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Congenital Hand Deformities

 

Clinodactyly

  • deformity in radio-ulnar plane, Rx rarely indicated, stretching/splinting ineffective.

Camptodactyly

  • deformity in A/P plane. Most commonly from anomalous lumbrical and superficialis insertions McFarlane RM, Classen DA, Porte AM, Botz JS:  The anatomy and treatment of camptodactyly of the small finger.  J Hand Surg Am 1992; 17:35-44.
  • RX:frequent stretching with splinting, surgery in deformity >60 degrees
  • Camptodactyly of the of the thumb DIP joint in an infant=locked trigger thumb-classically occurs at 18-24 months.

Kirner’s Deformity

  • volar curvature of distal phalanx, not clinically apparent until 8-12 yrs, usually bilateral

transverse Congenital absence =transverse absence, constriction ring syndrome, symbrachydactyly (unilateral, no foot involvement)

Radial Club hand-50-75% bilateral. Stage I=deficient distal radial epiphysis. Stage II=complete but short/hypoplasia. III=partial aplasia. IV=total aplasia. Humerus often short,  ulna thick 60%normal length. Rx=passive motion, if +elbow motion consider centralization at 6-12months.

Ulnar Club hand-elbow problem. Absent/syndactylized ulnardigits. Stage I=ulnar hypoplasia. II=partial aplasia. Stage III=total aplasia. IV=radiohumeral synostosis. Rx:syndactyl release, varied

Cleft Hand-bilateral, familial, feet, absent metacarpals.  Rx=varied

Radioulnar Synostosis

Symphalangism

  • Congenital digital stiffness
  • failure of IP joint development
  • Treatment rarely needed

 

Flexed thumb=congenital trigger thumb or congenital clasped thumb

 

Syndactyl

most commom congenital hand anomaly. Simple=soft tissue. Complex=bony. Complete=to tip of finger vs Incomplete.5-15-50-30%. Rx=release

 

Pre-axial Polydactyl=thumb.Wassel classification type IV-duplicated prox phalanx=43%-most common

Post axial =small finger. A=well formed. B=skin tag. Back\white=10\1. Whites need genetic work-up

Macrodactyly-

 

Thumb hypoplasia

  • classified by Blauth.
  • Type I=small thumb: no treatment.
  • Type II=adduction, floppy, normal skeleton. Treatment=reconstruction
  • Type IIIA=musculotendinous deficiencies, intact CMC joint. Treatment=reconstruction
  • Type IIIB=no CMC joint. IV=MC aplasia. Treatment=pollicization.
  • Type V=complete absence. Treatment = pollicization

Madelungs Deformity

  • disruption of volar ulnar distal radial epiphysis. >radial inclination, ulnocarpal impaction usually in adolescence

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