1
|
Mohan M, Sabapathy SR. Clinical evidence of the association between radial longitudinal deficiency and radial polydactyly: a case series. J Hand Surg Eur Vol 2023; 48:1177-1183. [PMID: 37395418 DOI: 10.1177/17531934231185036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Radial longitudinal deficiency (RLD) is commonly associated with thumb hypoplasia. The association between RLD and radial polydactyly (RP) is uncommon, but case reports or case series have been reported. We report our experience of managing patients with this association. A total of 97 patients with RLD were seen in our department, of which six were children with concomitant RLD and RP. Four children had both RLD and RP in the same limb; of them, three also had RLD in the contralateral limb. The mean age at presentation was 11.6 months. Awareness of this association alerts the clinician to look for RLD in the presence of RP and vice versa. This case series supports recent experimental and clinical evidence that RP and RLD may be part of the same developmental spectrum. Further studies may guide its inclusion as a possible new category in the Oberg-Manske-Tonkin (OMT) classification of congenital upper-limb anomalies.Level of evidence: IV.
Collapse
Affiliation(s)
- Monusha Mohan
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - S Raja Sabapathy
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| |
Collapse
|
2
|
Goldfarb CA, Wall LB, McCombe D, Huelsemann W, Lam W. An international survey on the adoption and practicality of the Oberg, Manske, Tonkin classification. J Hand Surg Eur Vol 2023; 48:1233-1236. [PMID: 37125761 DOI: 10.1177/17531934231169157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
| | - Lindley B Wall
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Wee Lam
- Royal Hospital for Children & Young People, Edinburgh, UK
| |
Collapse
|
3
|
Habenicht R, Mann M, Huelsemann W, Pira CU, Oberg KC. Heterotopic respiratory mucosa as a potential source of ectopic Sonic hedgehog (SHH) in the development of complex radial polydactyly and ulnar dimelia. J Hand Surg Eur Vol 2023; 48:1221-1224. [PMID: 37751494 DOI: 10.1177/17531934231193358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
We report eight cases of complex radial polydactyly and/or ulnar dimelia each with a fistulous lesion of heterotopic respiratory mucosa in radial-anterior skin ranging from shoulder to wrist. Although speculative, the coincidence of these rare conditions suggests a mechanistic relationship.
Collapse
Affiliation(s)
- Rolf Habenicht
- Department of Hand Surgery, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
| | - Max Mann
- Department of Hand Surgery, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
| | - Wiebke Huelsemann
- Department of Hand Surgery, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
| | - Charmaine U Pira
- Pathology and Human Anatomy, Loma Linda University, Loma Linda, CA, USA
| | - Kerby C Oberg
- Pathology and Human Anatomy, Loma Linda University, Loma Linda, CA, USA
| |
Collapse
|
4
|
Tiourin E, Sharpe F, Kalina S, Leis AR. Surgical Reconstruction for the Triphalangeal Thumb. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5379. [PMID: 37928630 PMCID: PMC10624463 DOI: 10.1097/gox.0000000000005379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/06/2023] [Indexed: 11/07/2023]
Abstract
The triphalangeal thumb poses a complex reconstructive challenge to the congenital hand surgeon due to its rarity and variable anatomy. We discuss the available evidence, reporting clinical characteristics and outcomes of surgical reconstructive procedures of triphalangeal thumb alongside a representative case. The congenital hand surgeon must approach each patient with triphalangeal thumb individually to optimize the use of available tissues to maximize functional and aesthetic outcomes.
Collapse
Affiliation(s)
- Ekaterina Tiourin
- From the Department of Plastic Surgery, University of California, Irvine Medical Center, Orange, Calif
| | - Frances Sharpe
- SCPM Southern California Permanente Medical Group, Fontana, Calif
| | - Sharon Kalina
- SCPM Southern California Permanente Medical Group, Fontana, Calif
| | - Amber R Leis
- From the Department of Plastic Surgery, University of California, Irvine Medical Center, Orange, Calif
- Division of Plastic Surgery, Children's Hospital Orange County, Orange, Calif
| |
Collapse
|
5
|
Al-Qattan MM. My journey in hand surgery: combining patient care, clinical and basic science research. J Hand Surg Eur Vol 2023; 48:710-724. [PMID: 37125458 DOI: 10.1177/17531934231167061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
This review is about my clinical and research journey in hand surgery. The journey has been a worthwhile and meaningful one, especially when I felt there were areas I could influence management, whether this be rare cases, common conditions or where a suggested algorithm may be helpful. I also had the unique privilege of working with geneticists, which has resulted in clinical-pathological publications that could influence patient management, as shared from a clinician's perspective. It is hoped this article will inspire young clinician scientists to pursue a journey of collaboration with other researchers.
