These are clenched hands resulting from camptodactyly (fingers bent over) and clinodactyly (fingers inclined to one side or the other). This particular appearance is very suggestive of trisomy 18. Note how digits 2 and 5 curve inward to overlap digits 3 and 4 of the right hand. The presence of external anomalies suggests an increased likelihood for internal organ anomalies that may impact health and survival. When multiple anomalies are present, a malformation syndrome may be present, and some have a genetic basis.