2 Reasons for Less than 5 Fingers

 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 […]

Cleft Hand: Beyond the Basics

I have posted numerous times on cleft hand. (See other posts.)  In my world, this is a still an unusual diagnosis and can be challenging as each child is somewhat different than the next.  The early and late treatment of cleft hand, therefore, has to be considered for each child.   Late treatment in cleft hand is […]

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 […]

Not the typical hand deficiency- ulnar cleft hand

A patient with a thumb and three normal fingers has a hand that functions at a near normal level and looks great.  The narrow hand caused by a lack of a single finger (as long as the others are well aligned and no significant gaps exist) is not easily detected by others- it looks good.  […]

Untreated Cleft Hand

Cleft hand is one of the most notable birth anomalies of the upper extremities.  The appearance is distinctive although function can be really well maintained.  One of the founding fathers of the discipline of hand surgery, Sterling Bunnell, labeled cleft hand, “a functional triumph and a social disaster”. There are other names for cleft hand.  […]

Cleft Hand Reconstruction

I have posted a number of times on cleft hand, or central deficiency as can be found HERE.  To me, cleft hand is one of the most interesting diagnoses as kids with it may look and function very differently from each other despite have the same diagnosis.  Some of my other posts highlight these differences between […]

The Big Thumb

The term ‘superdigit’ is utilized in congenital hand surgery to describe a digit that is larger than we expect. It is often related to the fusion of two digits into one and may be seen in cleft hand and central polysyndactyly among other conditions.  We also see large digits in other conditions such as Macrodactyly.  […]

Ulnar Sided Cleft Hand

I have previously posted on cleft hand with a number of discussions.  More to come on this topic in the future as well.  However, I wanted to share a less common type of cleft hand, the ulnar cleft hand. Dr Tonkin from Sydney Australia has written about this unusual condition in the Journal of Hand Surgery.  In this case […]

Central Polysyndactyly

Polydactyly means that more than the normal 5 digits.  Typically patients have either an extra thumb or an extra pinky. A patient with radial polydactyly (extra thumb). Syndactyly is the abnormal joining of the fingers.  It is most common between the middle digits but can affect any of the fingers. Syndactyly of the fingers. While […]

Challenges with Cleft Hand Reconstruction

When surgery is required for cleft hand, the goal is to create a maximally functional hand that is as “normal” appearing as possible.  While each child with cleft hand is different, usually we can create a hand that works well and looks good.  However, certain challenges exist after surgery related to hand anatomy.  A cleft […]

Hand Society 2013

Last week was the annual meeting of the American Society for Surgery of the Hand in San Francisco.  As usual, it was a great meeting with an amazing collection of speakers giving paper presentations and courses on a variety of topics.  There were two presentations of congenital research from our institution (along with a number […]

Cleft Hand Long Term Follow- up

Cleft hand, central deficiency, is an uncommon birth anomaly of the hand.  I have previously posted a few times on this interesting difference including one about surgery https://congenitalhand.wustl.edu/2012/05/cleft-hand-surgery.htmland another about cleft hand in general https://congenitalhand.wustl.edu/2012/01/central-deficiency.html and a few others as well.  I thought a long- term follow- up sequence of pictures might be interesting to share. We […]

Clinodactyly

I have previously posted on clinodactyly but recently performed several surgeries so I though adding a few more pictures and thoughts might be helpful.  There are two types of clinodactyly: isolated and associated with a syndrome.  Isolated clinodactyly is common in the general population but is very well tolerated and usually ignored.  In fact, many […]

Toe Transfers

There are 2 types of toe transfers for children born with hand deficiencies: vascularized complete toe transfer and non vascularized transfer of a toe phalanx (i.e., just the bone).  Vascularized toe transfers are considered for children with absent digits, typically in cases of symbrachydactyly (or transverse arrest) or amniotic constriction band.  One or two toes […]

Unusual Combination

We have come a long way in understanding congenital hand and upper extremity abnormalities.  Dr Swanson, more than 40 years ago, published a classification system that was adopted by most of us who treat patients with birth anomalies.  This classification system was based purely on appearance of the extremity but allowed us to communicate better […]

Central Deficiency with 2-3 fingers

Central deficiency (cleft hand) is classically as I have shown in previous blogs.  https://congenitalhand.wustl.edu/2012/05/cleft-hand-surgery.html We have previously published our experience with the classic central deficiency, that is the hand with a limited thumb- index web space, 3 fingers (index, ring, and small finger), and a large cleft http://www.ncbi.nlm.nih.gov/pubmed/18984341 However, there are many different varieties of cleft […]

Finger Lengthening

Lengthening a finger or thumb may be a good treatment option for a number of conditions including symbrachydactyly, constriction band syndrome, and ulnar deficiency.  Essentially any congenital or traumatic condition that leads to a shortened digit (or digits) may interfere with function.  If lengthening that digit will help pinch or large object grasp (i.e., soda […]

Cleft Hand Surgery

Cleft hand (Central Deficiency) reconstruction is a challenging surgical procedure.  This child’s hand demonstrates some of the difficulties.  There are 3 problems in the hand.  First, the space between the thumb and the index finger is narrowed which limits his ability to grasp large objects.  Despite his young age (2 years), mom and dad have […]

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 […]

Central Deficiency

Central deficiency is also called cleft hand.  It typically includes a missing long finger (middle finger) and a narrow thumb- index web space.  Severity varies and some patients have loss of additional digits or a syndactyly of the ring and small fingers.  Like many congenital anomalies, central deficiency is considered from both a functional and […]