846:(687 adults and 1259 larvae) were captured from a large wetland complex and evaluated for malformations. Among the 687 adults, 54 (7.9%) were malformed. Of these 54 adults, 46 (85%) had missing (ectrodactyly), extra (polyphalangy) or dwarfed digits (brachydactyly). Among the 1259 larvae, 102 were malformed, with 94 (92%) of the malformations involving ectrodactyly, polyphalangy, and brachydactyly. Results showed few differences in the frequency of malformations among life-history changes, suggesting that malformed larvae do not have substantially higher mortality than their adult conspecifics.
67:
596:
321:). The exact chromosomal defect in isolated cleft hand is not yet defined. However, the genetic causes of cleft hand related to syndromes have more clarity. The identified mutation for SHSF syndrome (split-hand/split-foot syndrome) a duplication on 10q24, and not a mutation of the tp63 gene as in families affected by EEC syndrome (ectrodactylyâectodermal dysplasiaâcleft syndrome). The p63 gene plays a critical role in the development of the apical ectodermal ridge (AER), this was found in mutant mice with dactylaplasia.
129:
cleft hand appears as a V-shaped cleft situated in the centre of the hand. The digits at the borders of the cleft might be syndactilyzed, and one or more digits can be absent. In most types, the thumb, ring finger and little finger are the less affected parts of the hand. The incidence of cleft hand varies from 1 in 90,000 to 1 in 10,000 births depending on the used classification. Cleft hand can appear unilateral or bilateral, and can appear isolated or associated with a syndrome.
39:
604:
2026:
714:
250:
between these morphogens, the involvement of modifier genes, and the presumed involvement of multiple gene or long-range regulatory elements in some cases of ectrodactyly. In the clinical setting these genetic characteristics can become problematic and making predictions of carrier status and severity of the disease impossible to predict.
137:(SHFM1 at 7q21-q22), SHFM2 (Xq26), SHFM3 (FBXW4/DACTYLIN at 10q24), SHFM4 (TP63 at 3q27), and SHFM5 (DLX1 and DLX 2 at 2q31). SHFM3 is unique in that it is caused by submicroscopic tandem chromosome duplications of FBXW4/DACTYLIN. SHFM3 is considered 'isolated' ectrodactyly and does not show a mutation of the tp63 gene.
631:
in 1575. Hartsink (1770) wrote the first report of true cleft hand. In 1896, the first operation of the cleft hand was performed by Doctor
Charles N. Dowed of New York City. However, the first certain description of what we know as a cleft hand as we know it today was described at the end of the 19th
574:
Ueba described a less complicated surgery. Transverse flaps are used to resurface the palm, the dorsal side of the transposed digit and the ulnar part of the first web space. A tendon graft is used to connect the common extensor tendons of the border digits of the cleft to prevent digital separation
561:
The goal of this procedure is to create a wide first web space and to minimise the cleft in the hand. The index digit will be transferred to the ulnar side of the cleft. Simultaneously a correction of index malrotation and deviation is performed. To minimise the cleft, it is necessary to fix together
451:
The social and stigmatising aspects of a cleft hand require more attention. The hand is a part of the body which is usually shown during communication. When this hand is obviously different and deformed, stigmatisation or rejection can occur. Sometimes, in families with cleft hand with good function,
128:
in which the development of the hand is disturbed. It is a type I failure of formation â longitudinal arrest. The central ray of the hand is affected and usually appears without proximal deficiencies of nerves, vessels, tendons, muscles and bones in contrast to the radial and ulnar deficiencies. The
833:
The
Department of Biological Sciences at the University of Alberta in Edmonton, Alberta performed a study to estimate deformity levels in wood frogs in areas of relatively low disturbance. After roughly 22,733 individuals were examined during field studies, it was found that only 49 wood frogs had
824:
Ectrodactyly is not only a genetic characteristic in humans, but can also occur in frogs and toads, mice, salamanders, cows, chickens, rabbits, marmosets, cats and dogs, and even West Indian manatees. The following examples are studies showing the natural occurrence of ectrodactyly in animals,
505:
When surgery is indicated, the choice of treatment is based on the classification. Table 4 shows the treatment of cleft hand divided into the classification of Manske and
Halikis. Techniques described by Ueba, Miura and Komada and the procedure of Snow-Littler are guidelines; since clinical and
496:
The timing of surgical interventions is debatable. Parents have to decide about their child in a very vulnerable time of their parenthood. Indications for early treatment are progressive deformities, such as syndactyly between index and thumb or transverse bones between the digital rays. Other
249:
A number of factors make the identification of the genetic defects underlying human ectrodactyly a complicated process: the limited number of families linked to each split hand/foot malformation (SHFM) locus, the large number of morphogens involved in limb development, the complex interactions
145:
Ectrodactyly can be caused by various changes to 7q. When 7q is altered by a deletion or a translocation, ectrodactyly can sometimes be associated with hearing loss. Ectrodactyly, or Split hand/split foot malformation (SHFM) type 1 is the only form of split hand/ malformation associated with
132:
Split hand/foot malformation (SHFM) is characterized by underdeveloped or absent central digital rays, clefts of hands and feet, and variable syndactyly of the remaining digits. SHFM is a heterogeneous condition caused by abnormalities at one of multiple loci, including
700:
Historically, a U-type cleft hand was also known as atypical cleft hand. The classification in which typical and atypical cleft hand are described was mostly used for clinical aspects and is shown in table 1. Nowadays, this "atypical cleft hand" is referred to as
260:
Ectrodactyly is frequently seen with other congenital anomalies. Syndromes in which ectrodactyly is associated with other abnormalities can occur when two or more genes are affected by a chromosomal rearrangement. Disorders associated with ectrodactyly include
351:
There are several classifications for cleft hand, but the most used classification is described by Manske and
Halikis see table 3. This classification is based on the first web space. The first web space is the space between the thumb and the index finger.
270:
2163:
854:
Davis and Barry 1977 tested allele frequencies in domestic cats. Among the 265 cats observed, there were 101 males and 164 females. Only one cat was recorded to have the ectrodactyly abnormality, illustrating this rare disease.