Collapse
Affiliation(s)
- Mohammad M Al-Qattan
- Division of Plastic and Hand Surgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
6
|
Preaxial Polydactyly in an Elderly Woman. Case Rep Orthop 2022; 2022:7031401. [PMID: 36092282 PMCID: PMC9453009 DOI: 10.1155/2022/7031401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/18/2022] [Indexed: 11/24/2022] Open
Abstract
A 70-year-old woman born and raised in India presented with Wassel type IV preaxial polydactyly of the right thumb and difficulty performing daily activities. She elected for surgical reconstruction after postponing the procedure for many years due to cultural norms. Her postoperative course was unremarkable. At her 3-month follow-up, she was diagnosed with carpal tunnel syndrome and underwent open carpal tunnel release. Preaxial polydactyly repair is unusual in patients older than 25 years. Though the duplication is considered lucky in South Asia, indications for this case were arthritic pain, cosmesis, and function. This case report details a unique indication for polydactyly reconstruction, arthritic pain, which may benefit hand surgeons when discussing the literature on adult polydactyly with their patients.
Collapse
|
7
|
Lam WL, Oberg KC, Goldfarb CA. The 2020 Oberg-Manske-Tonkin classification of congenital upper limb differences: updates and challenges. J Hand Surg Eur Vol 2020; 45:1117-1119. [PMID: 33200663 DOI: 10.1177/1753193420964335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Wee L Lam
- Department of Plastic and Hand Surgery, Royal Hospital for Sick Children, Edinburgh, UK
| | - Kerby C Oberg
- Department of Pathology and Human Anatomy, Loma Linda University, Loma Linda, CA, USA
| | - Charles A Goldfarb
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| |
Collapse
|
8
|
Halverson SJ, Takayama S, Ochi K, Seki A, Wall LB, Goldfarb CA. Radial Longitudinal Deficiency: Severity Differences Between U.S. and Japanese Cohorts. J Hand Surg Am 2020; 45:196-202.e2. [PMID: 31959377 DOI: 10.1016/j.jhsa.2019.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 10/23/2019] [Accepted: 12/04/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Radial longitudinal deficiency (RLD) presents on a spectrum of severity and associated diagnoses. The literature is limited in describing patient presentation without comparative data between countries. In a study comparing 2 cohorts of patients, 1 in the United States and 1 in Japan, we hypothesized that there would be a similar presentation of forearm deficiency severity, thumb hypoplasia severity, and associated syndromes between the 2 cohorts. METHODS Patients with RLD were identified via a comprehensive chart review at 2 pediatric hospital cohorts, 1 in the United States and 1 in Japan, capturing patients presenting over 15 years. We assessed RLD and thumb hypoplasia severity via a modified Bayne and Klug and modified Blauth classifications. The relationship between these 2 diagnoses and the presence of common medical conditions were evaluated and correlated. RESULTS A total of 194 Japanese patients with 290 involved extremities were compared with 107 U.S. patients with 174 involved extremities. The U.S. cohort had a significantly more severe RLD, and a higher rate of bilaterality (63% vs 50%, respectively). A total of 131 Japanese patients (68%) and 41 U.S. patients (38%) had associated medical syndromes/associations, most frequently vertebral abnormalities, anal atresia, cardiac abnormalities, tracheoesophageal fistula and/or esophageal atresia, renal agenesis and dysplasia, and limb defects (VACTERL; 46 Japanese, 14 U.S.), Holt-Oram (44 Japanese, 5 U.S.), and thrombocytopenia absent radius syndrome (0 Japanese, 12 U.S.). Correlation analysis showed that increased RLD severity was associated with increased thumb hypoplasia severity in both groups, with 95% of modified Bayne and Klug III, IV, or V patients having severely affected thumbs (type IIIb, IV, or V). CONCLUSIONS The U.S. patients had a more severe RLD and a higher rate of bilaterality. Japanese patients had a higher incidence of associated syndromes and radial polydactyly. Both cohorts showed that increased forearm severity was associated with more severe thumb hypoplasia. TYPE OF STUDY/LEVEL OF EVIDENCE Differential diagnosis/symptom prevalence study III.
