Congenital anomalies are deformities that your child has at birth. Congenital hand deformities are particularly disabling for children and present a challenge to the orthopedic specialist. These deformities vary from minor types, such as a digital disproportion, to severe forms, such as the total absence of a bone.
If your child has a congenital hand deformity, I recommend early consultation with an orthopedic specialist who specializes in hand surgery. Reconstructive surgery may not be an option for your child, but I have many different prosthetic devices that can increase hand function for your child.
What are the different classifications of congenital hand deformities?
I use the classification for hand deformities accepted by the American Society for Surgery of the Hand (ASSH). This classification system recognizes six groups of deformities.
Problems in Development of the Parts – This occurs when a specific part or parts of the body stop developing when the baby is in the womb. This results in either complete absences of the hand or a missing structure, such as the thumb. Two kinds of problems in development are radial clubhand and ulnar clubhand. Radial clubhand is a type of deformity involving the tissue on the thumb side of the forearm and hand. This condition could lead to shortening o the bone, absence of the thumb, or a small thumb.
I typically operate on radial clubhand at age 6 months. Ulnar clubhand is a deformity where there is underdevelopment of the bone on the side of the little finger (the ulna). This could result in absence of the little finger or a short fifth digit.
Failure of Parts of the Hand to Separate – This occurs when either the bones or the tissues fail to separate in the womb. The most common form of this congenital anomaly is syndactyly, the condition where two or more fingers fuse together. This condition typically involves both hands. Simple syndactyly involves the fusion between the tissues only, whereas complex syndactly involves the fusion between the bones.
Contractures of the hand develop when there is failure of the cells to differentiate during formation in utero. With a contracture, there is abnormal pulling forward of the digits of the hand, and the digits are unable to extend. Surgery is necessary for children with this condition and is recommended around the age of 3.
Duplication of Digits – This is also called polydactyly, and the little finger is most commonly affected. There are three types of polydactyly: 1, 2, and 3. With type 1, there is an extra digit attached by nerves and skin only. Type 2 involves an extra digit attached to the bone or joint. Type 3 is more complex, with an extra digit connected to extra normal metacarpal bone of the hand. Surgery can easily correct these types of deformities.
Undergrowth of Digits – When fingers or thumbs are underdeveloped, there could be a digit that is small, missing muscles or bones, or the complete absence of a digit. Surgery is not always necessary for the correction of these types of deformities.
Overgrowth of Digits – When there is an abnormally large digit, the medical term used is macrodactyly. Some conditions also involve the forearm. The most common digit that overgrows is the index finger. Surgical treatment is complex and I often recommend complete amputation of the large digit.
Congenital Constriction Band Syndrome – This condition is the result of the formation of a tissue band around a finger or limb. This causes problems of blood flow and normal growth. The cause of this syndrome is unknown, but some experts believe that amniotic banding leads to constrictions around a finger or limb. There are four degrees of severity, ranging from simple constrictions to serious constrictions where amputation is necessary.
What is the treatment for congenital hand deformities?
I base treatment of congenital hand deformities on several factors. These include:
- The extent of the condition
- The cause of the condition
- The child’s age, medical history, and overall health status
- The child’s tolerance to procedures, medications, and therapies
- The parents’ opinion and preference
Treatment measures include:
- Splinting the affected limb
- Correction of contractures
- Limb manipulation and stretching
- Tendon transfer
- Skin grafting to replace or attach skin that is missing or removed during the procedure
- Physical therapy to increase function and strength
- External appliances to realign misshapen hands or digits
- Prosthetics used when surgery is not an option or in conjunction to surgery
Surgical Correction
When is surgical correction performed?
Surgery that is performed within the first 2 years of life is considered early surgery. There are several advantages to early surgery including potential for growth and development, improved scarring, early use of the reconstructed portion, and reduce psychological impact. The disadvantages to early surgery are possible increased anesthetic risk and technical difficulties. Most surgical correction is done after the age of 2 or 3.
What are the different types of surgeries to treat congenital hand deformities?
There are several methods of surgery I perform to treat congenital hand deformities. These include:
Reduction and Fixation of a Broken Bone – This procedure can be open or closed depending on the type of deformity or injury. Many times, I employ a combination of the open and closed approaches using internal fixtures to realign broken or misshapen bones. Immobilization of the hand with a splint follows to assure that the fracture heals properly.
Drainage and Debridement – This technique is done when there is formation of an abscess from infection. This promotes faster healing of the affected region.
Micro-Surgical Replantation – This procedure involves the reattachment of the finger, part of the finger, or hand by way of precise micro-surgical methods.
Skin Grafting – During this method, skin is taken from a healthy body area and used to replace the skin missing on the hand. This is done when there is an amputation of a finger or portion of a finger and in burn deformities.
Skin Flap – This procedure is used when there is damage to the deep tissues of the hand. The tissue take from an area of the body has fat, muscles, and blood vessels that must be attached during the operation.
Tendon and Nerve Repairs – Some hand deformities require repair of a tendon and/or nerve component. These deformities cause decreased movement of the hand, numbness, and weakness.
