Revisiting Radiographic Characteristic of the Hands in Apert Syndrome: A Literature Review with Cases

Abstract

Introduction: Syndactyly of the hand in Apert syndrome involves all components of the hands. In 1991, Joseph Upton introduced a comprehensive classification of the Apert hands based on its severity. Plain x-ray is the most commonly used to evaluate bony abnormality. Case Presentation: We present two cases with classic characteristics of Apert syndrome with demonstrated different types of Apert hands; type II and type III. Radiographs exhibited bony deformities with typical misalignment and multiple osseous formations in several parts of phalanges. Discussion: Apert hands present complex syndactylies involving the index, middle, and ring fingers in different stages regarding Upton’s classification system. Almost all Apert hands also lack the active motion of the interphalangeal joints. The ossification allowed the synostosis and symphalangism to become evident on radiographs. The abnormality of the epiphysial growth causes short and deviated fingers. Conclusion: Apert hands demonstrate complex deformity involving bony structures that developed prenatally and postnatally. Typical deformities including complex syndactyly, clinodactyly, and symphalangism.