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An Overview of Congenital Hand Deformities

If your child has a congenital hand deformity, early consultation with an orthopedic specialist who specializes in hand surgery is recommended. Reconstructive surgery may not be an option for your child, but there are many different prosthetic devices that can increase the function of your child’s hand.

What are the different classifications of congenital hand deformities?

Many doctors use the accepted American Society for Surgery of the Hand (ASSH) classification of hand deformities. This classification system recognizes six groups of deformities.

Problems in the development of parts: This occurs when a specific part or parts of the body stop developing when the baby is in the womb. This results in the complete absence of the hand or the lack of a structure, such as the thumb. Two types of developmental problems are radial clubhand and ulnar clubhand. Radial clubhand is a type of deformity that affects the tissue on the thumb side of the forearm and hand. This condition could result in shortening of the bone, a missing thumb, or a small thumb.

Doctors will usually operate on the radial club hand at 6 months of age. The ulnar club hand is a deformity in which there is underdevelopment of the bone on the side of the little finger (the ulna). This could result in a missing little finger or a short fifth digit.

Failure of parts of the hand to separate: This occurs when the bones or tissues fail to separate in the womb. The most common form of this birth defect is syndactyly, the condition in which two or more fingers are fused together. This condition usually involves both hands. Simple syndact involves fusion between tissues only, while complex syndact involves fusion between bones.

Hand contractures develop when cells fail to differentiate during formation in the womb. With a contracture, there is an abnormal forward pull of the fingers of the hand and the fingers cannot be extended. 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 the most affected. There are three types of polydactyly: 1, 2, and 3. With type 1, there is an extra finger attached only by nerves and skin. Type 2 involves an extra finger attached to the bone or joint. Type 3 is more complex, with an extra finger connected to the normal extra metacarpal bone of the hand. Surgery can easily correct these types of deformities.

Undergrowth of the fingers: When the fingers or thumbs are underdeveloped, there could be a small finger, lack of muscles or bones, or the complete absence of a finger. Surgery is not always necessary to correct these types of deformities.

Excessive finger growth: When there is an abnormally large finger, 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 big toe.

Congenital Constriction Band Syndrome: This condition results from the formation of a band of tissue around a finger or limb. This causes problems with blood flow and normal growth. The cause of this syndrome is unknown, but some experts believe that amniotic bands cause tightness around a finger or limb. There are four degrees of severity, ranging from simple strictures to severe strictures where amputation is necessary.

What is the treatment for congenital malformations of the hand?

Treatment of congenital hand deformities is based on several factors. These include:

The scope of the condition

The cause of the condition

The child’s age, medical history, and general health.

The child’s tolerance for procedures, medications, and therapies.

The opinion and preference of the parents.

Treatment measures include:

Splinting of the affected limb

Correction of contractures

Limb manipulation and stretching.

tendon transfer

Skin graft 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 fingers

Prostheses used when surgery is not an option or in conjunction with surgery

Surgical Correction

When is surgical correction performed?

Surgery that is done within the first 2 years of life is considered early surgery. Early surgery has several advantages, including the potential for growth and development, better healing, earlier use of the reconstructed part, and reduced psychological impact. Disadvantages of early surgery are possible increased anesthetic risk and technical difficulties. Most surgical corrections are done after 2 or 3 years.

What are the different types of surgeries to treat congenital hand deformities?

There are various methods of surgery that can be performed to treat congenital deformities of the hand. 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, the orthopedic specialist will employ a combination of open and closed approaches using internal fixtures to realign broken or misshapen bones. The hand is then immobilized in a splint to ensure that the fracture heals properly.

Drainage and debridement: This technique is performed when an abscess forms from an infection. This promotes faster healing of the affected region.

Microsurgical Replantation: This procedure involves reattachment of the finger, part of the finger, or the hand using precise microsurgical methods.

Skin grafting: During this method, skin is removed from a healthy area of ​​the body and used to replace the missing skin on the hand. This is done when there is an amputation of a finger or part of a finger and in burn deformities.

Skin flap: This procedure is used when there is damage to the deep tissues of the hand. Tissue that is taken from an area of ​​the body has fat, muscle, and blood vessels that must be clamped during the operation.

Tendon and Nerve Repairs: Some hand deformities require repair of a tendon and/or nerve component. These deformities cause decreased hand movement, numbness, and weakness.