Collapse
Affiliation(s)
- Schuyler J Halverson
- Department of Orthopaedic Surgery, Washington University School of Medicine and Shriners Hospital for Children, St. Louis, MO
| | - Shinichiro Takayama
- Department of Orthopaedic Surgery, Tokyo Dental College Ichikawa General Hospital, Tokyo, Japan
| | - Kensuki Ochi
- Department of Orthopaedic Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Atsuhito Seki
- Department of Orthopaedic Surgery, Tokyo Dental College Ichikawa General Hospital, Tokyo, Japan
| | - Lindley B Wall
- Department of Orthopaedic Surgery, Washington University School of Medicine and Shriners Hospital for Children, St. Louis, MO
| | - Charles A Goldfarb
- Department of Orthopaedic Surgery, Washington University School of Medicine and Shriners Hospital for Children, St. Louis, MO.
| |
Collapse
|
9
|
Su P, Xu C, Yang X, Zhou H, Li QZ. Response to Potuijt et al. Genet Med 2019; 22:819-820. [PMID: 31822852 DOI: 10.1038/s41436-019-0726-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 11/09/2022] Open
Affiliation(s)
- Peiqiang Su
- Department of Orthopedics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China. .,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China.
| | - Caixia Xu
- Research Center for Translational Medicine, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Xiaoming Yang
- Department of Orthopedics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
| | - Hang Zhou
- Department of Orthopedics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
| | - Quan-Zhen Li
- Department of Immunology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
10
|
A novel ZRS variant causes preaxial polydactyly type I by increased sonic hedgehog expression in the developing limb bud. Genet Med 2019; 22:189-198. [PMID: 31395945 PMCID: PMC6944640 DOI: 10.1038/s41436-019-0626-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 07/22/2019] [Indexed: 02/06/2023] Open
Abstract
Purpose Preaxial polydactyly (PPD) is a common congenital hand malformation classified into four subtypes (PPD I–IV). Variants in the zone of polarizing activity regulatory sequence (ZRS) within intron 5 of the LMBR1 gene are linked to most PPD types. However, the genes responsible for PPD I and the underlying mechanisms are unknown. Methods A rare large four-generation family with isolated PPD I was subjected to genome-wide genotyping and sequence analysis. In vitro and in vivo functional studies were performed in Caco-2 cells, 293T cells, and a knockin transgenic mouse model. Results A novel g.101779T>A (reference sequence: NG_009240.2; position 446 of the ZRS) variant segregates with all PPD I–affected individuals. The knockin mouse with this ZRS variant exhibited PPD I phenotype accompanying ectopic and excess expression of Shh. We confirmed that HnRNP K can bind the ZRS and SHH promoters. The ZRS mutant enhanced the binding affinity for HnRNP K and upregulated SHH expression. Conclusion Our results identify the first PPD I disease-causing variant. The variant leading to PPD I may be associated with enhancing SHH expression mediated by HnRNP K. This study adds to the ZRS-associated syndromes classification system for PPD and clarifies the underlying molecular mechanisms.
Collapse
|
11
|
Lam WL, Oh JDH, Johnson EJ, Pertinez SP, Stephens C, Davey MG. Experimental evidence that preaxial polydactyly and forearm radial deficiencies may share a common developmental origin. J Hand Surg Eur Vol 2019; 44:43-50. [PMID: 29587601 DOI: 10.1177/1753193418762959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Preaxial polydactyly is a congenital hand anomaly predominantly of sporadic occurrence, which is frequently associated with abnormalities of the Sonic hedgehog signalling pathway. In experimentally induced preaxial polydactyly, radial aplasia is also frequently observed. To determine if there is a correlation between preaxial polydactyly and radial aplasia, we induced ectopic Sonic hedgehog signalling during chicken limb development with application of a smoothened-agonist (SAG) or retinoic acid. Application of SAG caused malformations in 71% limbs including preaxial polydactyly (62%) and forearm abnormalities (43%). Retinoic acid application induced malformations in 56% of limb including preaxial polydactyly (45%) and forearm abnormalities (50%). Radial dysplasia and ulnar dimelia were observed in both experimental conditions. We demonstrate that ectopic Sonic hedgehog signalling may cause both preaxial polydactyly and predictable forearm anomalies and that these conditions could potentially be classified as one embryological group. We propose a unifying model based on known models of ectopic Sonic hedgehog signalling.
