HAND DEFORMITIES
(A) Syndactyly
– Webbing of two or more finger.
– An abnormal connection of 2 fingers.
– Most commonly occurs between middle and ring finger.
– Webbing can involve entire fingers or just involve part of finger.
– It can involve skin or bone.
• Classification
1) Incomplete
– Webbing doesn’t extend all the way to finger tips .
2) Complete
– Webbing extends all the way to fingertips.
3) Simple
– Joined only by soft tissue
4) Complex
– Fingers joined by bone / bony cartilage, and soft tissue
• Function and appearance.
– There will be problem in grabbing large objects / grabbing circular objects.
– Hand looks different with Syndactyly and may lead to stress and decreases self esteem.
• Management
√ Surgical management
– Syndactyly involving thumb and pointer finger or king and small finger : early surgery by 6 month is done.
– Other Syndactyly : surgery is done between 12-18 months of age.
– Syndactyly is reconstructed through series of flaps .
– New skin must be bought between fingers.
– Placing bulky soft dressings until 4 weeks after surgery is important and then start the therapy.
– Importance of therapy : it will keep the scars soft and helps to regain motion.
(B) Polydactyly
– It is a condition where a person is born with an extra finger / toe on one or both of the hands and feet.
– It can be ,
√ small and raised lump of soft tissue connects no bones
√ Partially formed finger or toe containing some bones but not joints.
√ Fully functioning finger or toe with soft tissue , bone and joints.
• Types
1) Ulnar / postaxial Polydactyly / small finger duplication
– Extra finger is on outside the little finger.
– When this form of condition affects toes , it is called fibular Polydactyly.
2) Radial / Preaxial / thumb duplication
– Extra finger on outside of the thumb.
– when it affects toes called as tibial Polydactyly.
3) Central Polydactyly
– Extra finger is attached to ring , middle or most oftenly index finger.
* Polydactyly can be associated with a genetic condition / syndrome.
• Treatment
(1) Little finger duplication
– May not require treatment
– It doesn’t affect use of hand but treatment can be done for cosmetic reasons
– If an extra little finger is partially formed : it can be removed easily but if it is fully formed / functional it may require surgery.
(2) Thumb duplication.
– Treatment is complicated
– Extra thumb may affects the function of other fingers
– Surgery is needed
(3) Central Polydactyly
– Keeping additional central finger and operating in tendons and ligaments to avoid deformities
– Removing an extra central finger and reconstructing the one it is attached.
– Removing both fingers and reconstruction of one new finger.
(C) Ectrodactyly
– Formation of Split hand or split foot.
– Genetic disorder characterized by complete or partial absence of some clefts in hands or feet.
– Appearance of webbing between fingers or toes , claw like appearance can also be present.
• Types
– Lobster claw variety : Absence of third digit
– 2 nd variety of split hand deformity : Presence of only 5 th digit and no cleft.
* Typical cleft hand
– Bilateral deep ‘V’ shaped central defect.
– Partial or complete absence of middle finger.
– Thumb may be involved.
– Associated cleft lip or palate
– No chest wall involvement is seen.
– No finger nubbing.
* Atypical cleft hand
– Unilateral shallow ‘U’ shaped defect.
– No associated cleft feet.
– thumb is rarely involved .
– There is no association with cleft lip / palate.
– Finger nabbins may occur.
• Manske’s classification of cleft hand
√ Type 1 : Normal first web
√ Type 2 : A – mild narrowed web .
B – Severly narrowed web
√ Type 3 : Syndactylised web
√ Type 4 : merged web
√ Type 5 : Absent web.
A – partial supression of radial ray
B – complete supression if radial ray.
• Treatment
– Cleft hand treatment is usually invasive and can differ each time because of heterogeneity of condition.
√ Surgical treatment
– Based on several indications
Improving function
Absent thumb
Deforming Syndactyly
Transverse bones
Narrowed first web space
Reducing deformity.