1660:
1760:
Eaton, Brian R.; Eaves, Sara; Stevens, Cameron; Puchniak, Allison; Paszkowski, Cynthia A.; et al. (2004). "Deformity Levels in Wild
Populations of the Wood Frog (Rana sylvatica) in Three Ecoregions of Western Canada".
329:
Some studies have postulated that polydactyly, syndactyly and cleft hand have the same teratogenic mechanism. In vivo tests showed that limb anomalies were found alone or in combination with cleft hand when they were given
2156:
241:
and X-linked forms occur more rarely. Ectrodactyly can also be caused by a duplication on 10q24. Detailed studies of a number of mouse models for ectrodactyly have also revealed that a failure to maintain median
2087:
2072:
1447:
Naruse, Takuji; Takahara, Masatoshi; Takagi, Michiaki; Ogino, Toshihiko (2007). "Early
Morphological Changes Leading to Central Polydactyly, Syndactyly, and Central Deficiencies: An Experimental Study in Rats".
862:
dog. In another study, Carrig and co-workers also reported a series of 14 dogs with this abnormality proving that although ectrodactyly is an uncommon occurrence for dogs, it is not entirely unheard of.
2149:
117:). The hands and feet of people with ectrodactyly (ectrodactyls) are often described as "claw-like" and may include only the thumb and one finger (usually either the little finger, ring finger, or a
211:
204:
1331:
Shamseldin, Hanan E; Faden Maha A; Alashram Walid; Alkuraya Fowzan S (Nov 2011). "Identification of a novel DLX5 mutation in a family with autosomal recessive split hand and foot malformation".
583:
The release of the first webspace has the same principle as the Snow-Littler procedure. The difference is the closure of the first webspace; this is done by simple closure or closure with
218:
1994:
Carrig, ColinB.; Wortman, JeffreyA.; Morris, EarlL.; Blevins, WilliamE.; Root, CharlesR.; Hanlon, GriseldaF.; Suter, PeterF. (1981). "Ectrodactyly (Split-hand deformity) in the dog".
925:
Durowaye, Mathew; Adegboye, Abdulrasheed; Mokuolu, Olugbenga
Ayodeji; Adeboye, Muhammed; Yahaya-Kongoila, Sefiyah; Adaje, Adeline; Adesiyun, Omotayo; Ernest, Samuel Kolade (2011).
301:
and cleft hand can occur within the same hand, therefore some investigators suggest that these entities occur from the same mechanism. This mechanism is not yet defined.
974:
Moerman, P.; Fryns, J.P. (1998). "Ectodermal dysplasia, RappâHodgkin type in a mother and severe ectrodactyly-ectodermal dysplasia-clefting syndrome (EEC) in her child".
448:
of the condition. The function of a cleft hand is mostly not restricted, yet improving the function is one of the goals when the thumb or first webspace is absent.
262:
162:
2850:
190:
1096:
Kay, Simon P.; McCombe, David (2005). "Central hand deficiencies". In Green, David P.; Hotchkiss, Robert N.; Pederson, William C.; et al. (eds.).
2141:
825:
without the disease being reproduced and tested in a laboratory. In all three examples we see how rare the actual occurrence of ectrodactyly is.
1798:
Manson, Jeanne; Dourson, Michael L.; Smith, Carl C. (1977). "Effects of
Cytosine Arabinoside on In vivo and In vitro Mouse limb Development".
1272:
Scherer, Stephen; Cheung, J; MacDonald, JR; Osborne, LR; Nakabayashi, K; Herbrick, JA; Carson, AR; Parker-Katiraee, L; et al. (2003).
1485:"Busulfan-induced central polydactyly, syndactyly and cleft hand or foot: A common mechanism of disruption leads to divergent phenotypes"
989:
976:
2743:
802:
694:
Suppression progresses in a more ulnar direction; therefore in the monodactylous form the thumb is usually the last remaining digit
654:
Atypical hand had a more severe manifestation in which there was varying absence of the central index, middle and ring finger rays
289:
The pathophysiology of cleft hand is thought to be a result of a wedge-shaped defect of the apical ectoderm of the limb bud (AER:
2236:
575:
during extension. The closure is simpler, but has cosmetic disadvantage because of the switch between palmar and dorsal skin.
1105:
1024:
909:
169:
550:
There is no cleft or web space and the thumb is very deficient. This hand requires consideration of creating a radial digit
2684:
778:
2102:
2045:
2036:
1588:
Manske, Paul R.; Halikis, Mark N. (1995). "Surgical classification of central deficiency according to the thumb web".
2171:
734:
as an inspirational character who battles her disease and counsels another family who have children with ectrodactyly
274:
842:
In a study performed by the
Department of Forestry and Natural Resources at Purdue University, approximately 2000
2638:
2357:
691:
Suppression progresses in a radial direction so that in the monodactylous form the most ulnar finger is preserved
1161:"Refinement of the deletion in 7q21.3 associated with split hand/foot malformation type 1 and Mondini dysplasia"
623:
there is a man whose hands are crescent-shaped, and have only two fingers each, and his feet similarly formed.
506:
anatomical presentation within the types differ, the actual treatment is based on the individual abnormality.
2030:
1539:"Cleft hand: Classification, incidence and treatment: review of the literature and report of nineteen cases"
2473:
2176:
2643:
2362:
2192:
2180:
1380:
1165:
176:
2674:
1011:
Peterson-Falzone, Sally J.; Hardin-Jones, Mary A.; Karnell, Michael P.; McWilliams, Betty Jane (2001).
792:
183:
452:
operations for cosmetic aspects are considered marginal and the families choose not to have surgery.
309:
The cause of cleft hand lies, for what is known, partly in genetics. The inheritance of cleft hand is
2728:
2648:
1575:
Falliner AA., Analysis of anatomic variations in cleft hands, J Hand Surg Am. 2004 Nov;29(6):994-1001
233:
A large number of human gene defects can cause ectrodactyly. The most common mode of inheritance is
2583:
2226:
2113:
1626:
Manske, Paul R.; Goldfarb, Charles A. (2009). "Congenital
Failure of Formation of the Upper Limb".
1235:
1159:
Wieland, I.; Muschke, P; Jakubiczka, S; Volleth, M; Freigang, B; Wieacker, PF; et al. (2004).
