EXPERTISE
CONGENITAL HAND ANOMALIES
Congenital anomalies are deformities that are present at birth. Any type of deformity in a newborn can become a challenge for the child as he or she grows. Hand deformities can be particularly disabling as the child learns to interact with the environment through the use of his or her hands. The degree of deformity varies from a minor deformity, such as unequal fingers, to a severe deformity, such as total absence of a bone. Early consultation with a hand surgeon is an important part of the treatment process for the child born with a hand deformity.
Problems in formation of the parts
- Radial Clubhand
- Ulnar Clubhand
Failure of parts of the hand to separate
- Simple syndactyly
- Complex syndactyly
- Duplications of fingers
- Undergrowth of fingers
- Overgrowth of Fingers (Macrodactyly)
- Congenital constriction band syndrome
- Other generalized problems with the
skeletal system
SYNDACTYLY
What is Syndactyly?
Syndactyly is the most common congenital hand anomalies. It is the failure of separation of the fingers in the embryogenic period. Fusion of the digits will reduce the spanning of fingers and reduces the child ability to grasp objects.
Case History
This 7 months old child presented with simple complete syndactyly between the thumb, index and middle finger and in complete syndactyly between the ring and little finger. For pincer grasp thumb should be in 90-degree perpendicular to the plane of palm.
Since this child has fusion of medial 3 digits, she underwent separation of thumb and index finger and dorsal rotation flap to recreate the 1st web and the opposing surfaces are covered with ‘Z’ pasty and full thickness skin grafts from groin area.
2 months’ post release, this child has good functional movement of thumb. She needs subsequent separation of other fingers.
EPL RUPTURE
Rupture of tendons is due to degenerative changes in the tendons and has lost its tensile strength. Ruptured tendons cannot be directly repaired, it need transfer or reinforcement.
Rupture can be due to chronic tear over bony prominences or failure to withstand a sudden stretch.
Case History
52 year old female presented with inability to extend the thumb, which was sudden in onset. On examination she had rupture of extensor pollicis longus tendon. Under supraclavicular block with tourniquet control, exploration confirmed the rupture of EPL.
She underwent transfer of extensor indices to distal part of EPL . Post operatively she regained thumb extension with preserved full thumb flexion
EPL RUPTURE
Rupture of tendons is due to degenerative changes in the tendons and has lost its tensile strength. Ruptured tendons cannot be directly repaired, it need transfer or reinforcement.
Rupture can be due to chronic tear over bony prominences or failure to withstand a sudden stretch.
Case History
52 year old female presented with inability to extend the thumb, which was sudden in onset. On examination she had rupture of extensor pollicis longus tendon. Under supraclavicular block with tourniquet control, exploration confirmed the rupture of EPL. She underwent transfer of extensor indices to distal part of EPL . Post operatively she regained thumb extension with preserved full thumb flexion