Congenital Deformities of the Hand

1 Introduction.- 1.1 General Directives.- 1.2 General Surgical Suggestions.- 1.2.1 Skin Preparation.- 1.2.2 Positioning.- 1.2.3 Anesthesia.- 1.2.4 Exsanguination.- 1.2.5 Instrumentarium.- 1.2.6 Operative Technique.- 1.2.7 Postoperative (Wound) Care.- 1.2.8 Postoperative Exercises.- 1.3 Review of Frequent Errors of Therapy and Their Consequences.- 2 Syndactylies.- 2.1 Cutaneous Syndactylies.- 2.1.1 Introduction.- 2.1.1.1 General Remarks.- 2.1.1.2 Timing of Surgery.- 2.1.1.3 General Surgical Directives.- 2.1.1.4 Postoperative Care.- 2.1.2 Total Syndactyly of Fingers of Equal Length (III/IV).- 2.1.3 Subtotal Syndactyly of Fingers of Unequal Length (IV/V).- 2.1.4 Total Syndactyly of Several Long Fingers.- 2.1.5 Partial Syndactyly ("Short Type").- 2.1.6 Partial Syndactyly ("Long Type").- 2.2 Osseous Syndactylies.- 2.2.1 Introduction: "Apert Hand".- 2.2.1.1 General Remarks.- 2.2.1.2 Timing of Surgery.- 2.2.1.3 General Surgical Directives.- 2.2.1.4 Postoperative Care.- 2.2.2 Total Syndactyly Between Thumb and Long Fingers.- 2.2.3 Partial Syndactyly Between Thumb and Index Finger.- 2.2.4 Total Syndactyly of the Long Fingers with Acrosynostosis.- 2.2.5 Radial Clinodactyly of the Thumb.- 2.3 Recurrent Syndactylies.- 2.3.1 Introduction.- 2.3.1.1 General Remarks.- 2.3.1.2 Timing of Surgery.- 2.3.1.3 General Surgical Directives.- 2.3.1.4 Postoperative Care.- 2.3.2 Recurrent Syndactyly of the Long Fingers (Narrow "Short" Type).- 2.3.3 Recurrent Syndactyly of the Long Fingers (Wide "Short" Type).- 2.3.4 Recurrent Syndactyly of the Long Fingers ("Short" Type) with Scars Extending to the Distal Phalanges.- 2.3.5 Recurrent Syndactyly of the Long Fingers ("Long" Type).- 2.3.6 Recurrent Syndactyly of the Long Fingers ("Long" Type) with Scars Extending to the Distal Phalanges.- 2.3.7 Recurrent Syndactyly Between Thumb and Index Finger.- 3 Peripheral Hypoplasias.- 3.1 Introduction.- 3.1.1 General Remarks.- 3.1.2 Indications for Surgery.- 3.1.3 Timing of Surgery.- 3.1.4 General Surgical Directives.- 3.1.5 Postoperative Care.- 3.2 Syndactyly with Digiti Superducti.- 3.3 Interdigital Cutaneous Bridge ("Bridge Syndactyly").- 3.4 Partial Syndactyly Between Thumb and Index Finger.- 3.5 Total Syndactyly of Rudimentary Fingers of Unequal Length.- 3.6 Total Syndactyly of Rudimentary Fingers of Equal Length.- 3.7 Anular Grooves with Excessive Dorsal Soft Tissue Finger Pads.- 3.8 Conical Rudimentary Finger; Excessive Dorsal Soft Tissue Finger Pad.- 3.9 Rudimentary Thumb with Excessive Soft Tissue.- 3.10 Anular Groove and Defect Pseudarthrosis of the Thumb.- 3.11 Rudimentary Index Finger with Excessive Soft Tissue and Anular Groove.- 3.12 Anular Groove of the Forearm.- 4 Numerical Variations.- 4.1 Introduction.- 4.1.1 General Remarks.- 4.1.1.1 Polydactylies.- 4.1.1.2 Oligodactylies.- 4.1.2 Timing of Surgery.- 4.1.3 General Surgical Directives.- 4.1.4 Postoperative Care.- 4.2 Thumb Hypo- and Aplasias.- 4.2.1 Partial Syndactyly Combined with Second-Degree Thumb Hypoplasia.- 4.2.2 Partial Syndactyly Combined with Second-Degree Thumb Hypoplasia and a Tight Web Space.- 4.2.3 Second-Degree Thumb Hypoplasia with Dysplasia of the First Metacarpophalangeal Joint and Hypo- or Aplasia of M. Opponens.