808:
66:
2620:
2254:
2231:
1483:
Naruse, Takuji; Takahara, Masatoshi; Takagi, Michiaki; Oberg, Kerby C.; Ogino, Toshihiko (2007).
290:
277:. More than 50 syndromes and associations involving ectrodactyly are distinguished in the London
243:
197:
728:
Once a popular television anchor woman in Los Angeles, she has appeared in the television drama
2845:
1901:
Constitutional Disorders of the Skeleton in Dogs and Cats: Textbook of Small Animal Orthopedics
1763:
473:
Transverse bones (this will progress the deformity; growth of these bones will widen the cleft)
225:
88:
899:
2523:
2188:
747:
2738:
1287:
858:
According to M.P. Ferreira, a case of ectrodactyly was found in a two-month-old male mixed
772:
1929:
1040:
8:
2556:
2172:
2091:
1916:
1914:
Davis, Brian; Davis, Barry (1977). "Allele frequencies in a cat population in Budapest".
314:
238:
125:
20:
1951:
Ferreira, M.P.; Alievi, M.M.; Beck, C.A.C.; Voll, J.; Muccillo, M.S.; Gomes, C. (2007).
1291:
444:
The treatment of cleft hand is usually invasive and can differ each time because of the
2418:
2007:
1876:
1851:
1823:
1780:
1402:
1375:
1356:
1308:
1273:
1187:
1160:
1013:
951:
926:
310:
234:
2096:
1601:
566:
which used to border the cleft. Through repositioning flaps, the wound can be closed.
246:(AER) signalling can be the main pathogenic mechanism in triggering this abnormality.
2753:
2733:
2124:
1933:
1881:
1815:
1737:
1692:
1643:
1605:
1558:
1554:
1506:
1501:
1484:
1465:
1407:
1348:
1330:
1313:
1278:
1254:
1192:
1138:
1101:
1020:
993:
956:
905:
55:
1969:
1952:
1827:
1784:
1360:
651:
Typical hand was manifest in the complete or incomplete absence of the middle finger
2800:
2795:
2716:
2708:
2628:
2592:
2400:
2352:
2309:
2003:
1974:
1964:
1925:
1871:
1863:
1807:
1772:
1684:
1635:
1597:
1550:
1496:
1457:
1397:
1389:
1340:
1303:
1295:
1244:
1182:
1174:
1130:
985:
946:
938:
742:
741:: known publicly as Lobster Boy and family, famous side show acts, featured on the
702:
595:
470:
Deforming syndactyly (mostly between digits of unequal length like index and thumb)
318:
60:
1344:
628:
19:
This article is about the congenital disorder. For the neurological syndrome, see
2816:
2551:
2381:
2347:
2300:
2118:
1710:
1121:
Upton, Joseph; Taghinia, Amir H. (2010). "Correction of the Typical Cleft Hand".
1100:(5th ed.). Philadelphia: Elsevier/ Churchill Livingstone. pp. 1404â15.
106:
798:
542:
Mobility and/or position of the thumb of ulnar digit to promote pinch and grasp
534:
Transposition of the index metacarpal with reconstruction of the thumb webspace
433:
Thumb elements suppressed, ulnar rays remain, thumb web space no longer present
2679:
2610:
2574:
2546:
2468:
2372:
2246:
2129:
1688:
1461:
1134:
877:
266:
2081:
1639:
2839:
2689:
2633:
2600:
2483:
2304:
1728:
Farrell HB (1984). "The two-toed Wadoma--familial ectrodactyly in Zimbabwe".
1010:
445:
1299:
1178:
990:
10.1002/(SICI)1096-8628(19960614)63:3<479::AID-AJMG12>3.0.CO;2-J
2771:
2664:
2506:
2264:
2259:
1885:
1867:
1850:
Williams, Rod N; Bos, David H; Gopurenko, David; DeWoody, J Andrew (2008).
1696:
1675:
Jones, Neil F; Kono, Michiyuki (2004). "Cleft hands with six metacarpals".
1647:
1562:
1510:
1469:
1352:
1317:
1258:
1196:
1142:
960:
872:
812:
738:
627:
The first modern reference to what might be considered a cleft hand was by
269:
and Limb-mammary (LMS) syndrome, Ectrodactyly-Cleft Palate (ECP) syndrome,
1741:
1609:
1411:
997:
105: 'finger') involves the deficiency or absence of one or more central
2694:
2461:
2452:
2337:
2269:
1937:
1819:
1538:
1393:
1249:
1230:
843:
764:
725:
563:
294:
942:
2669:
2605:
2518:
2512:
2488:
2456:
2423:
2392:
2342:
2314:
1979:
1811:
786:
584:
355:
Table 3: Classification for cleft hand described by Manske and Halikis
298:
278:
118:
47:
2064:
599:
Ectrodactyly in all extremities; only eight total digits present, 1870
497:
surgical interventions are less urgent and can wait for 1 or 2 years.
460:
Surgical treatment of the cleft hand is based on several indications:
2776:
2721:
2528:
2413:
2406:
2387:
2319:
2283:
1045:
509:
Table 4: Treatment based on the classification of Manske and Halikis
335:
317:
of 70%. Cleft hand can be a spontaneous mutation during pregnancy (
2218:
2214:
2196:
1776:
927:"Familial Ectrodactyly Syndrome in a Nigerian Child: A Case Report"
759:
730:
38:
2786:
2444:
1903:. Ithaca, New York: International Veterinary Information Service.
859:
620:
603:
331:
2107:
2049:
2040:
611:
Literature shows that cleft hand is described centuries ago. In
2076:
2025:
1158:
880:, a main gene responsible for body symmetry during development.
768:
755:
717:
422:
Index ray suppressed, thumb web space is merged with the cleft
924:
273:, Ectrodactyly-Fibular Aplasia/Hypoplasia (EFA) syndrome, and
1271:
134:
713:
271:
Ectrodactyly-Ectodermal Dysplasia-Macular Dystrophy syndrome
2329:
1849:
254:
1993:
781:
showing his right profile and right hand with ectrodactyly
411:
Thumb and index rays syndactylized, web space obliterated
2762:
2292:
2205:
1759:
1482:
1446:
607:
Monodactyly of both hands; only two fingers present, 1897
263:
Ectrodactyly-Ectodermal Dysplasia-Clefting (EEC) syndrome
334:. These anomalies take place in humans around day 41 of
16:
Malformation of the central digit(s) of the hand or foot
1957:
Arquivo Brasileiro de Medicina VeterinĂĄria e Zootecnia
1950:
789:, a Korean pianist with only two fingers on each hand.
