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Wehrenpfennig P, Schmierer P. Ectrodactyly with Polydactyly in a Dog-Case Description and Description of Surgical Therapy with Resection and Fusion Podoplasty. Animals (Basel) 2024; 14:1647. [PMID: 38891696 PMCID: PMC11171004 DOI: 10.3390/ani14111647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/25/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE To describe a rare congenital deformity of the phalanges and the surgical details and outcome in a dog with ectrodactyly combined with polydactyly. STUDY DESIGN Single case report. ANIMAL A 3.5-month-old male intact mixed breed dog with forelimb lameness and paw malformations. METHODS Surgery was performed on a dog with a congenital limb deformity consisting of resection of the extra bone and soft tissue structure to prevent further subluxation of the remaining metacarpals. Stabilisation consisted of a cortical screw in compression and a K wire across the proximal metacarpals. RESULTS Postoperative radiographs showed adequate implant positioning and good reduction of the proximal metacarpal row. At six weeks, the dog showed improvement in limb function and weight bearing. Major complications occurred at twelve weeks, and revision surgery with implant removal was required. At six months, the dog showed near normal range of motion and no lameness. CONCLUSIONS AND CLINICAL RELEVANCE The decision to perform surgery on a dog with limb deformity resulted in an almost physiological gait, and the dog showed no abnormalities in daily life. This report adds to the literature on congenital limb deformities by describing the combination of ectrodactyly and polydactylism in a canine species, including the surgical approach and outcome. However, the optimal management of this heterogeneous condition is currently unclear.
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Affiliation(s)
| | - Philipp Schmierer
- Veterinarian Clinic Posthausen, Posthausen, 28870 Ottersberg, Germany
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2
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SAIT A, ACHARYA AM, BHAT AK. Epidemiology of Congenital Hand Differences at a Tertiary Hospital in Southern India – Establishment of a New Registry and Assessment Using Both the Swanson/IFSSH and the Oberg, Manske and Tonkin Classifications. J Hand Surg Asian Pac Vol 2022; 27:801-809. [DOI: 10.1142/s2424835522500825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: In resource challenged nations, the true magnitude of the congenital hand differences (CHD) remain unknown due to a lack of nation-wide surveillance system. We created a hospital-based registry system with the aim to determine the prevalence and distribution of CHD and compare the Swanson/IFSSH (SI) and Oberg, Manske and Tonkin (OMT) classifications. Methods: Data of children aged 0 to 18 years with CHD was entered into the online registry and classified based on the SI and OMT classifications from January 2018 to December 2021. The prevalence and distribution of CHD and risk factors like family history were summarised using descriptive analysis. Syndromic and heredity associations were further analysed using Fischer exact test and odds ratio. Clustered columns were used to compare the two classification systems. Results: A total of 307 patients with CHD presented during the study with a prevalence of 2.4/1,000 patients. Among them, 164 were unilateral, 21 were born of consanguineous marriages (7.6%) and 10 (3.6%) had a family history of CHD. Although not statistically significant, bilateral involvement was twice as likely to be hereditary compared to unilateral involvement. A total of 10 different syndromes were identified among 27 patients of which Holt–Oram syndrome was most common. The most common CHD was Radial longitudinal defificiency (111). A total of 82 (27%) children had other associated anomalies that could not be grouped as a syndrome. Two patients could not be classified using either SI or OMT classifications. Conclusions: The online registry established an efficient way to store and analyse data related to CHD. It provides new information on its prevalence in South India, which is similar to the existing literature. Most of the CHD can be grouped in both the SI and OMT classifications. However, there still remains some conditions that are unclassifiable. There is a need for a national registry of CDH for effective management, funding and research. Level of Evidence: Level IV (Epidemiological)
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Affiliation(s)
- Anika SAIT
- Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College & Hospital, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Ashwath M. ACHARYA
- Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College & Hospital, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Anil K. BHAT
- Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College & Hospital, Manipal, Manipal Academy of Higher Education, Manipal, India
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Falco P, Hovius S, van Alfen N. Peripheral Nerve Innervation in Bilateral Cleft Hand Syndrome Elucidated by Ultrasound. Front Neurol 2022; 13:857363. [PMID: 35669874 PMCID: PMC9163380 DOI: 10.3389/fneur.2022.857363] [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: 01/31/2022] [Accepted: 04/21/2022] [Indexed: 11/21/2022] Open
Abstract
Bilateral cleft hand syndrome is a rare congenital malformation with complex anatomy. Previous reports have mainly focused on the description of bone and soft tissue abnormalities, but information about innervation is scarce. Knowledge of the peripheral nerve anatomy is helpful for surgical treatment, optimizing the reconstruction, and preventing iatrogenic damage. Following clinical assessment and conventional radiologic imaging, we used high-resolution ultrasound of both hands and forearms to image the peripheral nerves in a patient with severe bilateral cleft hand syndrome. The patient presented with two ulnar digits, a deformed thumb on the right, and a rudimentary thumb appendage on the left. In keeping with the tissue elements present and absent, we found a severe bilateral nerve size reduction of the median nerves, sparing the anterior interosseous nerve fascicles. The radial nerve and end branches were intact, and a slightly smaller ulnar nerve was found that ended in two digital branches to a single digit. Our study shows that in cleft hand syndrome the peripheral nervous system anatomy exactly reflects the presence and absence of the corresponding muscle and skin innervation areas. This information is helpful for planning a surgical-reconstructive approach and suggests a potential role for nerve ultrasound in the assessment of complex limb malformations.
