congenital syndactyly polydactyly
Introduction
Congenital and refers to the introduction of multi-finger malformation Congenital and finger deformity means that adjacent fingers are integrated into one another. Congenital refers to the finger, the most common 3rd and 4th fingers, and the thumb is rarely involved. Most commonly, adjacent two fingers are only connected by soft tissue, occasionally with bone and joints. More common on both sides, sometimes complicated toe deformity, and other limb abnormalities. Congenital multi-finger and toe deformity is the congenital disease with the highest incidence in children, and some are accompanied by malformations of other systems such as cardiovascular or urinary. Multi-finger is more common on the outside of the thumb and on the inside of the little finger, and other fingers are less involved. Among them, the incidence of complex deformity is the highest, and the appearance and function of the opponent are significant. The diagnosis and treatment are the focus of children's orthopedic surgeons. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious complication:
Cause
Congenital and refers to the cause of polymorphism
During the development of the hand, the fingers begin to be together, and then gradually form a thumb and four fingers. If an abnormality occurs during this process, the fingers are not completely separated or separated, and partial or complete pointing will occur. And the exact cause of the occurrence is not clear, a few are hereditary, and most of the reasons are unknown.
Multi-finger malformation is a disease of the chromosome, many of which are related to heredity.
Prevention
Congenital and refers to prevention of multiple finger deformity
Because the majority of Chinese people's polyphagia grows beside the thumb, and the thumb is the most important finger, it is very important to retain and reconstruct the thumb function when removing the extra finger. Most of the more ones are not functional or deformed, so they should be removed to avoid affecting the normal function of the hand, and the removal is also very helpful. Some patients also found that the remaining thumb is paralyzed after multi-finger resection. This is usually caused by deformity of the ligament or multiple deformed bones. It is also a deformity that should be corrected early. Otherwise, it will not be easy to cure after deforming. .
Complication
Congenital and refers to multiple finger malformation complications Complication
Clinically, according to the tissue components contained in the twins, they can be divided into three categories: 1 soft tissue multi-finger: multi-finger only soft tissue neoplasms, no bone, tendon and other tissues; 2 simple multi-finger: multi-finger contains phalanx, Tendons and vascular nerve bundles are connected to normal fingers as a functionally defective finger; 3Complex multi-finger: Multi-finger for true repetition not only contains phalanx tendon, but also metacarpal.
Symptom
Congenital refers to multi-finger malformation symptoms common symptoms multi-finger (toe) deformity
Congenital refers to the finger, the most common 3rd, 4th, and thumb are rarely involved. The most common ones are only soft tissue connections between adjacent two fingers, occasionally bone and joint connections, more common on both sides, sometimes complicated toe deformity, and other limb abnormalities.
Multi-finger malformation not only hinders the functional activities of the hand, but also affects the appearance. Multi-finger is often a 6-point deformity, sometimes with a bifurcated multi-finger deformity. Multi-finger is only a soft tissue connection, can be removed at any time after birth by color line ligation or surgical resection; if multiple fingers and political parties refer to bones, joints, tendons connected, surgery should be performed at 6 to 7 years old; Surgery for bone and joint rectangle surgery can be performed after 12 years of age.
Pre-shaft type multi-finger
1, type I and type II symmetrical multi-finger: the central part of the bifurcation including the thumb nail, phalanx and soft tissue for equal wedge resection, the remaining part is closed together; asymmetric multi-finger: will be skewed to normal fingers, development Small multi-finger resection, but care should be taken to reconstruct the lateral nail groove of the nail.
2, type III and type IV symmetrical multi-finger: the use of type I and type II symmetrical multi-finger treatment, can also be removed from the temporal or ulnar side of the multi-finger, right position after the Kirschner wire, but Note that the resection of the temporal side of the multi-finger should be transplanted with the thumb abductor muscle, the removal of the ulnar side of the multi-finger should be transplanted to the adductor muscle, the re-implantation of the severed finger to correct the congenital malformation of the asymmetrical multi-finger: after the removal of multiple fingers to do the metacarpal bone-shaped bone, Also pay attention to the repair of the collateral ligament and the end of the fish muscle.
3, V-type and VI-type: usually the most commonly removed multi-finger (such as the unilateral multi-finger, but also the ulnar side of the multi-finger) tiger stenosis can be a "Z"-shaped extension surgery, the tiger mouth expansion is feasible for stenosis surgery.
4, VII type refers to the most common malformation is the thumb bifurcation, resection of the multi-finger wedge-shaped osteotomy or Kirschner wire internal fixation to correct the deformity.
Post-shaft type multi-finger
Type I multi-finger complete resection of multiple-finger sutures. For type II and III multi-finger, it is necessary to identify and protect very fine abductor tendons and bifurcated periosteal ulnar collateral ligaments, remove excess fingers, and trim the bifurcation. Excess bone, reconstruction of the collateral ligament and abductor tendon.
Central multi-finger
Simple central multi-finger should remove the worst-developed fingers, and the principles of repair and reconstruction are the same as thumb and little finger. The malformation of the distal phalanx fusion should be performed within 1 year of age, so that the function of the hand can develop normally, and the rest of the deformity is best to be operated at about 5 years old. For example, if the deformity occurs due to developmental imbalance, surgery should be performed in advance, and fingers without function can be operated at a later stage.
Examine
Congenital and refers to the examination of multiple fingers
Auxiliary examination: X-ray examination to understand the bones and joints of multiple fingers.
Diagnosis
Congenital and multi-finger malformation diagnosis
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
Need regular check to see if there are other congenital hand deformities:
1. Multi-finger: It can be more deformed than the normal hand, and the active finger is poorly developed. It is necessary to perform X-ray examination to identify the diagnosis. The conventional multi-fingery requires multi-fingerectomy.
2. Three-section thumb: The thumb of the affected side can have two joints and is skewed toward the ankle and ulnar side. X-ray examination revealed that it had 3 phalanxes and required pre-school osteotomy.
3. Split hands: The affected hands may have obvious developmental abnormalities and deformities. At the same time accompanied by dysplasia of the phalanx. X-ray examination can confirm the diagnosis, the split hand is a more recurrent deformity, and the surgical method is determined according to the specific situation.
4. Amniotic membrane lock syndrome: Children may have finger dysplasia, and multiple fingers are together. Early surgical intervention is required, and multiple fingers and fingers are needed. It is necessary to perform surgical intervention before 6 months to ensure the development of each finger and avoid abnormalities such as dislocation of the interphalangeal joint.
