Ulnar cleft hand, part II

My most recent post, from Dec 5th, was on a rare type of cleft hand, the ulnar cleft hand.  Ulnar cleft hand is very different and even less common that the classic cleft hand which involves the central hand (classically with middle finger absence).  There have been a few manuscripts on the topic of ulnar cleft hand including (among others):

2014 Al- Qattan paper

2002 Tonkin paper

These papers demonstrate how truly rare ulnar cleft hand is.  The patients have a cleft between the ring and little fingers and may have deformity of the little finger or, more commonly, have a very small little finger which may be duplicated (i.e., extra little finger). 

This case, just like my previous post, is an example of ulnar cleft hand but is more similar to other cases in the literature.  Thankfully, the patient has done wonderfully,  Importantly, the family wished to remove the abnormal finger with unusual bones and to maintain both little fingers- their goal (as was mine) was to improved alignment for function and appearance.

Ulnar cleft hand preoperative

Ulnar cleft hand preoperative from palm side

Ulnar cleft hand before surgery.  Note abnormal collection of bones.

In these pictures from 2012, the thumb is normal as are the index and middle fingers.  However, there are three small digits on the ulnar side of the hand.  The central one was removed and the outer two were preserved at surgery and realigned through a bony cut.  

The next group of pictures if from 2019 show the appearance and motion now.

Ulnar cleft hand after surgery

Finger motion in ulnar cleft hand after surgery

Appearance from palm of ulnar cleft hand

These three pictures confirm an outstanding outcome for a challenging presentation of ulnar cleft hand with rotated and malaligned digits.  While the thumb, index and middle fingers are the key for function, the two small digits on the ulnar hand do not interfere with function and are utilized for activities.  This patient has excellent function and the family is thrilled with the appearance outcome.

Charles A. Goldfarb, MD              

My Bio at Washington University     
email: congenitalhand@wustl.edu

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