Clinical presentations of macrodactyly in adults vs. children: a descriptive analysis

Macrodactyly of the hand is an uncommon anomaly. There are few studies looking at late presentation or adults with macrodactyly. This study specifically aims to describe the presentation and surgical management of adult macrodactyly and to compare these findings with those in children, highlighting the distinct challenges associated with late presentation.

This is a retrospective study of 13 adults (18 years or older) and 19 children with macrodactyly of the upper limb who underwent surgery in a 13 year period. Clinical features including radiographic findings, number and types of surgeries were compared between adults and children.

Common reasons for presentation in adulthood were carpal tunnel syndrome and functional impairment. Radiographs of adults showed exostoses, arthritis, bony fusions and angulation deformities. The mean number of surgeries that children underwent was almost double that of adults. The average number of debulking procedures per patient was significantly more in children including soft tissue resection, osteotomy and reconstructive surgeries. Amputations were slightly more common in adults. Carpal tunnel syndrome or trigger fingers were seen only in adults.

Adults and paediatric patients with macrodactyly seek treatment for different reasons. Presentation in childhood often results in multiple debulking stages or reconstructive attempts. In adults, surgery is often for improving function and usually single staged. Untreated, long-term progression of joint changes can lead to pain and disability. Recognition of these symptoms can guide treatment in older patients or prevent age-related changes in younger populations.

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