Saturday, February 18, 2012

Central Deficiency, Severe

Central deficiency (cleft hand) may present in many different ways.  Sometimes, there is just long (or middle) finger absence and other times more than one digit may be missing.  The thumb- index web space is often affected, ranging from a mild narrowing to a complete syndactyly/ merging of the space.

In this young patient, both the long finger and the ring finger are completely absent.  There is a large cleft between the index finger and the small finger.  Finally, the thumb and the index finger are merged.

The primary functional limitation for this child is related to the lack of a thumb- index web space.  This affects large object grasp (think: soda can) and tip-to-tip pinch (think: manipulating beads).  In some children the large space between the index and small fingers (the cleft) can return some of this functionality, but certainly not all function.
Central Deficiency (cleft hand) with merged thumb and index finger.

Xray of central deficiency (cleft hand) with missing long and ring fingers.

If both the thumb and index finger have independent function on examination (can be difficult to assess), separation can be accomplished with reconstruction of the thumb- index web space.  This provides a thumb and two fingers.  It is important to note that reconstruction is not appropriate in all children with a limited number of digits and a number of factors should be considered including the opposite hand (i.e., whether it is affected).  Some families will favor a surgical approach while others may not.

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