526:
Reconstruction of the transverse metacarpal ligament
2054:
1231:"Pathogenesis of split-hand/split-foot malformation"
897:
121:
of the two) with similar abnormalities of the feet.
491:
1797:
1012:
2837:
904:. Oxford: Oxford University Press. p. 197.
163:Ectrodactylyâectodermal dysplasiaâcleft syndrome
1373:
500:
2851:Congenital disorders of musculoskeletal system
1625:
1274:"Human Chromosome 7: DNA Sequence and Biology"
2157:
1587:
1427:
1425:
1423:
1421:
1120:
973:
811:, British pro tennis player, former #149 in
1845:
1843:
1841:
1839:
1837:
1621:
1619:
1436:. American Society for Surgery of the Hand.
1374:Winter, R.M.; Baraitser, M. (August 1987).
977:American Journal of Medical Genetics Part A
2164:
2150:
1913:
1727:
1431:
1418:
1095:
65:
37:
1978:
1968:
1875:
1674:
1583:
1581:
1532:
1530:
1528:
1526:
1524:
1522:
1520:
1500:
1489:Development, Growth & Differentiation
1401:
1307:
1248:
1186:
1154:
1152:
950:
109:of the hand or foot and is also known as
1852:"Amphibian malformations and inbreeding"
1834:
1755:
1753:
1751:
1670:
1668:
1616:
1224:
1222:
1220:
1218:
1216:
1214:
1212:
1210:
1208:
1206:
712:
602:
594:
1703:
646:Atypical cleft hand (symbrachydactyly)
212:Ectrodactyly/mandibulofacial dysostosis
2838:
1953:"Ectrodactilia em cĂŁo: relato de caso"
1578:
1536:
1517:
1367:
1228:
1149:
1091:
1089:
1087:
1085:
1083:
1081:
1079:
1077:
1075:
1073:
205:Ectrodactyly and cleft palate syndrome
2145:
1930:10.1093/oxfordjournals.jhered.a108768
1898:
1748:
1665:
1543:The Journal of Bone and Joint Surgery
1203:
1071:
1069:
1067:
1065:
1063:
1061:
1059:
1057:
1055:
1053:
898:Giele, Henk; Cassell, Oliver (2008).
265:, which is closely correlated to the
170:Split-Hand-Foot Malformation Syndrome
2685:Greig cephalopolysyndactyly syndrome
705:and is not a subtype of cleft hand.
2046:Online Mendelian Inheritance in Man
2037:Online Mendelian Inheritance in Man
1376:"The London Dysmorphology Database"
635:
615:(426 A.D.), St. Augustine remarks:
578:
124:It is a substantial rare form of a
50:on the hand of a one-year-old child
13:
2175:malformations and deformations of
2008:10.1111/j.1740-8261.1981.tb01363.x
1229:Pascal, H.G.; et al. (2003).
1050:
901:Plastic and Reconstructive Surgery
400:Thumb web space severely narrowed
284:
257:was found to be involved in SHFM.
219:Ectrodactyly and macular dystrophy
111:split hand/split foot malformation
14:
2862:
2018:
346:
2024:
1661:City of God, Book XVI, Chapter 8
1555:10.2106/00004623-196446080-00006
1502:10.1111/j.1440-169X.2007.00949.x
849:
708:
492:Timing of surgical interventions
389:Thumb web space mildly narrowed
98: 'miscarriage' and
2358:Congenital patellar dislocation
2237:WallisâZieffâGoldblatt syndrome
1987:
1970:10.1590/S0102-09352007000400015
1944:
1907:
1892:
1791:
1721:
1711:"Medical Mystery: Ectrodactyly"
1654:
1569:
1476:
1440:
1324:
1265:
556:
237:with reduced penetrance, while
140:
1114:
1098:Green's Operative Hand Surgery
1033:
1004:
967:
918:
891:
837:
455:
1:
1602:10.1016/S0363-5023(05)80293-X
1432:Katarincic, Julia A. (2003).
1345:10.1136/jmedgenet-2011-100556
884:
378:Thumb web space not narrowed
324:
304:
253:In 2011, a novel mutation in
834:the ectrodactyly deformity.
828:
670:One limb involved (no feet)
639:
511:
501:Classification and treatment
439:
357:
341:
146:sensorineural hearing loss.
7:
2644:Oto-palato-digital syndrome
2639:HallermannâStreiff syndrome
2363:Congenital knee dislocation
2181:musculoskeletal abnormality
1677:The Journal of Hand Surgery
1590:The Journal of Hand Surgery
1450:The Journal of Hand Surgery
1381:Journal of Medical Genetics
1333:Journal of Medical Genetics
1166:Journal of Medical Genetics
1123:The Journal of Hand Surgery
1041:Congenital Hand Deformities
866:
149:
10:
2867:
2675:Craniodiaphyseal dysplasia
1689:10.1016/j.jhsa.2004.04.002
1462:10.1016/j.jhsa.2007.06.017
1135:10.1016/j.jhsa.2009.12.021
819:
803:2020 US Open Quad Champion
667:One to four limbs involved
590:
184:Cornelia de Lange syndrome
18:
2809:
2785:
2761:
2752:
2707:
2657:
2649:Treacher Collins syndrome
2619:
2591:
2582:
2573:
2539:
2500:reduction deficits / limb
2499:
2443:
2436:
2371:
2328:
2291:
2282:
2245:
2213:
2204:
2187:
2058:
1640:10.1016/j.hcl.2008.10.005
1537:Barsky, Arthur J (1964).
54:
45:
36:
31:
2474:CenaniâLenz syndactylism
2227:Cleidocranial dysostosis
1236:Human Molecular Genetics
720:people with ectrodactyly
275:Ectrodactyly-Polydactyly
2621:Craniofacial dysostosis
1300:10.1126/science.1083423
1179:10.1136/jmg.2003.010587
795:, freak show performer.
