Orthopedics - Oleksa A.P. 2006

Congenital upper limb malformations
Congenital hand deformities
Congenital cleft hand

This congenital anomaly involves a cleft hand or FOOT. The severity of the splitting varies widely: from a partial cleft in the distal metacarpus or metatarsus to a complete split of the entire hand extending to the wrist or even the forearm.

In such cases, the hand is divided into two halves, with the split typically occurring at the site of the absent third metacarpal bone and digit, giving the hand a "lobster-claw" appearance.

Occasionally, only the third digit is absent while the third metacarpal bone remains intact. In some instances of cleft hand, Syndactyly of the fourth or fifth digits is also present.

Marginal ectrodactyly can also occur, characterized by the absence of the thumb and first metacarpal or the fifth digit and fifth metacarpal. This defect is sometimes associated with congenital radial or ulnar Clubhand. Similar cleft variants may affect the foot (Fig. 128). As a rule, children adapt well to this condition, though conservative Treatment is initially required to improve grip strength and hand function. I.V. Shvedovchenko and E.L. Proger utilize a specialized device to assess digital grip characteristics, having established that this strength is reduced by half in the affected digits.

Surgical treatment aims to minimize cosmetic defects and improve hand function. Before surgery, the child's level of adaptation to daily life must be considered, but corrective surgery is generally recommended to enhance cosmetic appearance. The Procedure involves incising the Tissues on both sides of the cleft, dissecting the soft tissues, bringing the second and fourth metacarpals together, securing them with transverse cerclage wiring, and approximating the Skin and subcutaneous flaps without tension. To prevent the cerclage wire from cutting through the bone, G.S. Godunova, I.V. Shvedovchenko, and co-workers (1986) use a bone graft as a bridge between the Metacarpal bones.

Class="center">

Fig. 128. Congenital cleft of both feet with adactyly.

In cases of marginal ectrodactyly, reconstructive bone-plastic Procedures for thumb creation (following Blokhin) or toe-to-hand autotransplantation of the second digit from the foot are performed.

Unfortunately, A number of children with cleft hands still do not receive timely and appropriate surgical care today.