There are many types of skeletal and soft tissue dysplasia in children's hands, and the degree of deformity varies. Some deformities such as syndactyly and polydactyly are quite common. Most of the causes of malformation are not completely clear, which may be related to the * * * or inhibition of fetal growth and development and heredity.
Syndactyly is a common hand deformity, and some patients are hereditary. Lighter, there is only an incomplete web between the two fingers; In severe cases, the skin is combined with subcutaneous soft tissue and the nails are separated. In severe cases, the second to fifth fingers are connected in parallel, the phalanges are not segmented, and there are many joint deformities. The phalanx of the distal phalanx of the finger is fused with the nail, and the rest is normal, which is called fingertip fusion type. Syndactyly mostly occurs between the middle finger and the ring finger, often bilateral. It can also be complicated with phalangeal fusion deformity, short finger, multi-finger, toe or foot deformity. Many fingers affect the function of the hand.
The treatment principle is to separate the fusion part, cover the two fingers with skin flap, and cover the rest of the wounds with free medium-thick skin graft. Multi-fingers should be operated by stages to avoid postoperative swelling and compression, affecting the blood supply of fingers and causing necrosis. The ideal age for operation is 5 ~ 12 years old. The age is too young, the operation is difficult, and the scar contracture after operation makes the fingers bend sideways. Fingertip fusion deformity can be operated within one year and can develop normally.
Multi-fingering is hereditary. Syndactyly, short finger and other deformities often exist at the same time. Thumb is the most common finger, followed by little finger, sometimes bilateral. There are three types of deformities: ① abnormal soft tissue masses that do not adhere to bone. ② Repeat fingers, including phalanges, joints, tendons, etc. The proximal phalanges and metacarpals or bifurcated metacarpals form joints. ③ Complete redundant fingers, including the complete metacarpal bones connected with phalanges. The diagnosis is not difficult. X-rays should be taken to check the development of phalanges and metacarpals, determine the type of deformity, and combine with finger function to determine which finger is redundant.
Excess fingers can be removed by surgery. A single phalanx or metacarpal can be used for joint amputation. The furcated phalanx or metacarpal bone should be excised with redundant branches, and if necessary, osteotomy should be performed to correct the bone bending deformity.
5. Finger amputation and hand cleft are rare. Because the development process of one or several fingers is inhibited, it can be divided into two types: central type and marginal type. Central finger loss refers to the loss of index finger, middle finger and ring finger, and sometimes the corresponding metacarpal bone is missing, and the palm is cracked, which divides the hand into two parts, shaped like a lobster claw or a hand crack; Some hand fractures only lack the middle finger and the third metacarpal bone. The hand looks ugly, but it has some functions. Capable people don't need treatment. If you have plastic surgery, you should remove the cracked skin of the palm, put the two metacarpals together and sew up the skin of the gap. The absence of marginal finger is the absence of thumb (or little finger), and the hand is narrow, leaving only a small bone protrusion at the original thumb; Thumb loss and palm-to-palm movement loss affect hand function, and thumb reconstruction can be done in adulthood to improve hand function.
6 floating thumb floating thumb is congenital loss of the first metacarpal bone, thumb dysplasia, thenar muscle loss, and flexor longus and extensor digitorum still have some motor functions. If there is no function, the floating thumb should be removed for thumb reconstruction.
Thumb refers to a rare deformity of one finger, several fingers or the whole hand, which may be caused by dysplasia or neurofibromatosis. The length and width of phalanges and soft tissues increased. Neurofibromatosis itself is often not significant, but the hypertrophy is prominent.
Hypertrophic soft tissues and nodular masses can be surgically removed to make the appearance of fingers close to normal. The operation can be carried out in stages to avoid damaging the finger blood vessels. Keep the normal digital nerve and only remove the surrounding soft tissue. If the finger or phalanx is too long and the deformity seriously affects the function, a part of the finger can be removed.
Short refers to the shortening of one or more fingers due to abnormal embryonic development, which may be accompanied by a decrease in the number of phalanges and a shortening of metacarpal bones. Deformities often occur simultaneously with syndactyly or polydactyly. The shape and function of fingers are generally normal. Short fingers themselves do not need treatment. When there are syndactyly or polydactyly, the corresponding operation is performed.
9 Stenosing tenosynovitis of flexor tendon of thumb is also called "trigger thumb". It is a common congenital malformation in children, mostly from 6 months to 2 years old. This disease refers to the narrowing of flexor tendon of thumb at the distal end of metacarpophalangeal joint due to fibrochondropathy of tendon sheath stenosis. After cutting the tendon sheath, there are notches or grooves in the tendon, and the tendon near the notch is thickened or nodular. The interphalangeal joint of thumb is fixed in flexion position, which can not be straightened actively, but can be flexed to some extent. Sometimes the thumb can be stretched out temporarily, but it will soon return to the flexion position, and passive stretching will cause pain or snapping of the thumb. Sometimes the palmar part of metacarpophalangeal joint can touch the thickened muscle nodules, and sometimes it has tenderness.
Early thumb can be passively straightened and fixed with splint for 3 weeks, sometimes it can be cured. Most children need surgical release. Make a transverse incision at the metacarpophalangeal joint of thumb, cut a narrow tendon sheath longitudinally or remove a small strip. The surgical effect was satisfactory.
10 thumb flexion, adduction deformity and finger flexion deformity When thumb flexion, adduction deformity and finger flexion deformity occur, all fingers will flex and contract, accompanied by thumb adduction deformity. This disease is rare and hereditary. The typical posture is adduction of the thumb and obvious flexion of the metacarpophalangeal joint. Flexion deformity of interphalangeal joint of other fingers. Skin contracture of palm. The extensor pollicis brevis is underdeveloped or missing. The internal muscles of the remaining fingers are underdeveloped or missing. Wrist flexion can reduce finger deformities, and the development disorder of flexor digitorum superficialis is the main cause of deformity.
In the early stage, you should stick your thumb out of the palm of your hand and abduct it, and then keep this posture with a proper splint. If it doesn't work, surgery is needed. During the operation, we should consider the absence or non-function of extensor pollicis brevis tendon and do tendon transfer, such as transferring the extensor index finger tendon to the dorsal side of the epiphysis of the first finger of the thumb. For other finger deformities, the flexor digitorum superficialis tendon can be transferred to the extensor tendon of the proximal phalanx, and when the skin is tense, Z-shaped plastic surgery or full-thickness free skin graft can be performed on the palmar surface. In order to correct deformity, it is fashionable to shorten the proximal phalanx.
1 1 hallux valgus deformity is rare, which mostly occurs in the little finger and has obvious heredity. The little finger flexes slightly and leans towards the ring finger. X-ray film shows the deformity of the distal phalanx or the distal phalanx.
Mild deformities do not require treatment. When the deformity affects the function of the hand, it can be corrected by finger osteotomy.
12 phalangeal fusion deformity refers to the development disorder of bone and joint, which causes phalangeal fusion. Most of them occur in the distal phalangeal joints. It's often hereditary. No dysfunction, no need for treatment.
13 The third phalanx of the thumb is deformed, the thumb develops into the third phalanx, the thenar muscle is stunted, the space between the first metacarpal and the second metacarpal is narrowed, and the thumb functions normally, so no treatment is needed. If one phalanx is deformed or wedge-shaped (mostly in the middle), it can be surgically removed, so that the two normal phalanges can be sutured close to the ligament, so that the joint has normal function and appearance.
14 little finger malnutrition