Congenital deformities of the hand & limbs

Congenital deformities of the musculoskeletal system are very commonly encountered & pose great challenges for the parents, family & the treating physician.

They come in all forms of severity & involve both upper & lower limbs.

Usually, the parents are the first ones to notice these deformities & then the treating pediatrician. Earlier the diagnosis is made & the treatment started, the better.

This deformity is present since the child is in the mother’s womb & can be diagnosed early in the womb with the help of ultrasonogram & colour Doppler etc.

Usually diagnosed at birth & treatment can be started as early as when the child is 4 days of age.

A common congenital anomaly in lower limbs is “The ClubFoot “ (Called “CTEV” in medical terms).

In the past it used to be neglected & then was treated at a very late age by multiple surgeries, now we have a very good & proven method of conservative treatment with serial casting & bracing which is called the Ponseti method. This method needs great compliance from parents, regular follow up & continue bracing until 4-5 years of age.

Congenital Hand Deformities

Surprisingly, many upper extremity malformations cause little functional deficit. Children develop prehension with hands as they are, and they usually are not self-conscious of the difference until they become socialized in school. In contrast, parents may be dismayed by the appearance of an anomalous hand and may be hoping that surgery can create a “normal” hand. The hand surgeon treating children with upper extremity anomalies must offer surgery to improve the child’s function and cosmesis, when possible, and counsel parents about what is and is not possible with surgery.

Can be classified into many variants but the most common ones are:

1. Syndactyly (Fused fingers) which can be complex & simple
2. Radial club hand: it is similar to clubfoot in the lower limb with sometimes absent of bones of the forearm
3. Flail or absent fingers or thumb
4. Duplication of digits i.e. extra digits

Congenital deformities need great attention by the treating doctor & compliance from parents & the timing of intervention is the key to success but most of them can be treated & the main aim is a functional improvement.

Dr. Girish Gupta, Orthopaedics, Narayana Multispeciality Hospital, Jaipur