Collapse
Affiliation(s)
- Wee L Lam
- 1 Royal Hospital for Sick Children, Edinburgh, UK
| | - Julia D H Oh
- 1 Royal Hospital for Sick Children, Edinburgh, UK.,2 Division of Developmental Biology, University of Edinburgh, Edinburgh, UK. In collaboration with Roslin Institute Chicken Embryology (RICE)
| | - Edward J Johnson
- 2 Division of Developmental Biology, University of Edinburgh, Edinburgh, UK. In collaboration with Roslin Institute Chicken Embryology (RICE)
| | - Sandra Poyatos Pertinez
- 2 Division of Developmental Biology, University of Edinburgh, Edinburgh, UK. In collaboration with Roslin Institute Chicken Embryology (RICE)
| | - Chloe Stephens
- 2 Division of Developmental Biology, University of Edinburgh, Edinburgh, UK. In collaboration with Roslin Institute Chicken Embryology (RICE)
| | - Megan G Davey
- 2 Division of Developmental Biology, University of Edinburgh, Edinburgh, UK. In collaboration with Roslin Institute Chicken Embryology (RICE)
| |
Collapse
|
12
|
Al-Qattan MM. A Review of the Genetics and Pathogenesis of Syndactyly in Humans and Experimental Animals: A 3-Step Pathway of Pathogenesis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9652649. [PMID: 31637260 PMCID: PMC6766129 DOI: 10.1155/2019/9652649] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/23/2019] [Accepted: 09/01/2019] [Indexed: 12/30/2022]
Abstract
Embryology of normal web space creation and the genetics of syndactyly in humans and experimental animals are well described in the literature. In this review, the author offers a 3-step pathway of pathogenesis for syndactyly. The first step is initiated either by the overactivation of the WNT canonical pathway or the suppression of the Bone Morphogenetic Protein (BMP) canonical pathway. This leads to an overexpression of Fibroblast Growth Factor 8 (FGF8). The final step is the suppression of retinoic acid in the interdigital mesenchyme leading to suppression of both apoptosis and extracellular matrix (ECM) degradation, resulting in syndactyly.
Collapse
Affiliation(s)
- Mohammad M Al-Qattan
- Professor of Hand Surgery, King Saud University, Riyadh, Saudi Arabia
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
13
|
Al-Qattan MM. The association between preaxial polydactyly and radial longitudinal deficiency in syndromic cases: a report on nine families. J Hand Surg Eur Vol 2018; 43:744-750. [PMID: 29451098 DOI: 10.1177/1753193418758862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Preaxial polydactyly and radial longitudinal deficiency are usually viewed as two different entities. We present nine families with different disorders in which both preaxial polydactyly and radial longitudinal deficiency were seen in the phenotype. This indicates that both entities may be caused by the same developmental error or insult. The pathogenesis is complex and may be related to the interactions of two signalling loops: the first loop (named as the radial longitudinal deficiency loop) contains genes/proteins responsible for the development of the radial ray; and the second loop (named as the preaxial polydactyly loop) contains the Sonic Hedgehog involved in the pathogenesis of preaxial polydactyly. This entity is named as the preaxial polydactyly-radial longitudinal deficiency association and should be included in the description of the preaxial polydactyly spectrum. LEVEL OF EVIDENCE IV.
