What Is Meant by Congenital Hand Anomalies?
The deformities of the hand and arms present from birth are considered congenital hand anomalies. Children may be born with various types of hand anomalies, and the varying in their types can affect the functions and appearance of the affected hand. Congenital hand anomalies usually develop during the early pregnancy stage when the upper limbs form in the fetus. Mostly congenital hand anomalies may run in the families or due to some medical conditions. But in many cases, the doctors may not be able to rule out the exact cause for the anomaly thus, it may be described as the congenital hand anomalies of an idiopathic cause. Congenital hand anomalies may affect both parents and children's physical and emotional stability. Most children adapt and function very well without treatment. Some of them need surgical treatment, occupational therapy, and other treatments to be more independent.
How Are Congenital Hand Anomalies Described?
Congenital hand anomalies often affect both the arms' and hands' function and shape. These congenital anomalies are more common in boy babies than in girl babies. Congenital hand anomalies cannot be detected before birth. Occasionally, extra fingers or some missing bones may be seen in prenatal ultrasound scans. These congenital hand anomalies can be divided into four categories. They include:
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Deformations.
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Malformations.
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Syndromes.
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Dysplasia.
What Are the Types of Congenital Hand Anomalies?
Congenital hand deformities have several types. But the outlined types of deformities include:
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Syndically.
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Polydactyly.
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Clubhands.
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Symbrachydactyly.
What Causes Hand Deformities at Birth?
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Most congenital abnormalities of the hands and bones have an unknown etiology. On the other hand, some conditions are recognized to be inherited and can be detected through genetic testing and/or parental genetic counseling.
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A few more are caused by systemic illnesses including multiple inherited exostosis, arthrogryposis multiplex congenita, or Holt-Oram Syndrome.
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Even if not all of the reasons have been found, developments in molecular biology and genetics have improved medical understanding of some of these illnesses and redefined earlier classification schemes.
What Are the Surgeries Used to Treat Congenital Hand Anomalies?
Most congenital hand deformities are treated with surgeries. Most of the surgical procedures are done in the child's early life. Occupational and physical therapists may play an important role in treating some minor congenital hand anomalies by suggesting stretching exercises and splinting.
Syndactyly Surgery
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The surgical procedure done to correct syndactyly is known as syndactyly release. This surgical procedure helps to correct or release one or more fused fingers (webbed fingers).
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This procedure is usually performed after one year of the child to reduce the risk of anesthesia. The syndactyly release surgery is done by making the zigzag incisions to divide the digits. This zigzag incision between the numbers may help the surgeons create pointed flaps on the skin to wrap around the digits. This procedure may help prevent the scars that tend to restrict the movements of the numbers in the future.
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Sometimes surgeons use skin grafts to fill the area between the digits after they are separated. When the fusion happens between the thumb and ring finger, the doctors may plan the surgery when the child is six months old to avoid problems in the growth as both of the fingers are smaller than the neighboring fingers.
Polydactyly Surgery
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When the child has extra digits, it is treated surgically between one and two years. The surgical procedures vary on the type of polydactyly. If the child has radial polydactyly, the surgeons may create one thumb from two split thumbs. The surgical procedure to correct radial polydactyly involves the reconstruction of the skin, tendons, joints, ligaments, and soft tissues. In some cases, the less functioning or small thumb is removed.
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The extra pinky finger may be removed if the child has ulnar polydactyly. In some cases, only the soft tissue may be attached; in that case, the surgeons allow the soft tissue to fall off itself by stopping its blood flow by using a suture or a clip. If the extra digit is well-formed in ulnar polydactyly, it needs reconstruction of the tissues as in radial polydactyly.
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In children with central polydactyly, the exact tissue reconstruction is suggested, and in rare cases, the removal of more than one digit is required to make the fingers function well and the hand looks normal.
Club Hand Surgery
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In mild radial and ulnar club hands, surgery is not always required. In children with radial club hands, the hand goes inward, causing a limited range of motion of the wrist. In children with the ulnar club hand, the forearm bone on the side of the little finger is absent or shorter than the other tissues on the same side.
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Within some days of the baby's birth, the surgeons should suggest using splints to straighten the hand, prevent the shortening of the soft tissues, and stabilize the wrist. The doctors may also recommend physical therapy and stretching exercises. This early stretching and splinting may help increase the procedures' effectiveness.
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In cases where the surgery is mandatory, the planned procedures may vary in severity.
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An external fixator is a device that helps stretch the soft tissues and lengthens the bone by attaching the device to the hand and forearm. In this procedure, the pins are placed into the bone, and it is attached to the frame of the fixator that is adjustable to ensure the position of the bone. This device can be worn for one to two months.
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Surgical procedures for clubhands can help in reducing the tightness of the tissue, which causes an abnormal angle of the wrist. In patients with ulnar club hands, additional therapies are suggested to treat elbow problems.
Symbrachydactyly Surgery
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Mild forms of symbrachydactyly do not require surgical treatment. In moderate to severe cases, surgery is done when the child is around one year old to improve the hand's function and look.
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The type of surgery needed to correct symbrachydactyly mainly depends on the severity of the condition.
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The surgeons usually perform procedures by making a deep incision between the webbed fingers. At the time of phalangeal transfer, the surgeons do the procedure by removing the bone from the phalanges of the toes and placing the bone inside the skin projection and soft tissues on the hand.
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Surgeons may perform the procedure by entirely transferring the toe to the hand to replace the missing finger.
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The other choice of treatment for symbrachydactyly is the placement of prosthetic fingers.
Conclusion:
The congenital hand anomalies may be treated at the child's early age to restore the appearance and function of the hand. Orthopedic surgeons perform several surgical procedures to treat congenital hand deformities. They may also be involved in ruling out if the deformations are related to any other syndromes or medical conditions.
