Complication Rates of Casts versus Bulky Dressings after Syndactyly Release

The arms are commonly immobilized in a cast after syndactyly release. Despite this practice, there is little research examining complications from cast immobilization. This study compares the complication rates of congenital syndactyly release using casts and bulky soft dressings.

A retrospective review was performed of patients undergoing syndactyly release. Patients were included if they underwent a primary release of congenital syndactyly and excluded if they had a noncongenital cause. Data regarding surgical procedures, medical complications, and unplanned caregiver phone calls and clinic/emergency department (ED) visits related to the dressings were recorded.

Ninety-five patients met inclusion criteria, representing 143 hands placed in casts and 25 in bulky dressings. No significant differences in surgical or medical complications were detected. The most common complications across all patients were web creep (10.1%), hypertrophic scarring (12.5%), and scar contracture (6.0%). Unplanned ED visits were noted in 1.4% of casts and 4.0% of bulky dressings and unplanned clinic visits were noted in 7.0% of casts and 8.0% of bulky dressings. Only 7.0% of casts and 8.0% of bulky dressings required replacement. Caregiver phone calls were seen for 14.0% of casted hands and 24.0% of bulky dressings. Regardless of dressing, hypertrophic scarring was more prevalent in non-White patients (22.9% versus 7.9%, P = 0.03), and web creep was more prevalent in male patients (14.4% versus 1.8%, P = 0.01).

There is no significant difference in complications, phone calls, or unplanned clinic/ED visits between patients undergoing congenital syndactyly release placed in a cast or bulky soft dressings.