congenital hand anomalies
DESCRIPTION
CHATRANSCRIPT
Congenital Hand Anomalies
Clinical examination approaches
Dr. Hendra Gunawan SpOT
Introduction
• Incidence : 1 in 600 live births
• Only a fraction are defects severe enough operative treatment
• Cause : – Heritable genetic mutations
– Intrauterine damage : • Drugs
• Infection
• Ionizing radiation
• UNKNOWN
Introduction
• Clinical examination in Orthopedics :
– Hx : • Symptoms (deformity/dysfunction)
– Physical examination • Look
• Feel
• Move
– Other investigation : • Imaging
• Laboratory
General considerations
• Abnormalities of upper extremity part of larger syndrome/isolated condition
• Radial dysplasia associated with VACTERL; – Vertebral anomalies
– Anal atresia
– Cardiovascular anomalies
– Tracheo-Oesophageal Fistula
– Renal anomalies
– Limb defect
Classification
1. Failure of formation
2. Failure of differentiation
3. Duplication
4. Undergrowth
5. Overgrowth
6. Congenital band syndrome
7. Generalized skeletal anomalies
Most common cases?
Syndactyly
• Look :
– deformity of fingers
• Feel :
– Web of fingers
• Move :
– Adjacent fingers
Polydactyly
• Extra digits
• Pre-axial, post axial,
central
• Painless
• Unable move
www.childrenshospital.org
Congenital trigger thumb
"Notta's node"
www.childrenshospital.org
Congenital trigger thumb
• Look :
– Minimal deformity
• Feel :
– Notta’s node
• Move :
– triggering
Clinodactyly
• Bent sideways
• Abnormal shaped
middle phalang
www.e-radiography.net
www.newborns.stanford.edu
Camptodactyly
• “Bent finger”
flexion deformity
• Abnormal muscle
insertion
www.congenitalhand.wustl.edu
Constriction rings
• Localized
strangulation
• Swollen, and cyanotic
• Painfull
• Auto amputation
threatening
www.childrenhospital.org
Radial dysplasia/Radial club
hand
Salam A.M.S.(Ortho), MRCS ( Edin) Fellow in Limb lengthening and reconstruction ( USA), Coimbatore Tamil Nadu, India
Salam A.M.S.(Ortho), MRCS ( Edin) Fellow in Limb lengthening and reconstruction ( USA), Coimbatore Tamil Nadu, India
Treatment
• Conservative
– Stretching
– Splinting
• Operative considerations
– Function
– Progression of deformity
– Appearance
– Pain