Adjunct Surgical Procedures Beyond Syndactyly Release in the Treatment of the Apert Hand: A Literature Review

<p dir="ltr">INTRODUCTION: Apert syndrome is a congenital disorder caused by a gain-of-function FGFR2 mutation, characterized by craniosynostosis and complex hand and foot syndactyly. Upton classified Apert hands into: Type I (“Spade Hand”) Type II (“Mitten Hand”) and Type III (“Rosebud hand”), with varying degrees of syndactyly, thumb hypoplasia, clinodactyly, and symphalangism. Although the primary surgical focus on the hand is syndactyly release, adjunct procedures are critical for improving function. Despite clinical importance, technique protocols are limited. This review summarizes key adjunct procedures to provide a comprehensive approach to Apert hand reconstruction.</p><p dir="ltr">METHODS: We searched PubMed, Cochrane, and Embase databases using the keywords “Apert Syndrome,” “coalition osteotomy,” “phalangeal augmentation,” “thumb lengthening,” and related terms. Inclusion criteria were English-language studies on Apert Syndrome describing at least one adjunct hand procedure. Studies lacking surgical detail or focused solely on syndactyly release were excluded.</p><p dir="ltr">RESULTS: Of the 100 articles identified, 14 met inclusion criteria (9 retrospective and 2 prospective cohort studies, 2 case reports, 1 technique report). Adjunct procedures were staged with or after initial syndactyly release. Apert thumb corrections included open or closed wedge osteotomies with iliac crest bone grafts, C-shaped osteotomies, distraction lengthening and angular correction without osteotomy. In Type III hands, central coalition osteotomies repositioned overlapping digits to a coplanar orientation for five-digit reconstruction. Bone grafts or distraction lengthening achieved phalangeal augmentation. Studies reported significant functional improvement with low complication rates.</p><p dir="ltr">CONCLUSIONS: This review highlights the importance of adjunct procedures in Apert hand reconstruction and emphasizes the need for more technique protocols.</p><p><br></p><br><hr><i>For inquiries regarding the contents of this dataset, please contact the Corresponding Author listed in the README.txt file. Administrative inquiries (e.g., removal requests, trouble downloading, etc.) can be directed to data-management@arizona.edu</i>