Collapse
|
14
|
Zone of Polarizing Activity Regulatory Sequence Mutations/Duplications with Preaxial Polydactyly and Longitudinal Preaxial Ray Deficiency in the Phenotype: A Review of Human Cases, Animal Models, and Insights Regarding the Pathogenesis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1573871. [PMID: 29651423 PMCID: PMC5832050 DOI: 10.1155/2018/1573871] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/19/2017] [Accepted: 01/16/2018] [Indexed: 02/06/2023]
Abstract
Clinicians and scientists interested in developmental biology have viewed preaxial polydactyly (PPD) and longitudinal preaxial ray deficiency (LPAD) as two different entities. Point mutations and duplications in the zone of polarizing activity regulatory sequence (ZRS) are associated with anterior ectopic expression of Sonic Hedgehog (SHH) in the limb bud and usually result in a PPD phenotype. However, some of these mutations/duplications also have LPAD in the phenotype. This unusual PPD-LPAD association in ZRS mutations/duplications has not been specifically reviewed in the literature. The author reviews this unusual entity and gives insights regarding its pathogenesis.
Collapse
|
15
|
Baas M, Stubbs AP, van Zessen DB, Galjaard RJH, van der Spek PJ, Hovius SER, van Nieuwenhoven CA. Identification of Associated Genes and Diseases in Patients With Congenital Upper-Limb Anomalies: A Novel Application of the OMT Classification. J Hand Surg Am 2017; 42:533-545.e4. [PMID: 28669419 DOI: 10.1016/j.jhsa.2017.03.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 01/09/2017] [Accepted: 03/30/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Congenital upper-limb anomalies (CULA) can present as a part of a syndrome or association. There is a wide spectrum of CULA, each of which might be related to different diseases. The structure provided by the Oberg, Manske, and Tonkin (OMT) classification could aid in differential diagnosis formulation in patients with CULA. The aims of this study were to review the Human Phenotype Ontology (HPO) project database for diseases and causative genes related to the CULA described in the OMT classification and to develop a methodology for differential diagnosis formulation based on the observed congenital anomalies, CulaPhen. METHODS We reviewed the HPO database for all diseases, including causative genes related to CULA. All CULA were classified according to the OMT classification; associated non-hand phenotypes were classified into 12 anatomical groups. We analyzed the contribution of each anatomical group to a given disease and developed a tool for differential diagnosis formulation based on these contributions. We compared our results with cases from the literature and with a current HPO tool, Phenomizer. RESULTS In total, 514 hand phenotypes were obtained, 384 of which could be classified in the OMT classification. A total of 1,403 diseases could be related to those CULA. A comparison with 10 recently published cases with CULA revealed that the presented phenotype matched the descriptions in our dataset. The differential diagnosis produced using our methodology was more accurate than Phenomizer in 4 of 5 examples. CONCLUSIONS The OMT classification can be used to describe hand anomalies that may present in over 1,400 diseases. CulaPhen was developed to provide a (hand) phenotype-based differential diagnosis. Differential diagnosis formulation based on the proposed system outperforms the system in current use. CLINICAL RELEVANCE This study illustrates that the OMT diagnoses, either individually or combined, can be cross-referenced with different diseases and syndromes. Therefore, use of the OMT classification can aid differential diagnosis formulation for CULA patients.
Collapse
Affiliation(s)
- Martijn Baas
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Andrew P Stubbs
- Department of Clinical Genetics, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - David B van Zessen
- Department of Clinical Genetics, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robert-Jan H Galjaard
- Department of Bioinformatics, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Peter J van der Spek
- Department of Clinical Genetics, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Steven E R Hovius
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Christianne A van Nieuwenhoven
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands.
