Clin Orthop Surg.  2011 Sep;3(3):172-177. 10.4055/cios.2011.3.3.172.

Congenital Differences of the Upper Extremity: Classification and Treatment Principles

• Chung MS

• KMID: 1743906
• DOI: http://doi.org/10.4055/cios.2011.3.3.172

Abstract

For hand surgeons, the treatment of children with congenital differences of the upper extremity is challenging because of the diverse spectrum of conditions encountered, but the task is also rewarding because it provides surgeons with the opportunity to impact a child's growth and development. An ideal classification of congenital differences of the upper extremity would reflect the full spectrum of morphologic abnormalities and encompass etiology, a guide to treatment, and provide prognoses. In this report, I review current classification systems and discuss their contradictions and limitations. In addition, I present a modified classification system and provide treatment principles. As our understanding of the etiology of congenital differences of the upper extremity increases and as experience of treating difficult cases accumulates, even an ideal classification system and optimal treatment strategies will undoubtedly continue to evolve.

Keyword

Upper extremity; Congenital differences; Classification; Treatment principles

MeSH Terms

Hand Deformities, Congenital/*classification/pathology/*surgery
Humans

Reference

1. Lamb DW, Wynne-Davies R, Soto L. An estimate of the population frequency of congenital malformations of the upper limb. J Hand Surg Am. 1982. 7(6):557–562.

2. Kozin SH. Upper-extremity congenital anomalies. J Bone Joint Surg Am. 2003. 85(8):1564–1576.

3. Bates SJ, Hansen SL, Jones NF. Reconstruction of congenital differences of the hand. Plast Reconstr Surg. 2009. 124:1 Suppl. 128e–143e.

4. Manske PR, Oberg KC. Classification and developmental biology of congenital anomalies of the hand and upper extremity. J Bone Joint Surg Am. 2009. 91:Suppl 4. 3–18.

5. Sammer DM, Chung KC. Congenital hand differences: embryology and classification. Hand Clin. 2009. 25(2):151–156.

6. Swanson AB. A classification for congenital limb malformations. J Hand Surg Am. 1976. 1(1):8–22.

7. Swanson AB, Swanson GD, Tada K. A classification for congenital limb malformation. J Hand Surg Am. 1983. 8(5 Pt 2):693–702.

8. Wassel HD. The results of surgery for polydactyly of the thumb: a review. Clin Orthop Relat Res. 1969. 64:175–193.

9. Frantz CH, O'Rahilly R. Congenital skeletal limb deficiencies. J Bone Joint Surg Am. 1961. 43(8):1202–1224.

10. O'Rahilly R. Morphological patterns in limb deficiencies and duplications. Am J Anat. 1951. 89(2):135–193.

11. Swanson AB, Barsky AJ, Entin MA. Classification of limb malformations on the basis of embryological failures. Surg Clin North Am. 1968. 48(5):1169–1179.

12. De Smet L. IFSSH. International Federation for Societies for Surgery of the Hand. JSSH. Japanese Society for Surgery of the Hand. Classification for congenital anomalies of the hand: the IFSSH classification and the JSSH modification. Genet Couns. 2002. 13(3):331–338.

13. Ogino T. Teratogenic relationship between polydactyly, syndactyly and cleft hand. J Hand Surg Br. 1990. 15(2):201–209.

14. Tonkin MA. Description of congenital hand anomalies: a personal view. J Hand Surg Br. 2006. 31(5):489–497.

15. Blauth W. The hypoplastic thumb. Arch Orthop Unfallchir. 1967. 62(3):225–246.

16. Manske PR, McCarroll HR Jr, James M. Type III-A hypoplastic thumb. J Hand Surg Am. 1995. 20(2):246–253.

17. Muragaki Y, Mundlos S, Upton J, Olsen BR. Altered growth and branching patterns in synpolydactyly caused by mutations in HOXD13. Science. 1996. 272(5261):548–551.

18. Cheng JC, Chow SK, Leung PC. Classification of 578 cases of congenital upper limb anomalies with the IFSSH system: a 10 years' experience. J Hand Surg Am. 1987. 12(6):1055–1060.

19. Miura T, Nakamura R, Horii E. The position of symbrachydactyly in the classification of congenital hand anomalies. J Hand Surg Br. 1994. 19(3):350–354.

20. Manske PR. Symbrachydactyly instead of atypical cleft hand. Plast Reconstr Surg. 1993. 91(1):196.