring fingers on both hands) and had surgery to lengthen the metacarpals with great results. Could not be happier!

  30. Hi. My daighter is having a amionic band syndrome and some of her finger on her left hand is not fully developed . It is the number 3 4 and 5 . Is it possible for her to have a finger extension to make it look normal?

  31. Thank you for the question. The exact anomaly is important in determining the best plan. If the thumb and index finger are normal, function will be very good and lengthening might not make sense. But, there are certainly times that lengthening will make sense.

  32. John. Thank you for the question. The middle phalanx can be short, classically in mild symbrachydactyly. But lengthening this bone is difficult and is usually not performed, for multiple reasons. Primarily, the limited length gains would likely make this intervention not sufficient.

  33. Hi Charles I have a shortened and crooked middle phalanx on my right middle finger. This middle phalanx is also wider and thicker than the other parts of my hand. I play Division 1 baseball and it has been hampering my ability to make accurate throws when playing. Would there be any recommendations for a lengthening or correction? Thank you.

    1. Mateo- congrats on your baseball success. Unfortunately, I cannot answer your question with certainty without seeing you and an x-ray. But, in principle, correcting angulation can be successfully done.

  34. Hello! Do you do lenghtening fingers and is it dangerous? Since I have shorter fingers? And what is the price?

    1. It is rare that I lengthen fingers. But, it can be appropriate and while there are risks, these are reasonable. I typically lengthen the thumb metacarpal or a little finger metacarpal to allow pinch to the thumb. Rarely other bones.

  35. Hello, I was looking up about finger lengthening as i have shortening on my left pinky on the metacarpal.

    I cant do much without pain. I cant use it when typing on a keyboard so it just hovers uselessly and painfully. (The other fingers i use as I do touch typing. ) It makes it very hard to type up college essays without bad pain. I was wondering if there was anything that could be done. It affects me a lot because i cant use it to hold things because it’s so small and painful.

    I have been told to try to adapt by a specialist but i feel it’s not working and im struggling with the aches and pains it causes. I was wondering if there’s anything they can do to make it less painful for me?

    I don’t want a life of pain from having found ways to adapt that work for about 1minute before the pain settles in.

    I have noticed that the finger doesn’t touch my ring finger when straightened, i think it’s because there’s a lot of skin or swelling above where the matacarpal joins the other bone above it.

    1. Kai- I am not certain what your condition is. Pain is just not common with short fingers. I would recommend seeing a hand surgeon with a specialty in caring for birth (ie, congenital) conditions. There may be a role for therapy or, rarely, surgery.

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