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Affiliation(s)
- Pietro Falco
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Steven Hovius
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
- *Correspondence: Nens van Alfen
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Kokkinos P, Pratschke K. Combined pentalogy of Cantrell with ectrodactyly and surgical implant‐free repair of a sternal cleft and supraumbilical hernia in an adult cat. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Panagiotis Kokkinos
- Small Animal Referrals Animal Health Trust Newmarket Suffolk UK
- Southfields Veterinary Specialists Southfields Laindon Essex UK
| | - Kathryn Pratschke
- Small Animal Referrals Animal Health Trust Newmarket Suffolk UK
- Veterinary Clinical Services The Royal (Dick) School of Veterinary Studies Midlothian UK
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Gill KG. Congenital musculoskeletal anomalies - key radiographic findings. Pediatr Radiol 2022; 52:777-785. [PMID: 34731287 DOI: 10.1007/s00247-021-05200-x] [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: 04/21/2021] [Revised: 06/23/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Abstract
Although radiographs are generally performed in the neonatal period to evaluate for causes of respiratory distress or to evaluate line placement, close attention to the osseous structures can provide important clues to an underlying diagnosis. Although segmentation anomalies can be random, they are frequently associated with more complex entities such as VACTERL association. A butterfly vertebral body can hint at a possible diagnosis of Alagille syndrome even before jaundice develops in an infant with a murmur. Close evaluation of the sacrum can identify abnormalities that point to caudal regression or Currarino triad. Other classic musculoskeletal abnormalities in the extremities are readily apparent on physical exam but require radiographic evaluation to define anatomy. Diagnoses such as congenital pseudoarthrosis of the clavicle, Apert syndrome, constriction band syndrome, and proximal focal femoral deficiency have pathognomonic imaging findings. Given that treatment for these is usually delayed until later in life, extremity imaging might not occur in the neonatal period.
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Affiliation(s)
- Kara G Gill
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Clinical Science Center, MC3252, 600 Highland Ave., Madison, WI, 53892, USA.
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Four Unusual Cases of Congenital Forelimb Malformations in Dogs. Animals (Basel) 2021; 11:ani11030813. [PMID: 33799336 PMCID: PMC7998683 DOI: 10.3390/ani11030813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Congenital limb defects are sporadically encountered in dogs during normal clinical practice. Literature concerning their diagnosis and management in canine species is poor. Sometimes, the diagnosis and description of congenital limb abnormalities are complicated by the concurrent presence of different malformations in the same limb and the lack of widely accepted classification schemes. In order to improve the knowledge about congenital limb anomalies in dogs, this report describes the clinical and radiographic findings in four dogs affected by unusual congenital forelimb defects, underlying also the importance of reviewing current terminology. Abstract Four dogs were presented with thoracic limb deformity. After clinical and radiographic examinations, a diagnosis of congenital malformations was performed for each of them. In one case, a deformity involving both the radial and ulnar side of the distal limb was observed. Based on clinical and radiological evaluations, a diagnosis of postaxial terminal longitudinal ulnar hemimelia was performed. The term ectrodactyly was used to refer different malformations characterized by skin and soft tissue separation of the distal forelimb observed in two dogs. Simple complete uncomplicated syndactyly of the right forelimb, and complex incomplete uncomplicated syndactyly of the left forelimb were diagnosed in the fourth case. To the authors’ knowledge, ectrodactyly and simple complete uncomplicated syndactyly are very uncommon anomalies in companion animals and have been rarely documented. Moreover, postaxial terminal longitudinal ulnar hemimelia has still not been reported in dogs.
