Hand Deformities in Children

Hand Deformities in ChildrenRadial and ulnar dysplasia show major differences.

Ulnar Dysplasia

Ulnar dysplasia includes an absence or hypoplasia of the ulna that is associated with anomalies of the hand in children. The deformity is often classified by the Bayne classification for the ulnar deficiency and the Manske classification for the hand anomalies. Often the radius is shortened and bowed and the radius may be fused with the humerus. Finger deformities are common. Look for associated skeletal problems.

Management Most improvement can be made by focusing on the hand.

Wrist If ulnar deviation exceeds about 30°, consider resection of the ulnar analogue and corrective osteotomy in Bayne II and IV forearms.

Hand Deepening on the thumb-index web space and rotational osteotomies of the metacarpals may improve hand function.

Forearm and elbow Consider creating a one bone forearm in Bayne II or osteotomies to improve elbow position in Bayne IV.

Cleft Hand Deformity

Cleft hands include a spectrum of deformities that are inherited, usually bilateral, and usually involve the feet. Function is good but appearance may be distressing. The clefts may be surgically reduced to improve appearance while preserving function.

Radial Dysplasia

Radial club hand includes an absence or hypoplasia of the radius and associated musculature, producing a radial deviation. The deficiency may be isolated or part of a generalized skeletal dysplasia or syndrome. Look for other problems by performing a screening evaluation, giving special attention to the hematologic, urinary, and cardiac systems as well as the spine.

Management depends upon the severity of the deformity and the presence of associated defects.

Mild hypoplasia may not require any treatment.

Complete aplasia Stretch out the soft tissue contracture with casts and splints during the first year. This may be followed by operative correction.

Operative correction may include soft tissue release or lengthening and centralization of carpals on the ulna.

Follow-up throughout infancy and childhood shows that recurrence of the deformity is likely.

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