569:
476:Narrowed first webspace
291:apical ectodermal ridge
244:apical ectodermal ridge
198:Focal dermal hypoplasia
177:SilverâRussell syndrome
2177:musculoskeletal system
1868:10.1098/rsbl.2008.0233
1764:Journal of Herpetology
721:
625:
608:
600:
226:Buttien-Fryns syndrome
2729:KlippelâFeil syndrome
737:Grady Stiles Sr. and
716:
617:
606:
598:
397:Severely narrowed web
2739:Spina bifida occulta
2255:Madelung's deformity
2232:Sprengel's deformity
2033:at Wikimedia Commons
1996:Veterinary Radiology
1899:Jezyk, P.F. (1985).
1394:10.1136/jmg.24.8.509
931:Oman Medical Journal
773:World Chess Champion
483:Aesthetical aspects
2557:RAPADILINO syndrome
1917:Journal of Heredity
1717:. January 27, 2007.
1292:2003Sci...300..767S
1015:Cleft Palate Speech
943:10.5001/omj.2011.67
386:Mildly narrowed web
315:variable penetrance
239:autosomal recessive
126:congenital disorder
21:split hand syndrome
2419:Rocker bottom foot
1812:10.1007/BF02615104
1250:10.1093/hmg/ddg090
758:tribe in northern
722:
683:Autosomal dominant
643:Typical cleft hand
609:
601:
487:Reducing deformity
464:Improving function
311:autosomal dominant
235:autosomal dominant
191:Acrorenal syndrome
2833:
2832:
2829:
2828:
2825:
2824:
2754:Thoracic skeleton
2734:Spondylolisthesis
2703:
2702:
2569:
2568:
2565:
2564:
2432:
2431:
2278:
2277:
2139:
2138:
2029:Media related to
1286:(5620): 767â772.
1107:978-0-443-06626-9
1026:978-0-8151-3153-3
911:978-0-19-263222-7
698:
697:
554:
553:
437:
436:
408:Syndactylized web
231:
230:
74:
73:
46:Ectrodactyly and
26:Medical condition
2858:
2801:Pectus carinatum
2796:Pectus excavatum
2759:
2758:
2717:Spinal curvature
2709:Vertebral column
2629:Crouzon syndrome
2593:Craniosynostosis
2589:
2588:
2580:
2579:
2445:fingers and toes
2441:
2440:
2353:Discoid meniscus
2310:Upington disease
2289:
2288:
2211:
2210:
2202:
2201:
2166:
2159:
2152:
2143:
2142:
2056:
2055:
2028:
2012:
2011:
1991:
1985:
1984:
1982:
1972:
1948:
1942:
1941:
1911:
1905:
1904:
1896:
1890:
1889:
1879:
1847:
1832:
1831:
1795:
1789:
1788:
1757:
1746:
1745:
1725:
1719:
1718:
1707:
1701:
1700:
1672:
1663:
1658:
1652:
1651:
1623:
1614:
1613:
1585:
1576:
1573:
1567:
1566:
1534:
1515:
1514:
1504:
1480:
1474:
1473:
1444:
1438:
1437:
1429:
1416:
1415:
1405:
1371:
1365:
1364:
1328:
1322:
1321:
1311:
1269:
1263:
1262:
1252:
1226:
1201:
1200:
1190:
1156:
1147:
1146:
1118:
1112:
1111:
1093:
1048:
1037:
1031:
1030:
1018:
1008:
1002:
1001:
971:
965:
964:
954:
922:
916:
915:
895:
739:Grady Stiles Jr.
703:symbrachydactyly
678:Lower incidence
675:Higher incidence
640:
636:Symbrachydactyly
621:Hippo-Diarrhytus
579:Miura and Komada
512:
367:Characteristics
358:
319:de novo mutation
154:
153:
70:
69:
61:Medical genetics
41:
29:
28:
2866:
2865:
2861:
2860:
2859:
2857:
2856:
2855:
2836:
2835:
2834:
2821:
2817:Poland syndrome
2805:
2781:
2748:
2699:
2653:
2615:
2561:
2552:Larsen syndrome
2540:multiple joints
2535:
2495:
2428:
2367:
2348:Genu recurvatum
2324:
2301:Hip dislocation
2274:
2241:
2191:
2183:
2170:
2140:
2135:
2134:
2067:
2021:
2016:
2015:
1992:
1988:
1949:
1945:
1912:
1908:
1897:
1893:
1856:Biology Letters
1848:
1835:
1796:
1792:
1758:
1749:
1726:
1722:
1709:
1708:
1704:
1673:
1666:
1659:
1655:
1624:
1617:
1586:
1579:
1574:
1570:
1535:
1518:
1481:
1477:
1445:
1441:
1430:
1419:
1372:
1368:
1329:
1325:
1270:
1266:
1227:
1204:
1157:
1150:
1119:
1115:
1108:
1094:
1051:
1038:
1034:
1027:
1009:
1005:
972:
968:
923:
919:
912:
896:
892:
887:
869:
852:
840:
831:
822:
809:Francesca Jones
711:
662:U-shaped cleft
638:
593:
581:
572:
559:
503:
494:
458:
442:
349:
344:
327:
307:
287:
285:Pathophysiology
152:
143:
64:
27:
24:
17:
12:
11:
5:
2864:
2854:
2853:
2848:
2831:
2830:
2827:
2826:
2823:
2822:
2820:
2819:
2813:
2811:
2807:
2806:
2804:
2803:
2798:
2792:
2790:
2783:
2782:
2780:
2779:
2774:
2768:
2766:
2756:
2750:
2749:
2747:
2746:
2741:
2736:
2731:
2726:
2725:
2724:
2713:
2711:
2705:
2704:
2701:
2700:
2698:
2697:
2692:
2687:
2682:
2680:Dolichocephaly
2677:
2672:
2667:
2661:
2659:
2655:
2654:
2652:
2651:
2646:
2641:
2636:
2631:
2625:
2623:
2617:
2616:
2614:
2613:
2611:Trigonocephaly
2608:
2603:
2597:
2595:
2586:
2584:Skull and face
2577:
2571:
2570:
2567:
2566:
2563:
2562:
2560:
2559:
2554:
2549:
2547:Arthrogryposis
2543:
2541:
2537:
2536:
2534:
2533:
2532:
2531:
2526:
2521:
2509:
2503:
2501:
2497:
2496:
2494:
2493:
2492:
2491:
2481:
2476:
2471:
2469:Arachnodactyly
2466:
2465:
2464:
2449:
2447:
2438:
2434:
2433:
2430:
2429:
2427:
2426:
2421:
2416:
2411:
2410:
2409:
2397:
2396:
2395:
2390:
2377:
2375:
2373:foot deformity
2369:
2368:
2366:
2365:
2360:
2355:
2350:
2345:
2340:
2334:
2332:
2326:
2325:
2323:
2322:
2317:
2312:
2307:
2297:
2295:
2286:
2280:
2279:
2276:
2275:
2273:
2272:
2267:
2262:
2257:
2251:
2249:
2247:hand deformity
2243:
2242:
2240:
2239:
2234:
2229:
2223:
2221:
2208:
2199:
2185:
2184:
2169:
2168:
2161:
2154:
2146:
2137:
2136:
2133:
2132:
2121:
2110:
2099:
2084:
2068:
2063:
2062:
2060:
2059:Classification
2053:
2052:
2043:
2034:
2020:
2019:External links
2017:
2014:
2013:
1986:
1943:
1906:
1891:
1833:
1806:(7): 434â442.
