Différences congénitales de la main: réponses chirurgicales à des problèmes fonctionnels et esthétiques chez les enfants (II)

2 avril, 2018


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Second entry of Dr Piñal’s blog in his series dedicated to the formation problems of the upper limb in newborns: ‘Congenital hand differences: surgical answers to functional and aesthetic problems in children’ (II). Malformation of the hand

Hypoplasia case
One of the most frequent congenital hand differences, lack of thumb or hypoplasia.

In an earlier article, Dr Piñal addressed the differentiation anomalies -through pathologies such as syndactyly or polydactyly– while in this second entry he focuses his attention on formation failures, which imply total or partial absence of fingers.

(comes from previous post)

 Dr, let’s move now if it feels right towards the second category, the formation failures.

This second large group of congenital malformations is associated with problems with the fingers formation buttons, on the fifth week of gestation. In this category, it is necessary to address symbrachydactyly, which would be in a third step in terms of prevalence, within the pathologies that we’ve talked so far, but it is undoubtedly the most serious.

Symbrachydactyly is a syndrome that groups different diseases and that causes the absence or incomplete formation of parts of the hand; from the so-called short fingers to the total lack thereof.

Even in its mildest forms, the impact extends to three fingers, usually annular, medium and index; whereas if we follow a progression of severity, the deprivation would also extend to the little finger and, finally, to the thumb.

Any other condition that we should highlight?

Yes. I think it would be interesting to conclude this journey through the most frequent congenital hand differences with aplasia and hypoplasia of the thumb; a finger that, as we have seen, is especially prone to this type of alterations.

Again we face a disease with manifestations of diverse severity: from what we could call a limited development of the thumb to its total absence.

What answers does surgery offer?

In intermediate cases we find solutions in the transplant of the foot joints, which provide the affected thumb with greater stability and capabilities. On the other hand, when this ‘does not exist’ we take the index and set it in its place. The patient remains with four fingers but with good mobility and function.

Hypoplasia of the thumb of type 3B
Hypoplasia of the thumb of type 3B. This manifestation of the pathology causes a poor development of the first metacarpus and the thenar muscles, as well as the carpometacarpal joint – “Thumb hypoplasia type 3b” by Iris Theunis – Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons.

In terms of approaching problem and prognosis, Dr, what are the differences between intervening an adult and a child in early childhood?

Multiple as you can imagine and at very different levels. Every procedure is unique, a challenge and a responsibility, but a child is someone who can feel fear even when is going to have a haircut (…). In a certain sense, we have to be able to ‘optimize’ the surgery to avoid as much as possible new interventions and minimize later needs such as cures, for example.

However, childhood surgery tends to offer us better perspectives.


Unlike pathologies or traumatic impacts in the adult hand, children have healthy tissues, do not suffer from other diseases, do not suffer damage linked to bad habits, etc. His main challenge, the aspect that we control the least, are the effects of growth, which sometimes are of help but in others an obstacle.

For this reason, patients having undergone procedures related to congenital malformations need follow-up until adulthood; in addition to subsequent corrective interventions in some cases.

However, if I had to summarize in two ideas the current possibilities offered by good surgery for children with these congenital malformations, would be the following: good clinical expectations and well-founded hope for patients and families.