Eight cases of the fetal alcohol syndrome are presented with emphasis on their frequent orthopedic anomalies, i.e. hypoplastic toenails (100%), shortened fingers, usually the fifth (75%), radioulnar synostosis, camptodactyly of fingers, clinodactyly of toes, and flexion contractures of the elbow (all 50%). These are in addition to 7 other orthopedic anomalies observed less frequently and some 18 general characteristics had an extensive endocrine, biochemical and genetic work-up and no abnormalities were found to explain the snydrome other than the teratogenicity of the maternal alcohol abuse. Since the orthopedist may be the first physician to see these patients, diagnosis of these musculoskeletal anomalies should include a social history and investigation for fetal alcohol syndrome.