1790:
1777:10.1670/95-03N
1771:(2): 283â287.
1747:
1730:S. Afr. Med. J
1720:
1702:
1664:
1653:
1615:
1577:
1568:
1516:
1475:
1439:
1417:
1388:(8): 509â510.
1366:
1323:
1264:
1243:(1): R51âR60.
1202:
1148:
1113:
1106:
1049:
1032:
1025:
1003:
966:
917:
910:
889:
888:
886:
883:
882:
881:
878:Sonic hedgehog
875:
868:
865:
851:
848:
839:
836:
830:
827:
821:
818:
817:
816:
806:
796:
793:Black Scorpion
790:
784:
783:
782:
771:chess player,
762:
752:
745:reality show,
735:
710:
707:
696:
695:
692:
688:
687:
684:
680:
679:
676:
672:
671:
668:
664:
663:
660:
659:V-shaped cleft
656:
655:
652:
648:
647:
644:
637:
634:
592:
589:
580:
577:
571:
568:
558:
555:
552:
551:
548:
544:
543:
540:
536:
535:
532:
528:
527:
524:
520:
519:
516:
502:
499:
493:
490:
489:
488:
481:
480:
477:
474:
471:
468:
465:
457:
454:
441:
438:
435:
434:
431:
428:
424:
423:
420:
417:
413:
412:
409:
406:
402:
401:
398:
395:
391:
390:
387:
384:
380:
379:
376:
373:
369:
368:
365:
362:
348:
347:Classification
345:
343:
340:
326:
323:
306:
303:
286:
283:
267:ADULT syndrome
229:
228:
222:
221:
215:
214:
208:
207:
201:
200:
194:
193:
187:
186:
180:
179:
173:
172:
166:
165:
159:
158:
151:
148:
142:
139:
72:
71:
58:
52:
51:
43:
42:
34:
33:
25:
15:
9:
6:
4:
3:
2:
2863:
2852:
2849:
2847:
2846:Rare diseases
2844:
2843:
2841:
2818:
2815:
2814:
2812:
2808:
2802:
2799:
2797:
2794:
2793:
2791:
2788:
2784:
2778:
2775:
2773:
2770:
2769:
2767:
2764:
2760:
2757:
2755:
2751:
2745:
2744:Sacralization
2742:
2740:
2737:
2735:
2732:
2730:
2727:
2723:
2720:
2719:
2718:
2715:
2714:
2712:
2710:
2706:
2696:
2693:
2691:
2690:Plagiocephaly
2688:
2686:
2683:
2681:
2678:
2676:
2673:
2671:
2668:
2666:
2663:
2662:
2660:
2656:
2650:
2647:
2645:
2642:
2640:
2637:
2635:
2634:Hypertelorism
2632:
2630:
2627:
2626:
2624:
2622:
2618:
2612:
2609:
2607:
2604:
2602:
2601:Scaphocephaly
2599:
2598:
2596:
2594:
2590:
2587:
2585:
2581:
2578:
2576:
2572:
2558:
2555:
2553:
2550:
2548:
2545:
2544:
2542:
2538:
2530:
2527:
2525:
2522:
2520:
2517:
2516:
2515:
2514:
2510:
2508:
2505:
2504:
2502:
2498:
2490:
2487:
2486:
2485:
2484:Brachydactyly
2482:
2480:
2477:
2475:
2472:
2470:
2467:
2463:
2460:
2459:
2458:
2454:
2451:
2450:
2448:
2446:
2442:
2439:
2437:Either / both
2435:
2425:
2422:
2420:
2417:
2415:
2412:
2408:
2405:
2404:
2403:
2402:
2398:
2394:
2391:
2389:
2386:
2385:
2384:
2383:
2379:
2378:
2376:
2374:
2370:
2364:
2361:
2359:
2356:
2354:
2351:
2349:
2346:
2344:
2341:
2339:
2336:
2335:
2333:
2331:
2327:
2321:
2318:
2316:
2313:
2311:
2308:
2306:
2305:Hip dysplasia
2302:
2299:
2298:
2296:
2294:
2290:
2287:
2285:
2281:
2271:
2268:
2266:
2263:
2261:
2258:
2256:
2253:
2252:
2250:
2248:
2244:
2238:
2235:
2233:
2230:
2228:
2225:
2224:
2222:
2220:
2216:
2212:
2209:
2207:
2203:
2200:
2198:
2194:
2190:
2186:
2182:
2178:
2174:
2167:
2162:
2160:
2155:
2153:
2148:
2147:
2144:
2131:
2127:
2126:
2122:
2120:
2116:
2115:
2111:
2109:
2105:
2104:
2100:
2098:
2094:
2093:
2089:
2085:
2083:
2079:
2078:
2074:
2070:
2069:
2066:
2061:
2057:
2051:
2047:
2044:
2042:
2038:
2035:
2032:
2027:
2023:
2022:
2009:
2005:
2002:(3): 123â44.
