Congenital Hand Anomalies Research Articles

Polydactyly 24 in a Female Neonate

Polydactyly is perhaps one of the most common congenital hand and foot anomalies. Tetrapolydactyly (polydactyly 24) is a very rare form of hand and foot anomalies. Postaxial ray polydactyly usually occurs in male blacks without associated congenital abnormalities. We report a case of postaxial ray tetrapolydactyly in a female neonate which occurred sporadically and without associated congenital abnormalities.

Outcome Measures of Microsurgical Toe Transfers for Reconstruction of Congenital Hand Anomalies: Level 4 Evidence

Outcome Measures of Microsurgical Toe Transfers for Reconstruction of Congenital Hand Anomalies: Level 4 Evidence

Congenital hand anomalies and reconstruction

The management of congenital hand deformities encompasses the care of the family from infancy, through childhood, to produce a well-adjusted adult who can function physically, socially and psychologically to the highest level that their anatomy will allow. It requires teamwork by all involved for this to be successful.

Unilateral Congenital Terminal Finger Absences: A Condition That Differs From Symbrachydactyly

To describe a type of nonhereditary unilateral transverse deficiency, which we have named hypodactyly, that is distinct from symbrachydactyly or amniotic disruption sequence.We identified 19 patients with unilateral congenital anomalies consisting of absent or short bulbous fingers that lack terminal ectodermal elements. Medical records and radiographs were retrospectively reviewed and contrasted with the typical findings of symbrachydactyly and amniotic disruption sequence.No associated syndromes or potentially causative diagnoses were identified in the hypodactyly patients. The digital absences were of a truncated pattern with thickened, tubular soft tissue coverage. Radiographs revealed a pattern of severity progression that is different from that of symbrachydactyly. Distal phalanges were the bony elements absent most frequently, followed sequentially by the middle phalanx and proximal phalanx. In all cases, metacarpals were present. Unlike symbrachydactyly, the ulnar 2 digits were more involved than the index and long fingers, and the thumb was the least involved digit.Hypodactyly appears to be a congenital hand anomaly that is clinically and radiographically different from symbrachydactyly or amniotic disruption sequence and is presumed to be caused by a distinct pathomechanism.Prognostic IV.

Congenital hand anomalies

Abstract Congenital upper limb anomalies affect 0.1–0.2% of all newborns. They are often isolated phenomena but can be associated with other congenital anomalies and may be the only external manifestation of a syndrome. Knowledge of the treatment options is imperative to ensure appropriate referral and counselling. The aim of surgery for a congenital hand anomaly is to improve both function and appearance. Apart from the face, the hand is the only other part of the body on regular display. Independent living is largely dependent on good bimanual hand function. For example a large proportion of activities of daily living such as washing, dressing, and feeding consist of bimanual tasks. It is only when we temporarily lose the function of one hand that the significance of this becomes apparent. However, children with congenital hand anomalies adapt very well to limitations of hand function and can often find “trick” manoeuvres to achieve essential tasks. As there is a wide variation in the types and severities of hand anomalies these cases are largely managed in specialized clinics. It is in this setting that the child and family will have access to long-term multidisciplinary care which includes input from geneticists, psychologists, therapists and children’s hand surgeons. For some children with more complex anomalies, psychological support can be as valuable as surgery to aid integration with and acceptance by their peers.

Surgical reconstruction of congenital thumb hypoplasia

This review article introduces a new classification of congenital hand anomalies. It then considers the classification of congenital thumb hypoplasia and describes the the authors indications for surgery. Specifically, attention is directed towards surgical techniques and problems encountered in the reconstruction of grade 2 hypoplastic thumbs and in pollicisation of the index finger for grades 3, 4 and 5 thumb hypoplasia.

Toe to hand transfer in children: Ten year follow up of psychological aspects

Our previous study found positive psychosocial effects from hand reconstruction in children, by microsurgical toe transfer. The aim of the current study was to determine whether these are enduring at ten years or more postoperatively. Twenty-five patients with congenital (n=21) or post-traumatic (n=4) hand anomalies underwent transfer of either one or two toes. (Nineteen of the patients had taken part in the previous study while six had not.) All families had undergone preoperative counselling. Ten years or more after surgery, the patients and their parents underwent review to assess the long-term psychosocial outcome of the surgery. As in the previous study, a high level of satisfaction was reported, in terms of function, appearance, donor site, psychosocial well-being and the reactions of others. This was true regardless of the gender of the child. Patient and parent responses were more similar to each other than they had been in the earlier study. It was concluded that the positive effects of toe transfer surgery are enduring at long-term follow-up.