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Naran S, Imbriglia JE. Case Report: 35-Year Follow-up for Nonvascularized Toe Phalangeal Transfer for Multiple Digit Symbrachydactyly. Hand (N Y) 2016; 11:NP38-NP40. [PMID: 28149225 PMCID: PMC5256662 DOI: 10.1177/1558944716658748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: A case is discussed in which a young girl was born with symbrachydactyly of multiple digits in whom nonvascularized proximal toe phalanges were transferred to the aphalangic digits at the age of four. At 39 years of age, she presented incidentally to our clinic and was observed to have a very functional hand with mobile metacarpophalangeal joints in all reconstructed digits. Methods: We present a case report which is discussed in the context of long-term follow-up, and phalangeal growth in the absence of distraction, and a review of the current literature in regards to outcomes for this modality of treatment. Results: We document growth of the transplanted phalanges, despite surgery occurring after the reported optimum age of before 18 months, and the patient not undergoing distraction. The patient reported no donor site morbidity in regards to function or psychosocial impact. Furthermore, we observed active function at the metacarpophalangeal joints of all operated digits. Conclusions: We report the longest follow-up (35 years) following nonvascularized proximal toe phalangeal transfer for short finger type symbrachydactyly. We highlight the long-term functional outcome of nonvascularized toe phalangeal transfers, and present an overview of the current outcome literature for this type of procedure, advocating that nonvascularized toe phalangeal transfers remain a viable treatment option for select cases of symbrachydactyly.
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Affiliation(s)
| | - Joseph E. Imbriglia
- University of Pittsburgh, PA, USA,Hand & UpperEx Center, Wexford, PA, USA,Joseph E. Imbriglia, 6001 Stonewood Drive, Wexford, PA 15090, USA.
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Di Dona F, Valle GD, Meomartino L, Lamagna F, Fatone G. Congenital deformity of the distal extremities in three dogs. Open Vet J 2016; 6:228-233. [PMID: 27928521 PMCID: PMC5133399 DOI: 10.4314/ovj.v6i3.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 11/18/2016] [Indexed: 12/13/2022] Open
Abstract
Congenital limb deformities are very rare conditions and the knowledge about etiology, pathogenesis, clinical presentation and treatment is still poor. Moreover, many defects are still not reported in veterinary literature. This report documents clinical and radiographic findings in three dogs with congenital deformity involving the distal extremities. Case 1 was affected with bilateral aphalangia of the pedes, case 2 presented a combination of brachydactyly and syndactyly, whereas in case 3 a unilateral ectrodactyly was observed. To the authors’ knowledge, brachydactyly, as well as aphalangia, are very uncommon anomalies and have been rarely documented. Moreover, association between syndactyly and brachydactyly has still not been reported.