- 4.2.4 Second/Third-Degree Thumb Hypoplasia (Index Finger Pollicization; Incision According to Blauth).- 4.2.5 Thumb Aplasia (and Fourth-Degree Thumb Hypoplasia) (Index Finger Pollicization; Incision According to Blauth).- 4.2.6 Thumb Aplasia (Index Finger Pollicization; Incision According to Buck-Gramcko).- 4.3 Long Finger Oligodactylies.- 4.3.1 Oligosyndactyly with Acrosynostosis.- 4.3.2 Oligodactyly with Total Syndactyly ("Spoon Hand").- 4.3.3 Oligodactyly with Total Syndactyly of the Long Fingers and Acrosynostosis.- 4.3.4 Oligodactyly with "Duplication" of a Middle and Distal Phalanx (and Acrosynostosis).- 4.3.5 Oligodactyly with Synostosis of the Proximal Phalanges.- 4.4 Thumb Duplication.- 4.4.1 Incomplete Duplication of the Distal Phalanx of the Thumb.- 4.4.2 Mirrorlike Duplication of the Distal Phalanx of the Thumb (with Widening of Its Proximal Phalanx).- 4.4.3 Duplication of the Distal Phalanx of the Thumb with a Smaller Radial Element.- 4.4.4 Thumb Duplication with Triphalangeal Radial Element.- 4.4.5 Thumb Duplication with an Ulnar Rudimentary Metacarpal.- 4.4.6 Thumb Duplication with Smaller Radial Element and Deformed Metacarpal.- 4.4.7 Thumb Duplication: Floating Thumb.- 4.5 Other Finger Duplications.- 4.5.1 Duplication of the Little Finger.- 4.5.2 Little Finger Duplication with Metacarpal Bifurcation.- 4.5.3 Duplication of the IVth Ray with Complete Syndactyly.- 4.5.4 Ring Finger Duplication with Syndactyly, Deviation, and Bifurcation of the Proximal Phalanx.- 4.5.5 Ring Finger Duplication with Acrosynostosis and Total Syndactyly of the IIIrd/IVth Rays.- 4.5.6 Index Finger Duplication.- 4.5.7 Hexadactyly (Six Triphalangeal Fingers).- 5 Metrical Variations.- 5.1 Introduction.- 5.1.1 General Remarks.- 5.1.1.1 Triphalangy of the Thumb.- 5.1.1.2 Brachydactyly.- 5.1.2 Indications for Surgery.- 5.1.3 Timing of Surgery.- 5.1.4 General Surgical Directives.- 5.1.5 Postoperative Care.- 5.2 Dolichophalangeal Thumb.- 5.3 Brachymesophalangeal Thumb: Ulnar Clinodactyly with Wedge-Shaped Rudimentary Phalanx.- 5.4 Radial Clinodactyly Combined with Brachybasophalangy of the Thumb.- 5.5 Brachymesophalangeal Long Finger.- 5.5.1 Radial Clinodactyly of the Index Finger.- 5.5.2 Radial Clinodactyly of the Index Finger (Alternative Method).- 6 Hypoplasias and Aplasias of Finger Joints.- 6.1 Introduction.- 6.1.1 General Remarks.- 6.1.2 Indications for Surgery.- 6.1.3 Timing of Surgery and General Surgical Directives.- 7 Joint Dysplasias.- 7.1 Introduction.- 7.1.1 General Remarks.- 7.1.2 Indications for and Timing of Surgery.- 7.1.3 General Surgical Directives.- 8 Symbrachydactylies.- 8.1 Introduction.- 8.1.1 General Remarks.- 8.1.2 Indications for Surgery.- 8.1.3 Timing of Surgery.- 8.1.4 General Surgical Directives.- 8.1.5 Postoperative Care.- 8.2 First-Degree Symbrachydactyly Combined with Total Syndactyly of Two Long Digits and Partial Syndactyly Between Thumb and Index Finger.- 8.3 Second-Degree Symbrachydactyly Combined with "Flat Hand".- 8.4 Second-Degree Symbrachydactyly with Budlike Finger Rudiments.- 8.5 Second-Degree Symbrachydactyly with Metacarpal and Syndactylous Finger Rudiments.- 8.5.1 Second-Degree Symbrachydactyly with Metacarpal and Syndactylous Finger Rudiments (Relatively Wide Commissure).