Treatment of Common Congenital Hand Conditions

After reading this article, the participant should be able to: 1. Recognize the clinical features associated with five common congenital hand conditions. 2. Describe the indications and appropriate timing for various surgical procedures used to treat congenital hand anomalies. 3. Identify the pearls and pitfalls of these surgical treatments to avoid complications. 4. Understand the expected postoperative outcomes associated with these surgical procedures. This article provides an introduction to congenital hand differences by focusing on practical surgical strategies for treating five commonly encountered conditions, including syndactyly, constriction ring syndrome, duplicated thumb, hypoplastic thumb, and trigger thumb. The accompanying videos demonstrate common and reliable surgical techniques for syndactyly release, duplicated thumb reconstruction, and pollicization for hypoplastic thumb.

Hand Therapy for Children With Congenital Hand Differences

Children with congenital hand anomalies benefit from a surgeon's partnership with a hand therapist, who can help the child and their family achieve goals of independence and improved self-esteem. Topics are addressed by age group and include evaluation of children with hand anomalies, splinting the child's hand after injury or surgery, treatment plans geared specifically for children, achieving increased independence with activities of daily living, and a discussion of how to support families as they adjust to life with a child who has a congenital hand anomaly.

The Epidemiology of Congenital Hand Anomalies in Northwest England

The Epidemiology of Congenital Hand Anomalies in Northwest England

Use of Calcium Sulphate Bone Graft at West Middlesex University Hospital: A Three Year Study of Outcomes

Use of Calcium Sulphate Bone Graft at West Middlesex University Hospital: A Three Year Study of Outcomes

Congenital Thumb Deformities and Associated Syndromes

Upper limb defects occur in approximately 3.4 per 10,000 live births. Major thumb defects represent 16% of these upper limb defects (Tay SC, Moran SL, Shin AY, et al. The hypoplastic thumb. J Am Acad Orthop Surg 2006;14:354-366). Embryologically, hand development begins by the fifth week. This occurs simultaneously with the growth and development of the cardiovascular, neurologic, and hematopoietic systems. Therefore, congenital anomalies seen in the hands of infants may indicate significant anomalies in these other systems, requiring a comprehensive physical evaluation. Although the cause of 40% to 50% of congenital hand anomalies is unknown (Gallant GG, Bora FW. Congenital deformities of the upper extremity. J Am Acad Orthop Surg 1996;4:163-171), several others have traced this to specific genetic mutations. Others are due to a variety of teratogenic effects (Sadler TW. Langman's Medical Embryology. 10th ed. Philadelphia: Lippincott Williams &Wilkins, Chapter 9, 2006:125-142). For the clinician, this paper has been organized to identify possible corresponding syndromes that may accompany specific thumb deformities.

Reconstruction of congenital hand anomalies to provide stable pinch and/or grasp: Case pictorial series

Congenital hand anomalies can cause substantial functional problems. There are multiple situations where there is lack of stable pinch and/or grasp that can be improved by surgical intervention. An example of reconstructive surgical intervention in each of three specific congenital hand anomalies is presented: hypoplastic thumb, absence of the fingers, and insufficient length and stability of the digits. Focus is on the approach to the patient, surgical treatment and the goals achieved. It is important to mention that other techniques may be preferred by other surgeons, and may also yield excellent results.

Clinical features and teratogenic mechanisms of congenital absence of digits

To have a better understanding of classification of congenital hand anomalies, clinical features and teratogenic mechanisms of congenital absence of digits including ulnar and radial deficiencies, cleft hand, symbrachydactyly and constriction band were reviewed. There seemed to be four different teratogenic mechanisms of congenital absence of digits. Ulnar and radial deficiencies have the same clinical features and the cause of these deficiencies is closely related to a deficit of mesenchymal cells in the limb-bud due to impairment before the formation of the limb-bud. Cleft hand, central polydactyly and osseous syndactyly were induced by the same treatment at the same developmental stage in rats. Roentgenograms of the clinical cases and skeletal changes of the anomalies in rats appear to demonstrate that cleft hand formation proceeds from osseous syndactylies and central polydactylies. The teratogenic mechanism of a cleft hand seemed to be failure of induction of digital rays in the hand plate. The sequence of anomalies from brachysyndactyly, or the atypical cleft hand, to the congenital amputation, can be regarded as equivalent to the category of transverse deficiency that is bony dysplasia of the hand. Congenital constriction ring syndrome appears after the formation of the digital rays.

Treatment of Congenital Upper Extremity Problems

After studying this article, the participant should be able to: 1. Describe the terminology and classification of congenital hand anomalies. 2. Describe the incidence and embryogenesis of some common congenital hand anomalies. 3. Discuss the general principles and goals for treatment of congenital hand anomalies. 4. Describe the management of five of the more common congenital hand anomalies (syndactyly, short digits, thumb duplication, hypoplastic thumb, and radial dysplasia). Congenital hand anomalies can cause substantial emotional and functional problems. This article reviews the etiology, classification, and management of some of the more common hand anomalies. A general approach to the patient and the goals of treatment are reviewed, as is the approach to five specific congenital hand anomalies: syndactyly, short digits, thumb duplication, hypoplastic thumb, and radial dysplasia.