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Affiliation(s)
- F Di Dona
- Department of Veterinary Medicine and Animal Productions, University of Napoli "Federico II", Italy
| | - G Della Valle
- Department of Veterinary Medicine and Animal Productions, University of Napoli "Federico II", Italy
| | - L Meomartino
- Interdepartmental Center of Veterinary Radiology, University of Napoli "Federico II", Italy
| | - F Lamagna
- Department of Veterinary Medicine and Animal Productions, University of Napoli "Federico II", Italy
| | - G Fatone
- Department of Veterinary Medicine and Animal Productions, University of Napoli "Federico II", Italy
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9
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Baek GH, Kim J. Oligodactyly with Thumb. J Hand Surg Asian Pac Vol 2016; 21:283-91. [PMID: 27595943 DOI: 10.1142/s2424835516400087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Oligodactyly of the hand is one of the rarest congenital anomalies of upper extremities and defined as the presence of fewer than five fingers on a hand. Although it usually occurs in association with hypoplasia or absence of ulna, it can occur without abnormality of the forearm bones. The purpose of this study is to present clinical features and radiographic characteristics of hand oligodactyly with thumb. METHODS Five patients of oligodactyly with thumb who showed normal forearm bones, were evaluated. Two patients had threefingered hand with thumb, and three had two-fingered hand with thumb. We analyzed associated abnormalities of carpal and metacarpal bones and measured the lengths of radius and ulna, and width of the wrist on the simple radiographs. We also devised new classification system of oligodactyly based on the thumb deformities and locations of missing digits. RESULTS Syndactyly among fingers was associated in four patients, clinodactyly caused by delta bone in one, hypoplasia of the thumb in one, camptodactylies in one, symphalangism in one, and radial head dislocation in one. Considering the abnormalities of the carpal bones, the missing digits were presumed to be ulnar-sided digits in two patients, central digits in one patient and both ulnar-sided and central digits in two patients. In patients with missing of central digits, an adjacent metacarpal was hypertrophied. Although the ulnar variances were within normal range, the average lengths of radius and ulna were 6% and 5% shorter than those of contralateral normal side. The average width of the wrist was 9% narrower than that of contralateral normal side. CONCLUSIONS Syndactyly and hypertrophied metacarpal were most commonly observed findings in the oligodactyly with thumb. Although oligodactyly with thumb may be a type of ulnar longitudinal deficiency, however, it can also be a type of central deficiency or combined type of ulnar longitudinal deficiency with central deficiency or radial longitudinal deficiency. We suggest a classification system of oligodactyly with thumb based on locations of missing digits and associated thumb deformities.
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Affiliation(s)
- Goo Hyun Baek
- 1 Department of Orthopaedic Surgery, Seoul National University College of Medicine Seoul, Korea
| | - Jihyeung Kim
- 1 Department of Orthopaedic Surgery, Seoul National University College of Medicine Seoul, Korea
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Liao CC, Qi HX, Reed JL, Miller DJ, Kaas JH. Congenital foot deformation alters the topographic organization in the primate somatosensory system. Brain Struct Funct 2016; 221:383-406. [PMID: 25326245 PMCID: PMC4446245 DOI: 10.1007/s00429-014-0913-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 10/07/2014] [Indexed: 12/20/2022]
Abstract
Limbs may fail to grow properly during fetal development, but the extent to which such growth alters the nervous system has not been extensively explored. Here we describe the organization of the somatosensory system in a 6-year-old monkey (Macaca radiata) born with a deformed left foot in comparison to the results from a normal monkey (Macaca fascicularis). Toes 1, 3, and 5 were missing, but the proximal parts of toes 2 and 4 were present. We used anatomical tracers to characterize the patterns of peripheral input to the spinal cord and brainstem, as well as between thalamus and cortex. We also determined the somatotopic organization of primary somatosensory area 3b of both hemispheres using multiunit electrophysiological recording. Tracers were subcutaneously injected into matching locations of each foot to reveal their representations within the lumbar spinal cord, and the gracile nucleus (GrN) of the brainstem. Tracers injected into the representations of the toes and plantar pads of cortical area 3b labeled neurons in the ventroposterior lateral nucleus (VPL) of the thalamus. Contrary to the orderly arrangement of the foot representation throughout the lemniscal pathway in the normal monkey, the plantar representation of the deformed foot was significantly expanded and intruded into the expected representations of toes in the spinal cord, GrN, VPL, and area 3b. We also observed abnormal representation of the intact foot in the ipsilateral spinal cord and contralateral area 3b. Thus, congenital malformation influences the somatotopic representation of the deformed as well as the intact foot.
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Affiliation(s)
- Chia-Chi Liao
- 301 Wilson Hall, Department of Psychology, Vanderbilt University, 111 21st Avenue South, Nashville, TN, 37212, USA.
