Complication Rates of Casts Versus Bulky Dressings After Syndactyly Release

Abstract

Introduction: Pediatric patients undergoing surgical correction of congenital syndactyly are commonly immobilized in rigid casts postoperatively . Casts have previously been associated with complications including skin irritation/breakdown, pressure sores, and unplanned cast changes in populations of pediatric fractures. This study directly compares complication rates between patients treated with postoperative casting and soft dressing after undergoing congenital syndactyly release. Methods: A retrospective chart review was performed of patients treated by one of two surgeons at a single institution between 2016 and 2024. Patients were included if they underwent primary surgical release of congenital syndactyly and excluded if their syndactyly was not congenital (i.e., a result of trauma). Data regarding surgical procedures and postoperative complications (infection, web creep, scar contracture, hypertrophic scarring, etc.) were recorded in addition to unplanned caregiver phone calls, clinic appointments, and emergency department (ED ) visits. Hands were categorized according to the type of dressing placed after surgery. Results: 92 patients met inclusion criteria, representing 151 hands in the casted group and 20 hands in soft dressings postoperatively. No significant differences were observed in complication rates between the two groups. The most common complications across all hands were web creep (9.9% vs.10.0%, casts vs. soft dressings, p=1 ), hypertrophic scarring (10.6% vs. 5.0%, p=0.697), and scar contracture (5.3% vs. 10.0%, p=0.330). Three casts required unplanned ED visits and 11 required unplanned clinic visits related to casts whereas no patients in the soft dressing group required ED or unplanned clinic visits (p=1 and p=0.366, respectively). Five casts (3.3%) required replacement. The number of parent phone calls and dressing changes were not significantly different between the two groups (p=0.976 and p=0.803, respectively). Conclusion: Utilizing rigid casts after syndactyly release is not associated with greater rates of postoperative complications compared to soft dressings alone.