- 8.5.2 Second-Degree Symbrachydactyly with Metacarpal and Syndactylous Finger Rudiments (Narrow Commissure).- 8.6 Second-Degree Symbrachydactyly with Clinodactyly.- 8.7 Third-Degree Symbrachydactyly (Monodactyly).- 9 Cleft Hand.- 9.1 Introduction.- 9.1.1 General Remarks.- 9.1.2 Indications for Surgery.- 9.1.3 Timing of Surgery.- 9.1.4 General Surgical Directives.- 9.1.5 Postoperative Care.- 9.2 Cleft Hand with Wide Interdigital Space.- 9.3 Lobster-Claw Hand with Thumb Clinodactyly.- 9.4 Cleft Hand with Transversal Bone.- 9.5 Cleft Hand with Total Syndactyly Between Thumb and Index Finger.- 9.6 Cleft Hand with Flexion Contracture of the Ring Finger.- 9.7 Cleft Hand with Dysplasia of the Index Finger.- 9.8 Duplication of the Proximal Thumb Phalanx, Thumb Hyperphalangia, and Partial Syndactyly I/II.- 10 Congenital Localized Giantism of the Hand (Macrodactyly).- 10.1 Introduction.- 10.1.1 General Remarks.- 10.1.2 Indications for Surgery.- 10.1.3 Timing of Surgery.- 10.1.4 General Surgical Directives.- 11 Pollex Flexus Congenitus (Congenital Trigger Thumb).- 11.1 Introduction.- 11.1.1 General Remarks.- 11.1.2 Timing of Surgery.- 11.1.3 General Surgical Directives.- 11.1.4 Postoperative Care.- 11.2 Flexion Contracture of the Interphalangeal Joint of the Thumb.- 12 Camptodactyly.- 12.1 Introduction.- 12.1.1 General Remarks.- 12.1.2 Indications for Surgery.- 12.1.3 Timing of Surgery.- 12.1.4 General Surgical Directives.- 12.1.5 Postoperative Care.- 13 Hypoplasias and Aplasias of the Radius (Radial Club Hand).- 13.1 Introduction.- 13.1.1 General Remarks.- 13.1.2 Indications for Surgery.- 13.1.3 Timing of Surgery.- 13.1.4 General Surgical Directives.- 13.1.5 Postoperative Care.- 13.2 Radius Aplasia.- 13.2.1 Correctable Club Hand (Operation According to Blauth).- 13.2.2 Correctable Club Hand (Alternative Operation According to Blauth.- 13.3 Recurrent Club Hand.- 13.4 Radioulnar Synostosis.- 14 Hypoplasias and Aplasias of the Ulna (Ulnar Club Hand).- 14.1 Introduction.- 14.1.1 General Remarks.- 14.1.2 Indications for Surgery.- 14.1.3 Timing of Surgery.- 14.1.4 General Surgical Directives.- 14.1.5 Postoperative Care.- 14.2 Ulnar Hypoplasia with Bowing of the Radius.- 15 Hereditary Multiple Exostoses.- 15.1 Introduction.- 15.1.1 General Remarks.- 15.1.2 Indications for Surgery.- 15.1.3 Timing of Surgery.- 15.1.4 General Surgical Directives.- 15.1.5 Postoperative Care.- 15.2 Exostosis of a Phalanx.- 15.3 Manus Vara and Bowing of the Radius Caused by an Exostosis of the Distal Ulnar Epiphysis.- 15.4 Bowing of the Radius Caused by an Exostosis of the Metadiaphyseal Segment of the Ulna.- 15.5 Radius Shaft Exostosis (with Relative Overgrowth of the Ulna).- 16 Enchondromatosis.- 16.1 Introduction.- 16.1.1 General Remarks.- 16.1.2 Indications for Surgery.- 16.1.3 Timing of Surgery.- 16.1.4 General Surgical Directives.- 16.1.5 Postoperative Care.- 16.2 Multiple Enchondromas of a Hand.- 16.3 Enchondroma of a Proximal Phalanx with Minimal Cortical Involvement.- 16.4 Large Enchondromas of the Proximal and Middle Phalanges (One-Stage Operation).- 16.5 Enchondroma of a Middle Phalanx.- 16.6 Metacarpal Enchondroma with Pathologic Fracture.- References.