The Effect of the Epiphyseal Growth Plate on the Length of the First Metacarpal in Triphalangeal Thumb

Triphalangeal thumb is characterized as a congenital difference of the thumb with an extra phalanx. Additional thumb length is attributed mostly to the extra phalanx. The influence of the epiphyseal plate positions on growth in congenital hand anomalies is unclear. The purpose of this article was to compare the length of the first metacarpal in triphalangeal thumbs with the length of the same bone in normal thumbs and to investigate the influence of the often aberrant metacarpal epiphyseal plates on the length of the triphalangeal thumb metacarpal during growth. The positions of the epiphyseal plate and the relative length of the first metacarpal were examined retrospectively in 37 patients with triphalangeal thumb. Ratios of the measurements were calculated (metacarpal II/metacarpal I) and compared with a normal population. Subjects were divided into 3 groups based on the position of the epiphyseal plate (double, proximal, distal). The distally placed growth plate was the most common variety, present in 22 of patients, followed by the proximal position in 14, and double epiphyseal plates in 6. All ratios of patients with triphalangeal thumb were significantly smaller than those of a normal population, indicating a longer first metacarpal in this condition. First metacarpals in triphalangeal thumb with double epiphyses grew disproportionately more than those of a normal population, whereas those with distal epiphyses grew disproportionately less than normal. First metacarpals with proximal epiphyses grew at the same rate as normal first metacarpals. In this study population the most common growth plate location was distal whereas the most common location in the normal population is proximal. The different positions of the epiphyseal plates correlate with growth differences in patients with triphalangeal thumb.

Description of congenital hand anomalies: a personal view

A series of four congenital hand cases exhibiting central clefting are presented. The cases are morphologically similar and exhibit characteristics of both symbrachydactyly and central longitudinal deficiency. The cases demonstrate difficulties in classification by either the IFSSH classification system or the JSSH modification of it. An alternative descriptive approach to classification is suggested.

Rational Treatment for Multiple Digit Congenital Absence

A case is discussed in which a young male was born with symbrachydactyly of multiple digits in whom nonvascularized proximal toe phalanges were transferred to the aphalangic digits when he was an infant. This initial surgical procedure was later followed by webspace deepening and ultimately by distraction lengthening of the digits. At 8 years of age, he has a very functional hand with mobile metacarpophalangeal joints in all reconstructed fingers. In fact, he uses this reconstructed right hand as his dominant extremity. The case is discussed in context of phalangeal growth potential, specific indications for this type of reconstruction, and final long-term outcome. This case also helps to recommend rational treatment protocols for similar congenital hand anomalies.

Orthopaedic Techniques of Sabuncuo??lu in the 15th Century Ottoman Period

Serefeddin Sabuncuoğlu (1385-1468) was the author of the surgical textbook Cerrahiyyetü'l-Haniyye (Imperial Surgery). It was the first illustrated surgical textbook in the Turkish-Islamic medical literature. Cerrahiyyetü'l-Haniyye is significant because it includes Sabuncuoğlu's color illustrations of surgical procedures, incisions, fracture dislocation reduction techniques, and instruments. There are only three handwritten copies. Two originally were written by Sabuncuoğlu and are exhibited in Paris and Istanbul. The book was rediscovered in 1936, but some parts are suspected to be missing. The book currently consists of three chapters divided into 193 sections. The third chapter includes orthopaedics and traumatology, reduction techniques of lower and upper extremities, fractures and dislocations, and relevant Greek, Arabic, and Persian textbooks are cited. Sabuncuoğlu also wrote about surgical treatment of congenital hand anomalies. He was the first to advise placing a wooden splint under the palmar side after hand surgery. We reviewed the sections of Cerrahiyyetü'l-Haniyye related to orthopaedics and traumatology. Compared with previous writings by Hippocrates, Ibn-i Sina, and Al-Zahrawi, there are no major differences in the treatment of fracture dislocations.

Upper Extremity Function in Children with Congenital Hand Anomalies

The enhancement of function takes priority in the management of children with congenital hand anomalies. The authors conducted a systematic review of studies of pollicization and centralization surgery to examine functional outcome. The search strategy included MEDLINE, CINAHL, and reference lists from secondary resources. The selection criteria included all literature pertaining to the functional outcome of children having either pollicization or centralization surgery. The studies were analyzed according to the levels of evidence for primary research. Ten studies were reviewed; one study was evaluated at level 3 and the remaining were level 4. Rigorous research of functional outcome is needed to validate surgical interventions. Enhancing the quality of functional outcome studies in this population requires improvements in research methodology, sampling, and measurement of function.