Congenital hand deformities - a clinical report of 191 patients.

OBJECTIVE: To evaluate the incidence, therapy results and complications of operatively treated congenital disorders of the hand in a large state hospital during a 14-year period. METHOD: The institutional database was retrospectively analysed for patients with congenital disorders of the hand during a 14-year period (1998-2012). Disorders were classified according to the modified Swanson classification. For each entity, the incidence, the patients age at the time of the operation and operation techniques were evaluated. RESULTS: A total of 191 patients was treated operatively for the congenital disorders of the hand with syndactyly being present in 87, polydactyly in 66, constriction ring syndrome in 7, clinodactyly in 5, macrodactyly in 10, camptodactyly in 8, cleft hand in 5 and thumb hypoplasia in 3 cases. Patients age at the time of the operation was 5.2 as a mean value. CONCLUSION: Congenital hand deformities were seen 1.5 times in male patients compared with female patients. In complex cases where bone deformities seem to disrupt the soft tissue envelope development, surgery is indicated at a preschool age.

Combined triggering at the wrist and fingers and severe carpal tunnel syndrome caused by macrodystrophia lipomatosa. Case report and review of literature.

Macrodystrophia lipomatosa (MDL) is a rare, congenital, developmental anomaly causing localized overgrowth of a digit(s) or extremity. Trigger wrist is a relatively rare entity, which may be caused by a mass originating from a tendon, an anomalous muscle or intracarpal pathologies. A 42-year-old male patient presented with triggering during active motion of the fingers and intractable pain and numbness in fingers to our emergency department. He had hypertrophy of the entire right upper extremity and his huge thumb was amputated due to MDL four years ago. The index finger was bigger than the other fingers and thenar eminence area of the hand looked like a large mass. Resection of hypertrophic carpal bone and debulking of large soft tissue mass removed the carpal tunnel symptoms and limited the range of motion of the wrist and fingers. This is a case report of triggering at the wrist and severe carpal tunnel syndrome due to carpal bone enlargement and lipofibromatous hamartoma (LH) of the median nerve in a patient with MDL.

Middle phalangeal distal condylar fracture remodelling in children: a case report.

We report on a 9-year-old girl who sustained an injury to her left middle finger with a piece of metal 2 months before she presented to our clinic. In the acute trauma phase she applied ice to her hand and did not consult a medical practitioner about the pain and swelling on her finger. Two months after the injury she came to us with a palpable mass on the volar side of middle phalanx. On lateral radiographic view, an apex volar angulation measuring approximately 45 degrees of vertically splitting midphalangeal fracture was noted. Bone remodelling was also seen dorsally extending from the midphalanx to the level of the DIP joint. During the operation the remodelled bone seemed to be in unity with the DIP joint. The apex volarly angulated distal fragment of the middle phalanx was osteotomized. In the postoperative 24 months a control radiologic view was obtained. Normal phalangeal alignment was noted.