Typical cleft hand Atypical cleft hand (symbrachydactyly) Typical hand was manifest in the complete or incomplete absence of the middle finger[20] Atypical hand had a more severe manifestation in which there was varying absence of the central index, middle and ring finger rays[20] “V”-shaped cleft[2] “U”-shaped cleft[6] One to four limbs involved[6] One limb involved (no feet)[6] Higher incidence[3] Lower incidence[16] Autosomal dominant[6] Sporadic[6] Suppression progresses in a radial direction so that in the monodactylous form the most ulnar finger is preserved[6] Suppression progresses in a more ulnar direction; therefore in the monodactylous form the thumb is usually the last remaining digit[6]