| | - Hui-Xin Qi
- 301 Wilson Hall, Department of Psychology, Vanderbilt University, 111 21st Avenue South, Nashville, TN, 37212, USA
| | - Jamie L Reed
- 301 Wilson Hall, Department of Psychology, Vanderbilt University, 111 21st Avenue South, Nashville, TN, 37212, USA
| | - Daniel J Miller
- 301 Wilson Hall, Department of Psychology, Vanderbilt University, 111 21st Avenue South, Nashville, TN, 37212, USA
| | - Jon H Kaas
- 301 Wilson Hall, Department of Psychology, Vanderbilt University, 111 21st Avenue South, Nashville, TN, 37212, USA
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Cortez M, Silva RFD, Gilbert A, Brandt CT, Valenti P. NOSOLOGY OF HAND DISEASES IN CHILDREN AND ADOLESCENTS OPERATED IN PROVISIONAL FACILITIES IN A MODEL HOSPITAL - PERNAMBUCO STATE, BRAZIL. Rev Bras Ortop 2015; 45:445-52. [PMID: 27022593 PMCID: PMC4799119 DOI: 10.1016/s2255-4971(15)30434-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
To report the frequencies of congenital hand diseases in patients who underwent surgery on a collective mobilization basis at SOS Hand, Recife, Pernambuco, between 2005 and 2009. Methods: Information was collected from 833 children and adolescents who were examined in eight missions. Results: Among the patients, 306 (36.7%) underwent surgery: 240 (78.4%) because of congenital malformation and 66 (21.6%) because of acquired lesions. The most frequent congenital malformations were: syndactyly, 72 cases (30.0%); polydactyly, 30 cases (12.5%); bifid thumb, 19 cases (7.9%); complex hand malformation, 14 cases (5.8%); cleft hand, 13 cases (5.4%); trigger finger, 12 cases (5.0%); camptodactyly, 11 cases (4.6%); and brachysyndactyly, 9 cases (3.7%). The most frequently acquired injuries were: obstetric traumatic lesions, 26 cases (39.4%); hand trauma sequelae, 18 cases (27.3%); cerebral paralysis sequelae, 7 cases (10.6%); electric shock sequelae, 5 cases (7.6%); and burn sequelae, 4 cases (6.1%). Conclusion: The nosology of hand diseases is similar to that of large series of elective surgery, especially regarding congenital deformities. The frequency of acquired hand lesions seems to be higher than the frequency in international series. The collective mobilization system for hand surgery is important for decreasing the need for this activity in public institutions, and it has been shown to be very efficient. The success of the project may provide support for the Brazilian National Health System to enroll hand surgeons in the on-call system, in emergency units.
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Affiliation(s)
- Mauri Cortez
- Adjunct Professor in the Federal University of Pernambuco; Director of SOS Hand, Recife, PE
- Correspondence: Rua Minas Gerais 147, Ilha do Leite, 50070-700 Recife, PECorrespondence: Rua Minas Gerais 147Ilha do LeiteRecifePE50070-700
| | | | - Alain Gilbert
- Hand Surgeon, La Chaîne de L'Espoir, Hand Institute, Jouvenet Clinic, 6 Square Jouvenet, Paris
| | | | - Philippe Valenti
- Hand Surgeon, La Chaîne de L'Espoir, Hand Institute, Jouvenet Clinic, 6 Square Jouvenet, Paris
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Hou WC, Chen CP, Hwang KS, Chen YC, Lai YJ, Tien CY, Su HY. Prenatal diagnosis of a de novo 9p terminal chromosomal deletion in a fetus with major congenital anomalies. Taiwan J Obstet Gynecol 2015; 53:602-5. [PMID: 25510709 DOI: 10.1016/j.tjog.2014.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE We describe a prenatal ultrasonography diagnosis of omphalocele and symbrachydactyly in a fetus and review the literature on prenatal diagnosis of 9p terminal chromosomal deletions. CASE REPORT A 31-year-old woman (gravida 3, para 1) was referred for genetic counseling because a fetal omphalocele had been detected. Prenatal ultrasonography at 17+ weeks of gestational age revealed a singleton female fetus with biometry equivalent to 18 weeks with an omphalocele. In addition, symbrachydactyly was also noted in the right arm; the wrist bones as well as the metacarpals were missing. A chromosomal study was arranged for a congenital anomaly involving omphalocele. We obtained Giemsa-banded chromosomes from fetal tissue cells, and an abnormal male karyotype with a terminal deletion of the short arm of chromosome 9 at band 9p13 was noted. After delivery, the fetus showed omphalocele, symbrachydactyly, trigonocephaly, sex reversal, a long philtrum, low-set ears, telecanthus, and a frontal prominence. CONCLUSION Prenatal diagnosis of abnormal ultrasound findings with omphalocele and symbrachydactyly should include the differential diagnosis of a chromosome 9p deletion.