| |
Collapse
|
16
|
Matsubara H, Saito D, Abe G, Yokoyama H, Suzuki T, Tamura K. Upstream regulation for initiation of restricted Shh expression in the chick limb bud. Dev Dyn 2017; 246:417-430. [PMID: 28205287 DOI: 10.1002/dvdy.24493] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 02/06/2017] [Accepted: 02/10/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The organizing center, which serves as a morphogen source, has crucial functions in morphogenesis in animal development. The center is necessarily located in a certain restricted area in the morphogenetic field, and there are several ways in which an organizing center can be restricted. The organizing center for limb morphogenesis, the ZPA (zone of polarizing activity), specifically expresses the Shh gene and is restricted to the posterior region of the developing limb bud. RESULTS The pre-pattern along the limb anteroposterior axis, provided by anterior Gli3 expression and posterior Hand2 expression, seems insufficient for the initiation of Shh expression restricted to a narrow, small spot in the posterior limb field. Comparison of the spatiotemporal patterns of gene expression between Shh and some candidate genes (Fgf8, Hoxd10, Hoxd11, Tbx2, and Alx4) upstream of Shh expression suggested that a combination of these genes' expression provides the restricted initiation of Shh expression. CONCLUSIONS Taken together with results of functional assays, we propose a model in which positive and negative transcriptional regulatory networks accumulate their functions in the intersection area of their expression regions to provide a restricted spot for the ZPA, the source of morphogen, Shh. Developmental Dynamics 246:417-430, 2017. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Haruka Matsubara
- Department of Developmental Biology and Neurosciences, Graduate School of Life Sciences, Tohoku University, Aobayama Aoba-ku, Sendai, 980-8578, Japan
| | - Daisuke Saito
- Department of Developmental Biology and Neurosciences, Graduate School of Life Sciences, Tohoku University, Aobayama Aoba-ku, Sendai, 980-8578, Japan.,Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Aobayama Aoba-ku, Sendai, 980-8578, Japan
| | - Gembu Abe
- Department of Developmental Biology and Neurosciences, Graduate School of Life Sciences, Tohoku University, Aobayama Aoba-ku, Sendai, 980-8578, Japan
| | - Hitoshi Yokoyama
- Department of Biochemistry and Molecular Biology, Faculty of Agriculture and Life Science, Hirosaki University, Hirosaki, 036-8561, Japan
| | - Takayuki Suzuki
- Division of Biological Science, Graduate School of Science, Nagoya University, Furo-Cho, Chikusa-ku, Nagoya, 464-8602, Japan
| | - Koji Tamura
- Department of Developmental Biology and Neurosciences, Graduate School of Life Sciences, Tohoku University, Aobayama Aoba-ku, Sendai, 980-8578, Japan
| |
Collapse
|
17
|
Al-Qattan MM, Shamseldin HE, Salih MA, Alkuraya FS. GLI3-related polydactyly: a review. Clin Genet 2017; 92:457-466. [PMID: 28224613 DOI: 10.1111/cge.12952] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 10/28/2016] [Accepted: 12/06/2016] [Indexed: 12/20/2022]
Abstract
GLI3 mutations are known to be associated with nine syndromes/conditions in which polydactyly is a feature. In this review, the embryology, pathogenesis, and animal models of GLI3-related polydactyly are discussed first. This is followed by a detailed review of the genotype-phenotype correlations. Based on our review of the literature and our clinical experiences, we recommend viewing GLI3-related syndromes/conditions as four separate entities; each characterized by a specific pattern of polydactyly. These four entities are: the preaxial polydactyly type IV-Greig-acrocallosal spectrum, postaxial polydactyly types A/B, Pallister-Hall syndrome (PHS), and oral-facial-digital overlap syndrome. We also provide illustrative clinical examples from our practice including a family with a novel GLI3 mutation causing PHS. The review also introduces the term 'Forme Fruste' preaxial polydactyly and gives several conclusions/recommendations including the recommendation to revise the current criteria for the clinical diagnosis of PHS.
Collapse
Affiliation(s)
- M M Al-Qattan
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - H E Shamseldin
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - M A Salih
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - F S Alkuraya
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Department of Anatomy and Cell Biology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| |
Collapse
|
18
|
Askari M, Christensen KN, Heath S, Moran SL, Lachman N. Presentation of soft tissue anatomy of mirror hand: an anatomical case report with implications for surgical planning. Surg Radiol Anat 2016; 38:855-62. [PMID: 26787301 DOI: 10.1007/s00276-015-1611-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 12/21/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Mirror hand or ulnar dimelia is a rare and poorly studied congenital anomaly of the upper extremity. Understanding of its anatomy is limited by the rarity of the deformity and the variability in presentation. We present the case of an 80-year-old female donor with an incidental finding of mirror hand. METHODS Medical history indicated no record of any surgical procedures or interventions to the right upper extremity suggesting that the donor had lived an independent life without the need for prosthetic aids. Unfortunately, no record of a hand examination or any visit to a hand specialist was identified within the medical record. Following imaging and disarticulation of the arm at the glenohumeral joint, an anatomical dissection was performed on the right upper extremity. RESULTS Findings were recorded and compared to three earlier reports in the limited literature with a strong focus on understanding the anatomy of this deformity important for surgical planning. The anatomy is highlighted with a brief description of the embryology associated with mirror hand deformity. The case presents a classic example of ulnar dimelia. Arterial patterns compared favorably with those described in the literature. In addition an aberrant branch of the median nerve and a deep branch supplying the extensor compartment were noted. CONCLUSION Based on the observations of this study (and the previous reports) we would recommend a study of vascular tree of the hand either through conventional arteriography or CT angiography prior to pollicization. The surgeon should also be prepared to perform a microsurgical arterial anastomosis if pollicization is not possible in case of an incomplete arch similar to one we described.
