I have previously posted on the topic of the 5- finger hand. This previous post summarized many of the key issues with this diagnosis. http://congenitalhand.wustl.edu/2013/03/the-5-finger-hand.html
Here is the preoperative picture of one such child with a 5- finger hand. Note the small extra thumb and the digits all aligned in the same plane.
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| 5 finger hand with an extra thumb as well. Note how difficult it is to sort out on which side the thumb resides. |
There are 2 main problems with this situation: 1) The “thumb” is too long which can make pinching awkward and 2) the patient does not have a wide first web space which would allow the child to grasp large objects (soda can, etc).
Additionally, the child has to depend on a scissor- like pinch (side to side) rather than placing the “pulps” of the digits together to pinch.
We corrected this child’s hand by:
1) removing small extra thumb
2) “pollicizing” the index finger. See previous posts:
http://congenitalhand.wustl.edu/2011/10/pollicization-creating-new-thumb.html
http://congenitalhand.wustl.edu/2011/12/more-thoughts-on-pollicization-decision.html
http://congenitalhand.wustl.edu/2013/09/more-thoughts-on-pollicization.html
3) Shortening the new thumb.
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| 5 finger hand after reconstruction including pollicization |
In this case, there was a strong family history of the condition and the family is very pleased both with appearance and function. The hand functions quite well with daily activities.