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Affiliation(s)
- Wen-Chien Hou
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Ping Chen
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; Department of Biotechnology, Asia University, Taichung, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kwei-Shuai Hwang
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ying-Chieh Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Ju Lai
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chau-Yang Tien
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Her-Young Su
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Iba K, Horii E, Ogino T, Kazuki K, Kashiwa K. The Classification of Swanson for Congenital Anomalies of Upper Limb Modified by the Japanese Society for Surgery of the Hand (JSSH). HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2015; 20:237-50. [PMID: 26094485 DOI: 10.1142/s0218810415300041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study is to introduce the classification of Swanson for congenital anomalies of upper limb modified by the Japanese Society for Surgery of the Hand (the JSSH modification) in English. The Swanson classification has been widely accepted by most hand surgeons. However, several authors have suggested that complex cases, particularly those involving the complex spectrum of cleft hand and symbrachydactyly, are difficult to classify into the classification schemes. In the JSSH modification, brachysyndactyly, so-called atypical cleft hand and transverse deficiency are included under the same concept of transverse deficiency. Cleft hand, central polydactyly, and syndactyly are included in the same category of abnormal induction of digital rays. We believe that the JSSH modification system is effective in providing hand surgeons with the clinical features and conditions for congenital anomalies.
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Affiliation(s)
- Kousuke Iba
- ¶ Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Emiko Horii
- * Hand Department, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | | | | | - Katsuhiko Kashiwa
- § Department of Plastic, Aesthetic and Reconstructive Surgery, Iwate Medical University School of Medicine, Iwate, Japan
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14
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Biswas S, Kundu P, Meyur R, Adhikari A, Mondal GC. Congenital upper limb anomaly as a cause of physical handicap. J ANAT SOC INDIA 2014. [DOI: 10.1016/j.jasi.2014.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Al-Qattan MM. Central and ulnar cleft hands: a review of concurrent deformities in a series of 47 patients and their pathogenesis. J Hand Surg Eur Vol 2014; 39:510-9. [PMID: 23824219 DOI: 10.1177/1753193413496945] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Two main types of cleft hands have been described. The ulnar cleft hand deformity is very rare and is characterized by two constant features: a deep cleft radial to the little finger and hypoplasia of the ulnar digits. The pathogenesis of ulnar clefts is unknown. The second type is the central cleft hand deformity, which is characterized by a soft tissue/bone defect in the hand centrally. Patients with central clefts also have several concurrent deformities in the remaining digits. This paper reviews the clinical features of three cases with ulnar cleft hands and 44 cases of central cleft hands, with special emphasis on concurrent deformities. The author's hypothesis of pathogenesis for both types of clefts and their concurrent deformities is then offered.
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Affiliation(s)
- M M Al-Qattan
- Division of Plastic Surgery, King Saud University, Riyadh, Saudi Arabia
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Metacarpophalangeal ligamentoplasty in typical cleft hand. Tech Hand Up Extrem Surg 2013; 17:120-2. [PMID: 23689862 DOI: 10.1097/bth.0b013e318291fc02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The surgical handling of central cleft hands may involve various procedures to restore acceptable function. Stabilization of the merged cleft is usually achieved through reconstruction of the intermetacarpal ligament. However, no attention has been paid to the agenesis of the metacarpophalangeal collateral ligaments adjacent to the cleft, which is responsible for an excessive laxity of the joint in the frontal plane. We propose an autologous ligamentoplasty aimed at stabilizing the metacarpophalangeal joint while taking into account the specificities of the immature skeleton. A tendon graft is harvested and passed in a figure-of-eight manner around the base of the proximal phalanx and the corresponding metacarpal neck. No transosseous tunnels or bone anchors are used, as these might result in growth plate injury. As the graft does not have any fixed bony attachment, it is free to glide throughout growth, therefore avoiding the occurrence of progressive overtightening.