2001:
1997:
1990:
1981:
1976:
1971:
1966:
1962:
1958:
1954:
1947:
1939:
1935:
1931:
1927:
1923:
1919:
1918:
1910:
1902:
1895:
1887:
1883:
1878:
1873:
1869:
1865:
1862:(5): 549â52.
1861:
1857:
1853:
1846:
1844:
1842:
1840:
1838:
1829:
1825:
1821:
1817:
1813:
1809:
1805:
1801:
1794:
1786:
1782:
1778:
1774:
1770:
1766:
1765:
1756:
1754:
1752:
1743:
1739:
1736:(13): 531â3.
1735:
1731:
1724:
1716:
1712:
1706:
1698:
1694:
1690:
1686:
1682:
1678:
1671:
1669:
1662:
1657:
1649:
1645:
1641:
1637:
1634:(2): 157â70.
1633:
1629:
1622:
1620:
1611:
1607:
1603:
1599:
1596:(4): 687â97.
1595:
1591:
1584:
1582:
1572:
1564:
1560:
1556:
1552:
1548:
1544:
1540:
1533:
1531:
1529:
1527:
1525:
1523:
1521:
1512:
1508:
1503:
1498:
1495:(6): 533â41.
1494:
1490:
1486:
1479:
1471:
1467:
1463:
1459:
1456:(9): 1413â7.
1455:
1451:
1443:
1435:
1428:
1426:
1424:
1422:
1413:
1409:
1404:
1399:
1395:
1391:
1387:
1383:
1382:
1377:
1370:
1362:
1358:
1354:
1350:
1346:
1342:
1338:
1334:
1327:
1319:
1315:
1310:
1305:
1301:
1297:
1293:
1289:
1285:
1281:
1280:
1275:
1268:
1260:
1256:
1251:
1246:
1242:
1238:
1237:
1232:
1225:
1223:
1221:
1219:
1217:
1215:
1213:
1211:
1209:
1207:
1198:
1194:
1189:
1184:
1180:
1176:
1172:
1168:
1167:
1162:
1155:
1153:
1144:
1140:
1136:
1132:
1128:
1124:
1117:
1109:
1103:
1099:
1092:
1090:
1088:
1086:
1084:
1082:
1080:
1078:
1076:
1074:
1072:
1070:
1068:
1066:
1064:
1062:
1060:
1058:
1056:
1054:
1047:
1043:
1042:
1036:
1028:
1022:
1017:
1016:
1007:
999:
995:
991:
987:
984:(3): 479â81.
983:
979:
978:
970:
962:
958:
953:
948:
944:
940:
936:
932:
928:
921:
913:
907:
903:
902:
894:
890:
879:
876:
874:
871:
870:
864:
861:
856:
850:Cats and dogs
847:
845:
835:
826:
814:
810:
807:
804:
800:
797:
794:
791:
788:
785:
780:
777:
776:
774:
770:
766:
763:
761:
757:
753:
750:
749:
744:
740:
736:
733:
732:
727:
724:
723:
719:
715:
709:Notable cases
706:
704:
693:
690:
689:
685:
682:
681:
677:
674:
673:
669:
666:
665:
661:
658:
657:
653:
650:
649:
645:
642:
641:
633:
630:
629:Ambroise Paré
624:
622:
616:
614:
605:
597:
588:
586:
576:
567:
565:
549:
546:
545:
541:
538:
537:
533:
530:
529:
525:
522:
521:
517:
514:
513:
510:
507:
498:
486:
485:
484:
478:
475:
472:
469:
466:
463:
462:
461:
453:
449:
447:
446:heterogeneity
432:
429:
426:
425:
421:
418:
415:
414:
410:
407:
404:
403:
399:
396:
393:
392:
388:
385:
382:
381:
377:
374:
371:
370:
366:
363:
360:
359:
356:
353:
339:
337:
333:
322:
320:
316:
312:
302:
300:
296:
292:
282:
280:
279:Dysmorphology
276:
272:
268:
264:
258:
256:
251:
247:
245:
240:
236:
227:
224:
223:
220:
217:
216:
213:
210:
209:
206:
203:
202:
199:
196:
195:
192:
189:
188:
185:
182:
181:
178:
175:
174:
171:
168:
167:
164:
161:
160:
156:
155:
147:
138:
136:
130:
127:
122:
120:
116:
112:
108:
104:
100:
97:
93:
90:
89:Ancient Greek
86:
82:
78:
68:
62:
59:
57:
53:
49:
44:
40:
35:
30:
22:
2665:Macrocephaly
2511:
2507:Acheiropodia
2479:Ectrodactyly
2478:
2399:
2380:
2265:Oligodactyly
2260:Clinodactyly
2189:Appendicular
2123:
2112:
2101:
2086:
2071:
2031:Ectrodactyly
1999:
1995:
1989:
1963:(4): 910â3.
1960:
1956:
1946:
1924:(1): 31â34.
1921:
1915:
1909:
1900:
1894:
1859:
1855:
1803:
1799:
1793:
1768:
1762:
1733:
1729:
1723:
1714:
1705:
1683:(4): 720â6.
1680:
1676:
1656:
1631:
1628:Hand Clinics
1627:
1593:
1589:
1571:
1546:
1542:
1492:
1488:
1478:
1453:
1449:
1442:
1433:
1385:
1379:
1369:
1339:(1): 16â20.
1336:
1332:
1326:
1283:
1277:
1267:
1240:
1234:
1170:
1164:
1129:(3): 480â5.
1126:
1122:
1116:
1097:
1039:
1035:
1014:
1006:
981:
975:
969:
937:(4): 275â8.
934:
930:
920:
900:
893:
873:Oligodactyly
857:
853:
841:
832:
823:
813:WTA rankings
799:Sam Schröder
746:
729:
699:
626:
618:
612:
610:
582:
573:
560:
557:Snow-Littler
508:
504:
495:
482:
467:Absent thumb
459:
450:
443:
354:
350:
328:
308:
288:
259:
252:
248:
232:
144:
141:Presentation
131:
123:
114:
110:
102:
99:
95:
92:
84:
80:
77:Ectrodactyly
76:
75:
32:Ectrodactyly
2695:Saddle nose
2462:Webbed toes
2453:Polydactyly
2338:Genu valgum
2270:Polydactyly
1980:10183/76981
1549:: 1707â20.
