Thumb polydactyly with symphalangism.

Three cases of thumb polydactyly in which one of the components demonstrated symphalangism are reported. This is a very rare anomaly and only one similar case could be found in the literature. The rarity of this anomaly was explained by the occurrence of two different abnormal molecular events along two different limb growth axes. Finally, the anomaly does not fit into the classification systems described for thumb polydactyly.

A unique fracture pattern of the proximal phalanx in children: fractures through the phalangeal neck with an attached dorsal bony flange.

This paper describes a unique fracture pattern of the proximal phalanx in children that has not been specifically studied in the literature. Volarly, the fracture line passes through the phalangeal neck and then the fracture line passes dorsally to include a dorsal flange of the metaphysis. Fractures were classified into three types: type I fractures were undisplaced with no finger deformity; type II fractures were mildly displaced in the antero-posterior plane without lateral angulation or scissoring; while type III fractures were severely displaced or had associated lateral angulation or scissoring deformity. Over a 6-year-period, nine cases were seen by the authors. The mechanism of injury was by entrapping the digit in a closing door in all cases. The mean age of patients was 5 years. Types I and II fractures were seen in five children and all were treated by splinting with an excellent outcome. Two children with type III fractures were treated with closed reduction and either splinting (one case) or k-wire (one case), and both had a poor initial outcome. The remaining two children with type III fractures were treated with open reduction and internal fixation with an excellent outcome. Differences between these fractures and the classic phalangeal neck fractures are discussed.

Craniofacial variability in parents of children with cleft lip and cleft palate.

The purpose of this study was to determine whether there are variations in the craniofacial morphology between parents of children with non-syndromic cleft lip and palate and normal controls with no history of cleft in the families in a Saudi sample. Frontal skull radiographs were obtained from a study group consisting of 40 couples, who have a child with cleft deformity and control group of 32 males and 35 females, who have no history of clefts in the family. A total of 18 landmarks were digitized for each individual by a custom made computer program. T-test, logistic regression analysis were applied to the data. Significant findings were obtained for both males and females of the affected children. The males displayed wider nasal cavity and a narrower maxillary width with asymmetry of the face. Females showed smaller facial dimension as a whole, and asymmetry of the face.

Nonunion following subcapital (neck) fractures of the proximal phalanx of the thumb in children.

Six cases of nonunion of subcapital (neck) fractures of the proximal phalanx of the thumb in children were seen over a period of 5 years. Ages at the time of injury ranged between 2 and 3 years. Entrapment of the thumb in a closing door was the mechanism of injury in all cases. All fractures were closed and were significantly displaced. Immediate management was by closed reduction and splinting in four cases, closed reduction and K-wire fixation in one case and no treatment in one case, which was later treated by delayed open reduction and K-wire fixation. Only two of the six ununited fractures were eventually treated with bone grafts and both fractures united resulting in a stable thumb but with a limited range of flexion of the interphalangeal joint. Factors that may increase the risk of nonunion of these fractures in children are discussed.

Classification of limb anomalies in oral-facial-digital syndromes.

A classification of limb anomalies in oral-facial-digital (OFD) syndromes is offered to help differentiate between the various types of OFD syndromes. A clinical case is presented with clinical features consistent with both OFD syndrome type I (Papillon Leage-Psaume syndrome) and type VI (Váradi syndrome). The final diagnosis as a new mutation of type I syndrome was established after reviewing the radiological findings in the hands.

Congenital palmar nail syndrome.

A rare case of congenital palmar nail syndrome is described. Nomenclature of this rare form of ectopic nail is discussed and a classification of the palmar nail deformity is offered.

Facial clefts in Saudi Arabia: an epidemiologic analysis in 179 patients.

One hundred and seventy-nine consecutive cases of facial clefts that were treated at the King Khalid University Hospital, in Riyadh, Saudi Arabia, were analyzed for an epidemiologic study. Isolated cleft lip was present in 38 percent, cleft of lip and palate in 37.4 percent, and cleft of the posterior palate in only 22.4 percent. There was a male preponderance in all types. In cases of cleft lip with or without cleft palate, the more commonly affected side was the left, followed by bilateral cases. Associated malformations were present in 13.4 percent. A positive family history was found in 26.8 percent of cases. A significant number of patients (7.8 percent) were first seen at more than 10 years of age. The incidence of facial clefts at this hospital was 0.3 per 1000 live births, computed over a period of 6 years. This incidence is significantly lower than that reported from European and Far Eastern countries.

Four years' experience of limb replantation in Saudi Arabia: a clinical review.

This is a review of 70 patients with traumatic limb and digit amputations treated at King Khalid University Hospital, Riyadh in Saudi Arabia from April 1984 to April 1988. Out of 70 cases 34 were not suitable for replantation. In the remaining 36 patients replantation or revascularization was attempted on 46 units. The data are discussed and compared with other published series. Our net survival rate was 67.4 per cent. The survival rate improved from 62.8 per cent in the first 2 years to 81.8 per cent in the subsequent 2 years. The average hospital stay (34 days) was much longer than that reported from developed countries. The increased emergency workload due to a high incidence of referral of unsuitable cases and the longer hospital stay should be taken into account while establishing a replant service in a developing country. Eighteen cases were followed up for more than 1 year; of these, 61 per cent had good (grade I or grade II) functional recovery. The survival rate and functional recovery improved with increased experience and this is a strong argument in favour of centralizing the replant services.

Mutilating meat mincer injuries of the hand.

A total of 25 cases of acute injuries caused by a meat mincer are presented. Of these, 20 were children. The pattern of injury and the extent of damage to individual digits of the hand are defined. Due to the mutilating nature of the injury, attempts at replantation or revascularization failed in all but two of the ischaemic digits. Emphasis must be placed on the safety and prevention of these dreadful accidents.