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Rahal SC, Volpi RS, Teixeira CR, Machado VMV, Soares GDP, Ramires Neto C, Linn K. Congenital deformity of the paw in a captive tiger: case report. BMC Vet Res 2012; 8:98. [PMID: 22747639 PMCID: PMC3453496 DOI: 10.1186/1746-6148-8-98] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 06/14/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this report was to describe the clinical signs, diagnostic approach, treatment and outcome in the case of a tiger with a deformity of the paw. CASE PRESENTATION A 1.5-year-old tiger (Panthera tigris) was presented with lameness of the left thoracic limb. A deformity involving the first and second metacarpal bones, and a soft tissue separation between the second and third metacarpal bones of the left front paw were observed. The second digit constantly struck the ground during locomotion. Based on the physical and radiographic evaluations, a diagnosis of ectrodactyly was made. A soft tissue reconstruction of the cleft with excision of both the second digit and distal portion of the second metacarpal bone was performed. Marked improvement of the locomotion was observed after surgical treatment, although the tiger showed a low degree of lameness probably associated with the discrepancy in length between the thoracic limbs. CONCLUSION This report shows a rare deformity in an exotic feline that it is compatible to ectrodactyly. Reconstructive surgery of the cleft resulted in significant improvement of limb function.
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Affiliation(s)
- Sheila C Rahal
- University Estadual Paulista (UNESP), Department of Veterinary Surgery and Anesthesiology, School of Veterinary Medicine and Animal Science, Botucatu, São Paulo, Brazil.
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Knight JB, Pritsch T, Ezaki M, Oishi SN. Unilateral congenital terminal finger absences: a condition that differs from symbrachydactyly. J Hand Surg Am 2012; 37:124-9. [PMID: 22051235 DOI: 10.1016/j.jhsa.2011.09.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 09/16/2011] [Accepted: 09/16/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe a type of nonhereditary unilateral transverse deficiency, which we have named hypodactyly, that is distinct from symbrachydactyly or amniotic disruption sequence. METHODS We identified 19 patients with unilateral congenital anomalies consisting of absent or short bulbous fingers that lack terminal ectodermal elements. Medical records and radiographs were retrospectively reviewed and contrasted with the typical findings of symbrachydactyly and amniotic disruption sequence. RESULTS No associated syndromes or potentially causative diagnoses were identified in the hypodactyly patients. The digital absences were of a truncated pattern with thickened, tubular soft tissue coverage. Radiographs revealed a pattern of severity progression that is different from that of symbrachydactyly. Distal phalanges were the bony elements absent most frequently, followed sequentially by the middle phalanx and proximal phalanx. In all cases, metacarpals were present. Unlike symbrachydactyly, the ulnar 2 digits were more involved than the index and long fingers, and the thumb was the least involved digit. CONCLUSIONS Hypodactyly appears to be a congenital hand anomaly that is clinically and radiographically different from symbrachydactyly or amniotic disruption sequence and is presumed to be caused by a distinct pathomechanism. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Saeed F, Paramasivam G, Wiechec M, Kumar S. Fetal transverse limb defects: case series and literature review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:454-457. [PMID: 21811998 DOI: 10.1002/jcu.20825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 02/23/2011] [Indexed: 05/31/2023]
Abstract
PURPOSE To investigate the incidence and outcome of antenatally diagnosed isolated transverse limb defects at a major tertiary center and to review the literature relevant to this rare condition. METHODS This was a retrospective review of all cases (2000-2009) diagnosed with an isolated transverse limb defect referred to a tertiary fetal medicine center. Isolated transverse limb defects were defined as partial or complete absence of a part of one or more limbs in the absence of other abnormalities. RESULTS Nine cases were identified. The upper limbs were affected in seven cases. The median gestational age at diagnosis was 22+5 weeks (range 21-29 weeks). The defects ranged from absence of digits to the absence of three limbs in one case. Four women opted to have termination of pregnancy. Postnatal and postmortem examination confirmed the ultrasound findings. No obvious risk factors could be identified in the majority of cases. CONCLUSIONS Most cases of limb defects are believed to be secondary to a vascular insult occurring early in embryonic life. The reason for upper limb predominance remains unclear. Perinatal outcome in this series was poor with the majority of pregnancies terminated. Long-term functional outcome depends on the severity of the limb reduction defect.
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Affiliation(s)
- Ferha Saeed
- Centre for Fetal and Maternal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College London, London W12 0HS, United Kingdom
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Papadogeorgou EV, Soucacos PN. Treatment alternatives of congenital hand differences with thumb hypoplasia involvement. Microsurgery 2008; 28:121-30. [DOI: 10.1002/micr.20463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Aoki M, Kiyonari H, Nakamura H, Okamoto H. R-spondin2 expression in the apical ectodermal ridge is essential for outgrowth and patterning in mouse limb development. Dev Growth Differ 2007; 50:85-95. [DOI: 10.1111/j.1440-169x.2007.00978.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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