844:salamanders
838:Salamanders
765:Mikhail Tal
726:Bree Walker
613:City of God
564:metacarpals
456:Indications
364:Description
295:Polydactyly
2840:Categories
2670:Platybasia
2606:Oxycephaly
2519:Phocomelia
2513:Ectromelia
2489:Stub thumb
2457:Syndactyly
2424:Hammer toe
2393:Pigeon toe
2343:Genu varum
2315:Coxa valga
2173:Congenital
2125:DiseasesDB
1434:Cleft Hand
1173:(5): e54.
885:References
787:Lee Hee-ah
779:Photograph
585:Z-plasties
518:Treatment
430:Absent web
419:Merged web
375:Normal web
325:Embryology
313:and has a
299:syndactyly
281:Database.
119:syndactyly
103:(daktylos)
87:(from
85:cleft hand
81:split hand
48:syndactyly
2722:Scoliosis
2529:Hemimelia
2414:Pes cavus
2407:Flat feet
2388:Club foot
2320:Coxa vara
1046:eMedicine
1019:. Mosby.
829:Wood frog
748:Freakshow
686:Sporadic
632:century.
440:Treatment
342:Diagnosis
336:gestation
157:Syndrome
96:(ektroma)
56:Specialty
2772:Cervical
2219:shoulder
2215:clavicle
2197:dysmelia
2048:(OMIM):
2039:(OMIM):
1886:18593670
1828:10311465
1800:In Vitro
1785:86275852
1715:ABC News
1697:15249100
1648:19380058
1563:14239859
1511:17661743
1470:17996777
1361:25692622
1353:22121204
1318:12690205
1259:12668597
1197:15121782
1143:20138711
961:22043435
867:See also
775:1960â61
760:Zimbabwe
731:Nip/Tuck
479:The feet
305:Genetics
150:Genetics
101:ÎŽÎŹÎșÏÏ
λοÏ
2787:sternum
2119:C574275
1877:2610075
1742:6710256
1610:7594304
1412:3656376
1403:1050214
1309:2882961
1288:Bibcode
1279:Science
1188:1735762
998:8737656
952:3191709
860:Terrier
820:Animals
591:History
531:IIB/III
332:Myleran
94:áŒÎșÏÏÏΌα
2810:other:
2524:Amelia
2401:valgus
2108:225300
2050:183800
2041:183600
1938:864231
1936:
1884:
1874:
1826:
1820:885563
1818:
1783:
1740:
1695:
1646:
1608:
1561:
1509:
1468:
1410:
1400:
1359:
1351:
1316:
1306:
1257:
1195:
1185:
1141:
1104:
1023:
996:
959:
949:
908:
769:Soviet
756:Vadoma
718:Vadoma
107:digits
63:
2777:Bifid
2658:other
2575:Axial
2382:varus
2130:32141
2097:755.4
2082:Q71.6
1824:S2CID
1781:S2CID
1357:S2CID
523:I/IIA
135:SHFM1
91:
83:, or
2763:ribs
2330:knee
2206:Arms
2193:limb
2114:MeSH
2103:OMIM
2092:9-CM
1934:PMID
1882:PMID
1816:PMID
1738:PMID
1693:PMID
1644:PMID
1606:PMID
1559:PMID
1507:PMID
1466:PMID
1408:PMID
1349:PMID
1314:PMID
1255:PMID
1193:PMID
1139:PMID
1102:ISBN
1021:ISBN
994:PMID
957:PMID
906:ISBN
754:The
570:Ueba
562:the
515:Type
361:Type
255:DLX5
115:SHFM
2293:hip
2284:Leg
2088:ICD
2073:ICD
2004:doi
1975:hdl
1965:doi
1926:doi
1872:PMC
1864:doi
1808:doi
1773:doi
1685:doi
1636:doi
1598:doi
1551:doi
1497:doi
1458:doi
1398:PMC
1390:doi
1341:doi
1304:PMC
1296:doi
1284:300
1245:doi
1183:PMC
1175:doi
1131:doi
1044:at
986:doi
947:PMC
939:doi
743:AMC
619:At
405:III
394:IIB
383:IIA
293:).
2842::
2455:/
2303:/
2217:/
2195:/
2179:/
2128::
2117::
2106::
2095::
2080::
2077:10
2000:22
1998:.
1973:.
1961:59
1959:.
1955:.
1932:.
1922:68
1920:.
1880:.
1870:.
1858:.
1854:.
1836:^
1822:.
1814:.
1804:13
1802:.
1779:.
1769:38
1767:.
1750:^
1734:65
1732:.
1713:.
1691:.
1681:29
1679:.
1667:^
1642:.
1632:25
1630:.
1618:^
1604:.
1594:20
1592:.
1580:^
1557:.
1547:46
1545:.
1541:.
1519:^
1505:.
1493:49
1491:.
1487:.
1464:.
1454:32
1452:.
1420:^
1406:.
1396:.
1386:24
1384:.
1378:.
1355:.
1347:.
1337:49
1335:.
1312:.
1302:.
1294:.
1282:.
1276:.
1253:.
1241:12
1239:.
1233:.
1205:^
1191:.
1181:.
1171:41
1169:.
1163:.
1151:^
1137:.
1127:35
1125:.
1052:^
992:.
982:63
980:.
955:.
945:.
935:26
933:.
929:.
801:,
767:,
587:.
539:IV
416:IV
338:.
297:,
79:,
2789::
2765::
2165:e
2158:t
2151:v
2090:-
2075:-
2065:D
2010:.
2006::
1983:.
1977::
1967::
1940:.
1928::
1888:.
1866::
1860:4
1830:.
1810::
1787:.
1775::
1744:.
1699:.
1687::
1650:.
1638::
1612:.
1600::
1565:.
1553::
1513:.
1499::
1472:.
1460::
1414:.
1392::
1363:.
1343::
1320:.
1298::
1290::
1261:.
1247::
1199:.
1177::
1145:.
1133::
1110:.
1029:.
1000:.
988::
963:.
941::
914:.
815:.
805:.
751:.
547:V
427:V
372:I
113:(
23:.
Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.