Collapse
Affiliation(s)
- Morad Askari
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, University of Miami Health System, Miami, USA
| | - Kevin N Christensen
- Department of Dermatology, Mohs and Dermasurgery Unit, MD Anderson Cancer Center, Houston, TX, USA
| | - Shaun Heath
- Department of Anatomy, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Steven L Moran
- Department of Surgery, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Nirusha Lachman
- Department of Anatomy, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Department of Surgery, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
19
|
|
20
|
Kropatsch R, Melis C, Stronen AV, Jensen H, Epplen JT. Molecular Genetics of Sex Identification, Breed Ancestry and Polydactyly in the Norwegian Lundehund Breed. J Hered 2015; 106:403-6. [PMID: 25994807 DOI: 10.1093/jhered/esv031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 04/13/2015] [Indexed: 11/14/2022] Open
Abstract
The Norwegian Lundehund breed of dog has undergone a severe loss of genetic diversity as a result of inbreeding and epizootics of canine distemper. As a consequence, the breed is extremely homogeneous and accurate sex identification is not always possible by standard screening of X-chromosomal loci. To improve our genetic understanding of the breed we genotyped 17 individuals using a genome-wide array of 170 000 single nucleotide polymorphisms (SNPs). Standard analyses based on expected homozygosity of X-chromosomal loci failed in assigning individuals to the correct sex, as determined initially by physical examination and confirmed with the Y-chromosomal marker, amelogenin. This demonstrates that identification of sex using standard SNP assays can be erroneous in highly inbred individuals.
Collapse
Affiliation(s)
- Regina Kropatsch
- From the Department of Human Genetics, Ruhr University, Universitätsstr. 150, 44801 Bochum, Germany (Kropatsch and Epplen); the Department of Biology, Centre for Biodiversity Dynamics, Norwegian University of Science and Technology, Trondheim, Norway (Melis and Jensen); the Department of Chemistry and Bioscience, Aalborg University, Fredrik Bajers Vej 7H, Aalborg Øst, Denmark (Stronen); and the Faculty of Health, University Witten/Herdecke, Witten, Germany (Epplen).
| | - Claudia Melis
- From the Department of Human Genetics, Ruhr University, Universitätsstr. 150, 44801 Bochum, Germany (Kropatsch and Epplen); the Department of Biology, Centre for Biodiversity Dynamics, Norwegian University of Science and Technology, Trondheim, Norway (Melis and Jensen); the Department of Chemistry and Bioscience, Aalborg University, Fredrik Bajers Vej 7H, Aalborg Øst, Denmark (Stronen); and the Faculty of Health, University Witten/Herdecke, Witten, Germany (Epplen)
| | - Astrid V Stronen
- From the Department of Human Genetics, Ruhr University, Universitätsstr. 150, 44801 Bochum, Germany (Kropatsch and Epplen); the Department of Biology, Centre for Biodiversity Dynamics, Norwegian University of Science and Technology, Trondheim, Norway (Melis and Jensen); the Department of Chemistry and Bioscience, Aalborg University, Fredrik Bajers Vej 7H, Aalborg Øst, Denmark (Stronen); and the Faculty of Health, University Witten/Herdecke, Witten, Germany (Epplen)
| | - Henrik Jensen
- From the Department of Human Genetics, Ruhr University, Universitätsstr. 150, 44801 Bochum, Germany (Kropatsch and Epplen); the Department of Biology, Centre for Biodiversity Dynamics, Norwegian University of Science and Technology, Trondheim, Norway (Melis and Jensen); the Department of Chemistry and Bioscience, Aalborg University, Fredrik Bajers Vej 7H, Aalborg Øst, Denmark (Stronen); and the Faculty of Health, University Witten/Herdecke, Witten, Germany (Epplen)
| | - Joerg T Epplen
