Early Vascularized Fibular Grafts in Infants with Congenital Pseudarthrosis

621 occurred at the distal parts of the phalanges or metatarsal bones; most frequently, the first and second metatarsals. The third, fourth, and fifth toes were partially or completely synostotic (Blauth and Borisch [4]). Ogino and Kato [5] described six cases of cleft hand with a normal number of fingers as well. Some anomalies of the adjacent fingers were recognized in several cases, including cutaneous syndactyly, brachymesophalangy, and central polydactyly. They considered the cause of cleft hand without absence of the finger as a failure of separation of the finger rays. This assumption is now accepted as “cleft of the palm”, which is classified as a type of abnormal induction of the digital rays in the modified International Federation of Societies for Surgery of the Hand classification. Ogino and Kato found another trend, in that the cleft in cases of cleft hand without absence of the finger was not much more severe than with absence of the finger (Ogino and Kato [5]). Given the literature, it is possible that the present case is “mild abnormal induction of digital rays,” though we were not able to find a cleft involving the foot. However, it is very difficult to make a fair judgment on the classification of this case. Further studies of the cause of this congenital foot abnormality are needed.