Thumb Duplication: Concepts and Techniques

Within the Oberg, Manske, Tonkin (OMT) classification, thumb duplications are a failure of formation and/or differentiation affecting the radial-ulnar axis of the hand plate. The Wassel description of seven types of thumb duplication provides a good structure from which an approach to management is based. The aim of surgical reconstruction is to obtain a stable, mobile thumb of adequate size and appropriate shape. The most common form of reconstruction is removal of the lesser digit and reconstruction of the dominant digit. Surgical techniques address the problems of deviation, instability and lack of size. The disadvantages of the Bilhaut-Cloquet procedure, these being joint stiffness and a nail ridge, may be lesser concerns when reconstruction of one digit will not create a satisfactory thumb of adequate mobility, stability, alignment and size. Complicated problems of triphalangism, triplication, ulnar dimelia and the rare circumstance in which neither of the duplicated thumbs may be adequately reconstructed present specific challenges which demand alternative techniques.

Thumb Duplication: Concepts and Techniques

Within the Oberg, Manske, Tonkin (OMT) classification, thumb duplications are a failure of formation and/or differentiation affecting the radial-ulnar axis of the hand plate. The Wassel description of seven types of thumb duplication provides a good structure from which an approach to management is based. The aim of surgical reconstruction is to obtain a stable, mobile thumb of adequate size and appropriate shape. The most common form of reconstruction is removal of the lesser digit and reconstruction of the dominant digit. Surgical techniques address the problems of deviation, instability and lack of size. The disadvantages of the Bilhaut-Cloquet procedure, these being joint stiffness and a nail ridge, may be lesser concerns when reconstruction of one digit will not create a satisfactory thumb of adequate mobility, stability, alignment and size. Complicated problems of triphalangism, triplication, ulnar dimelia and the rare circumstance in which neither of the duplicated thumbs may be adequately reconstructed present specific challenges which demand alternative techniques.

Congenital Differences of the Upper Extremity: Classification and Treatment Principles

For hand surgeons, the treatment of children with congenital differences of the upper extremity is challenging because of the diverse spectrum of conditions encountered, but the task is also rewarding because it provides surgeons with the opportunity to impact a child's growth and development. An ideal classification of congenital differences of the upper extremity would reflect the full spectrum of morphologic abnormalities and encompass etiology, a guide to treatment, and provide prognoses. In this report, I review current classification systems and discuss their contradictions and limitations. In addition, I present a modified classification system and provide treatment principles. As our understanding of the etiology of congenital differences of the upper extremity increases and as experience of treating difficult cases accumulates, even an ideal classification system and optimal treatment strategies will undoubtedly continue to evolve.

agenesies centrales de la main

Central aplasia represent under 10% of congenital malformations of the hand. It is characterized by the partial or complete absence of the median ray. We adopted the classification of swanson and considered this anomaly a stop of median longitudinal development. We separate 2 groups: hand in folk: the aplasia interested only the median digits, all metacarpal are present. Hand in lobster's pincer: all median rays are absent including the metacarpal. We report a set of 16 children carriers of 23 central aplasia of the hand, it was about 14 hands in lobster pincer and 9 hands in folk. In any case, the gene was merely aesthetic, the hand's function was complete. A child has been operated, and benefitted a closing of the median crack defect, he had a free thumb. For the other cases, abstention has been decided indeed to close this cracks deprive these hands of a first corner the alone present

Mano hendida: clasificación, diagnóstico diferencial y tratamiento

Se intenta actualizar el tema, ahondando en la embriogénesis de la mano hendida, se adhiere a la teoría de que se trata de una polisindactilia que se atrofia antes del nacimiento. Se presentan 9 casos de pacientes, 17 manos afectadas que se clasifican de acuerdo con Watari. Se describe detalladamente la clínica. El diagnóstico diferencial se establece por las agenesias longitudinales radiales y cubitales, las bridas circulares y los síndromes de Apert, Polland, etc. Además, se establecen diagnósticos diferenciales entre distintos pies hendidos. Tratamiento: No estamos de acuerdo con el cierre de la comisura realizado con partes blandas, porque los resultados son malos. En cambio, sugerimos el cierre de la comisura por medio de una osteotomía de traslado y desrotación. Cuando la mano es del tipo 6, a veces sólo hace falta profundizar la comisura, otras, se requiere separar la comisura, y practicar osteotomía de desrotación. En caso de sindactilia entre el pulgar y el índice, y hendidura entre el índice y el resto de los dedos, se propone la técnica de Snow y Littler, técnica difícil, con posibles complicaciones, pero que ofrece una solución estética en un solo tiempo quirúrgico

Deficiência ulnar congênita: conduta e tratamento / Congenital ulnar deficiency

Os autores apresentam uma série de seis casos de deficiência ulnar congênita do tipo II da classificaçäo radiológica de Dobyns, Wood & Bayne. Enfatizam a técnica de ressecçäo do extremo distal da ulna e do extremo proximal do rádio (luxado) como método de eleiçäo para esses casos. Em seus resultados, puderam concluir que essas osteotomias para ressecçäo, além de auxiliar a correçäo das deformidades, trazem ganho da amplitude articular e impedem a progressäo da doença com o crescimento

Centralización de muñeca en mano zamba radial / Wrist centralization for the radial club hand

Se revisa el resultado del tratamiento quirúrgico de 19 manos zambas radiales en 15 pacientes, tratados de 1982 a 1992. La edad promedio al momento de la cirugía fue de cuatro años ocho meses. La longitud de los miembros torácicos en los bilaterales fue similar; los casos unilaterales tuvieron en promedio, un acortamiento del 60 por ciento con respecto de la normal. Se realizaron dos abordajes, fijación con un clavo de Steinmann centromedular perdido a través del tercer metacarpiano y el cúbito. El seguimiento fue en promedio de cuatro años dos meses, con un mínimo de 14 meses y un máximo de 10 años. La desviación radial preoperatoria fue de 95.5º en promedio, con un mínimo de 80º y un máximo de 130º. El promedio de la desviación radial postoperatoria fue de 5.5º, con un mínimo de 0º y un máximo de 15º

Paquioniquia congénita: síndrome de Jadassohn Lewandowsky / Pachyonychia congenita: syndrome of Jadassohn Lewandowsky

Los autores presentan una familia con dos miembros afectados en 4 generaciones, que son madre e hijo, con paquioniquia congénita, hiperqueratosis palmoplantar, queratosis folicular, y disqueratosis corneal, además de bulas plantares en la primera, ambos con severa limitación visual y relativa al deambular. Genodermatosis de presentación infrecuente, se comentan sus rasgos clínicos, de clasificación, patogenéticos, histológicos como los de terapia y pronóstico