Introduction Syndrome characterized by bilateral complex syndactyly of hands and feet index, middle, and ring fingers most affected symphalangism premature fusion of cranial sutures (craniosynostosis) results in flattened skull and broad forehead (acrocephaly) hypertelorism (increased distance between paired body parts, as in wide set eyes) normal to moderately disabled cognitive function glenoid hypoplasia radioulnar synostosis Epidemiology Incidence rare 1/80,000 live births Etiology Genetics autosomal dominant, but most new cases are sporadic mutation of FGFr2 gene Presentation Physical exam dysmorphic face craniosynostosis results in flattened skull and facial features rosebud hands (complex syndactyly where the index, middle, and ring finger share a common nail) Imaging Radiographs will show complex syndactyly Treatment Operative surgical release of border digits indications perform ~ 1 year of age digit reconstruction indications perform ~ 1.5 years of age to convert central three digits into two digits Prognosis Spectrum of normal to moderately disabled cognitive function