Congenital Hand Anomalies
Congenital Hand Anomalies
Overview
Congenital hand anomalies occur in approximately 1 in 500 live births. These conditions can range from mild cosmetic differences to severe functional impairment. Early recognition and appropriate intervention are crucial for optimal outcomes.
Camptodactyly
Definition
Nontraumatic flexion contracture of the proximal interphalangeal (PIP) joint, most commonly affecting the small finger.
Classification
- Type I: Infantile (present at birth)
- Type II: Adolescent (develops during adolescence)
- Type III: Multiple fingers involved
Associated Conditions
- Trisomy 21
- Arthrogryposis
- Freeman-Sheldon syndrome
- Marfan syndrome
Management
- Conservative:
- Passive stretching
- Static and dynamic splinting
- Occupational therapy
- Surgical (if >60° contracture):
- Soft tissue release
- Tendon transfers
- External fixation
Clinodactyly
Definition
Radioulnar deviation of fingers, typically affecting the small finger with radial deviation.
Key Features
- Delta phalanx (triangular-shaped middle phalanx)
- Most commonly affects small finger
- Usually bilateral
- Often inherited (autosomal dominant)
Associated Syndromes
- Down syndrome
- Apert syndrome
- Silver-Russell syndrome
- Seckel syndrome
Management
- Observation for mild cases
- Surgery indicated if:
- Deviation >30 degrees
- Functional impairment
- Significant cosmetic concern
Polydactyly
Classification
- Preaxial (Thumb/Radial)
- Type I: Bifid distal phalanx
- Type II: Duplicated proximal phalanx
- Type III: Complete thumb duplication
- Type IV: Triphalangeal thumb
- Central (Index through Ring)
- Postaxial (Small finger/Ulnar)
- Type A: Well-formed digit
- Type B: Rudimentary digit
Associated Conditions
- Isolated finding (most common)
- Ellis-van Creveld syndrome
- Trisomy 13
- McKusick-Kaufman syndrome
Management
- Timing: 6-12 months of age
- Preaxial:
- Reconstructive surgery
- Preserve radial digit
- Joint reconstruction if needed
- Postaxial:
- Type A: Reconstructive excision
- Type B: Simple ligation at birth
Thumb Hypoplasia
Blauth Classification
- Type I: Small thumb, all structures present
- Type II: Hypoplastic thenar muscles, narrow first web
- Type III:
- IIIA: Stable carpometacarpal joint
- IIIB: Unstable carpometacarpal joint
- Type IV: Floating thumb
- Type V: Absent thumb
Associated Conditions
- Holt-Oram syndrome
- VACTERL association
- Fanconi anemia
- Radial longitudinal deficiency
Management
- Type I: Observation
- Type II: Reconstruction
- First web space deepening
- Opponensplasty
- Type III-V:
- Pollicization of index finger
- Microsurgical reconstruction
Syndactyly
Classification
- By Tissue Involvement:
- Simple: Soft tissue only
- Complex: Bony fusion
- Complicated: Additional abnormalities
- By Completeness:
- Complete: Full length of digits
- Incomplete: Partial fusion
Associated Conditions
- Apert syndrome
- Poland syndrome
- Carpenter syndrome
- Pfeiffer syndrome
Management
- Timing:
- Border digits (thumb-index, ring-small): 6-12 months
- Central digits: 18-24 months
- Surgical Techniques:
- Zigzag incisions
- Full-thickness skin grafting
- Local flap coverage
- Nail fold reconstruction
- Post-operative Care:
- Regular wound care
- Early motion
- Scar management
Disclaimer
The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.
