Syndactyly, Macrodactyly, and Keloid
Congenital Hand and Arm Differences
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2y ago
The treatment of syndactyly is highly successful, no matter the preferred technique. That is the classic technique of Flatt (dorsal commissure flap and zig- zag incisions- ) or graftless techninques or hyalomatrix- all can work. Complications include web creep (maybe not a true complication as it is so commonly seen), wound healing issues, rare infections, etc. Hypertrophic scarring is very, very uncommon. However, with macrodactyly there is a risk of keloid formation. While we do not understand this, it is likely related to PIK3CA . While macrodactyly may be dramatic, it can also be subtle a ..read more
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Understanding the 'Why' of Upper Extremity Birth Differences Part 1
Congenital Hand and Arm Differences
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3y ago
Birth differences of the upper extremity have many different forms/ presentations. These can be a dramatic with a shortened or deviated extremity or very subtle/ mild with slightly short fingers or a subtle lack of muscle development. In my three decades of caring for kids, it has always been clear that our team is truly caring for the whole family. Families have many questions about what we can do to help their child (surgery, therapy, what the future holds for their child, and the 'why'- why is their chiild, their family affected with this anomaly. The purpose of this blog post is to discuss ..read more
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Forearm Synostosis- Facts and My Approach to Treatment
Congenital Hand and Arm Differences
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3y ago
 I have previously blogged about forearm synostosis HERE.  A few important points 1) It uncommon compared to other upper extremity anomalies but is perhaps the most common of the forearm birth differences. 2) It is really well tolerated by most children.  Especially because the rest of the upper extremity is typically normal (most importantly, the hand) 3) The function impact depends on a few factors: The position of the forearm (i.e., how rotated is it) Whether one arm or both The child- each child is affected differently 4) It is recognized later than many birth anomali ..read more
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2 Reasons for Less than 5 Fingers
Congenital Hand and Arm Differences
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3y ago
 A brief post with lots of pictures and videos on two conditions that may cause less than five fingers.  As I have previously written, there are 5 common causes.  Parents have given permission. Diagnosis 1.  Symbrachydactyly.  This patient has a great thumb and nubbins past the metacarpals.  However function is excellent.  The child will likely favor the normal opposite extremity. Symbrachydactyly with great thumb Palm view of symbrachydactyly with great thumb Effective grasp in patient with symbrachydactyly Diagnosis 2.  ..read more
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2 Common Types of an Uncommon Condition- Symbrachydactyly
Congenital Hand and Arm Differences
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3y ago
When I consider all of the different patients with a birth anomalies that I have the privilege to evaluate and treat, there is no question that symbrachydactyly is the diagnosis most often misnamed or unnamed.  Amniotic constriction band is perhaps most commonly given as the incorrect diagnosis for the patients. Symbrachydactyly literally means short, webbed fingers.  And that certainly can be how patients with symbrachydactyly present as I have previously shared here- Previous Post.  While there are 7 types (depending on your favorite classification), in my mind there are ..read more
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An Unusual Pollicization Procedure
Congenital Hand and Arm Differences
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3y ago
Radial polydactlyly (extra thumb) is a relatively common problem for those of us who treat kids with birth differences/ anomalies of the upper extremity.  Please see the following link for previous posts on the topic LINK.  Sometimes these can be treated by a "straightforward" procedure with excision of the extra thumb and stabilization of the primary thumb.  Other times a more complex surgery is required which can include a similar procedure + cutting and realigning the bones.  More rarely, other procedures are required.  This is one such case.   This ..read more
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Early Action in Madelungs Deformity
Congenital Hand and Arm Differences
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3y ago
Years ago, I met an 7 year young lady who came to my office with no complaints.  Mom brought her even though she had no hand or wrist pain and no functional limitations.  The reason for the visit was a strong family history of Madelungs deformity (mom and sister).  There was no clinical evidence of a syndrome and the patient was of normal height.  However, xrays did confirm very early, quite subtle Madelungs deformity of both wrists. First, most of the time we do not have the opportunity to see patients so early.  The typical patient with Madelungs deformity presents a ..read more
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Syndactyly as part of a syndrome
Congenital Hand and Arm Differences
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3y ago
Syndactyly is most commonly an isolated finding which we believe is "simply" related to a failure of the cells to regress during development.  This failure to regress means that the webspace does not develop ~ the 7th-8th week of gestation.  We know that the apical ectodermal ridge is involved and signaling mechanisms including FGF-8.  This manuscript from Al-Qattan (an expert and highly experienced hand surgeon) provides one pathway explanation: Al-Qattan publication 2019 While most kids affected with syndactyly are otherwise without a medical condition, there are a number ..read more
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Tight First Webspace
Congenital Hand and Arm Differences
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3y ago
 The space between the thumb and index (pointer) finger is crucial for function.  We say that the thumb accounts for 40% of hand function - much of that function is related to grasping large objects in this 'first webspace'.   The thumb-index webspace, or as it is also called- the first webspace, can be tight or contracted for two basic reasons- a limitation present at birth or a limitation related to trauma.   Birth differences leading to first webspace contracture I have previously shared thoughts on the first webspace in arthrogryposis a few times, here is one ..read more
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Pollicization Long Term
Congenital Hand and Arm Differences
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4y ago
Hello all.  I want to share a good result in a challenging pollicization procedure.  This patient has radial longitudinal deficiency with a poor, very limited thumb (we call it type 4 hypoplastic thumb).  The decision was made to excise the thumb and create a new one with the index finger (e.g., the pollicization procedure).  We know that this is a great procedure- I have blogged about this many times as you can see at this link:  http://congenitalhand.wustl.edu/search?q=pollicization We also know that there are a couple of factors that affect the results after t ..read more
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