- From the Department of Human Genetics, Ruhr University, Universitätsstr. 150, 44801 Bochum, Germany (Kropatsch and Epplen); the Department of Biology, Centre for Biodiversity Dynamics, Norwegian University of Science and Technology, Trondheim, Norway (Melis and Jensen); the Department of Chemistry and Bioscience, Aalborg University, Fredrik Bajers Vej 7H, Aalborg Øst, Denmark (Stronen); and the Faculty of Health, University Witten/Herdecke, Witten, Germany (Epplen)
| |
Collapse
|
21
|
Al-Qattan MM, Abou Al-Shaar H. Molecular basis of the clinical features of Holt–Oram syndrome resulting from missense and extended protein mutations of the TBX5 gene as well as TBX5 intragenic duplications. Gene 2015; 560:129-36. [DOI: 10.1016/j.gene.2015.02.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 11/24/2014] [Accepted: 02/02/2015] [Indexed: 01/13/2023]
|
22
|
Al-Qattan MM. Involvement of hand surgeons in research on the genetics and pathogenesis of congenital upper limb anomalies. J Hand Surg Eur Vol 2015; 40:220-1. [PMID: 25618871 DOI: 10.1177/1753193414542400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M M Al-Qattan
- Hand and Plastic Surgery, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
23
|
Afshar A. An update on embryology of the upper limb. J Hand Surg Am 2013; 38:2304. [PMID: 24207000 DOI: 10.1016/j.jhsa.2013.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 09/13/2013] [Indexed: 02/02/2023]
Affiliation(s)
- Ahmadreza Afshar
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
| |
Collapse
|
24
|
Dai L, Guo H, Meng H, Zhang K, Hu H, Yao H, Bai Y. Confirmation of genetic homogeneity of syndactyly type IV and triphalangeal thumb-polysyndactyly syndrome in a Chinese family and review of the literature. Eur J Pediatr 2013; 172:1467-73. [PMID: 23793141 DOI: 10.1007/s00431-013-2071-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 06/09/2013] [Indexed: 12/11/2022]
Abstract
UNLABELLED Syndactyly type IV (SD4) is inherited in an autosomal dominant fashion and characterized by complete cutaneous syndactyly of all fingers accompanied with polydactyly. Triphalangeal thumb-polysyndactyly syndrome (TPTPS) consists of a triphalangeal thumb, polydactyly, and syndactyly and is transmitted in an autosomal dominant manner with variable expression. Genomic duplications of the long-range limb-specific cis-regulator (ZRS) cause SD4 and TPTPS. Here, we report two individuals from a Chinese family with syndactyly. One individual had overlapping clinical symptoms of TPTPS and SD4, while the other had a typical SD4 with postaxial polydactyly of the toe. Results of quantitative PCR suggested that the duplication of ZRS involved all affected individuals, and array comparative genomic hybridization detected its size as 115.3 kb. CONCLUSION This work confirms the genetic homogeneity of SD4 and TPTPS. Our result expands the spectrum of ZRS duplications. TPTPS and SD4 should be considered as a continuum of phenotypes.
Collapse
Affiliation(s)
- Limeng Dai
- Department of Medical Genetics, College of Basic Medical Science, Third Military Medical University, Chongqing, 400038, China
| | | | | | | | | | | | | |
Collapse
|
25
|
Al-Qattan MM, Kozin SH. In reply. J Hand Surg Am 2013; 38:2304-5. [PMID: 24206999 DOI: 10.1016/j.jhsa.2013.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 09/07/2013] [Accepted: 09/13/2013] [Indexed: 02/02/2023]
Affiliation(s)
- Mohammad M Al-Qattan
- Division of Plastic Surgery, King Saud University, Riyadh, Saudi Arabia; Upper Extremity Center of Excellence, Shriners Hospital for Children, Philadelphia, PA
| | | |
Collapse
|
26
|
Abstract
Current concepts in the steps of upper limb development and the way the limb is patterned along its 3 spatial axes are reviewed. Finally, the embryogenesis of various congenital hand anomalies is delineated with an emphasis on the pathogenetic basis for each anomaly.
Collapse
|