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

Trigger finger is a common disease particularly in the middle aged women. A very rare case in which an adult man had 10 trigger fingers was experienced. He was treated with local steroid injections in both thumbs, but trigger finger disease has been aggravated in every digit of both hands. We performed an early operative treatment. Three months after the operation, the patient could perform his work without discomfort in his hands and showed normal range of motion in all fingers.
Tenosynovitis/genetics/physiopathology/*surgery ; Male ; Humans ; Hand Deformities, Acquired/genetics/physiopathology/*surgery ; Fingers/physiopathology/*surgery ; Adult

OBJECTIVETo investigate the efficacy of buried purse-string suture in the treatment of mallet finger deformities.

METHODSFrom February 2009 to February 2010, 12 patients with closed non-fracture mallet fingers were treated by buried purse-string suture. The rupture tendons were sutured by purse-string suture with an atraumatic needle, and the knots were buried under subcutaneous tissue. External fixator was used at the extension position of the finger every night within three weeks after operation.

RESULTSAll patients were followed up for 6-12 months, mean 7 months. According to the Patel's evaluation criteria, 2 cases (17%) obtained excellent results, 7 good (58%), 2 fair (17%) and 1 poor (8%). The overall rate of the cases with excellent and good outcomes was 75%.

CONCLUSIONBuried purse-string suture is an easy and effective way to treat mallet finger deformities, with no serious postoperative complications or no need for reoperation.

External Fixators ; Finger Injuries ; surgery ; Hand Deformities, Acquired ; Humans ; Sutures ; Tendon Injuries ; surgery

Adult ; Gout ; complications ; Hand Deformities, Acquired ; diagnostic imaging ; etiology ; Humans ; Male ; Radiography

Child ; Foot Deformities, Congenital ; genetics ; Hand Deformities, Congenital ; genetics ; Humans ; Male ; Pedigree

OBJECTIVE: To analyze the molecular genetics of a Chinese pedigree with congenital hand foot cleft. METHODS: Single nucleotide polymorphism microarray (SNP array) was used to analyze the whole genome copy number variation. RESULTS: SNP array analysis showed that there was a 433 kb repeat in 10q24.31-10q24.32 region, which contained LBX1, BTRC, POLL, OPCD and FBXW4 genes. CONCLUSION Microduplication of chromosome 10q24.31-10q24.32 may be the cause of congenital hand foot cleft in this pedigree.
China ; DNA Copy Number Variations/genetics* ; Foot Deformities, Congenital/genetics* ; Hand Deformities, Congenital/genetics* ; Humans ; Pedigree

OBJECTIVE: To determine the usefulness of Jebsen hand function test in rheumatoid arthritis patients. METHOD: The experimental subjects were divided into 3 groups (Group 1 : 17 persons; control, Group 2 : 21 persons; RA without hand deformity, Group 3 : 16 persons; RA with hand deformity). They were assessed by Jebsen hand function test. Further included assessments were grip and pinch strength, joint deformity counts, and visual analogue scales. RESULTS: Jebsen hand function test scores were significantly decreased in rheumatoid arthritis patients compared with control. Jebsen hand function test scores were well correlated with visual analogue scales in group 2 and correlated with joint deformity counts in group 3. CONCLUSIONS: Jebsen hand function test would be useful tool for the evaluation of hand function in the rheumatoid arthritis patients with hand deformity.
Arthritis, Rheumatoid* ; Congenital Abnormalities ; Hand Deformities ; Hand Strength ; Hand* ; Humans ; Joints ; Pinch Strength ; Weights and Measures

OBJECTIVE: To determine the usefulness of hand grip and pinch strength in rheumatoid arthritis (RA) patients. METHOD: The experimental subjects were divided into 3 groups (Group 1: 100 persons; control, Group 2: 100 persons; RA without hand deformity, Group 3: 100 persons; RA with hand deformity). They were assessed with using the Modified Barthel Index (MBI), evaluating the activity of daily living (ADL). A JAMAR Hand Dynamometer(R), JAMAR Hydraulic Pinch Gauge(R) (Sammons Preston Rolyan, Ilinois, USA) were used to measure grip and pinch strength. Further assessments included joint deformity counts, and visual analogue scales. RESULTS: The grip and pinch strength significantly decreased in all groups. The total MBI with other groups significantly decreased in RA patients with hand deformity (group 3). The MBI correlated well with visual analogue scales in group 2 and with joint deformity counts in group 3. CONCLUSION: Hand grip and pinch strength tests would be a useful tool for the evaluation of hand function in rheumatoid arthritis patients.
Arthritis, Rheumatoid ; Congenital Abnormalities ; Hand ; Hand Deformities ; Hand Strength ; Humans ; Joints ; Pinch Strength ; Weights and Measures

OBJECTIVETo explore the genetic etiology of three families affected with split-hand/split-foot malformation (SHFM).

METHODSPeripheral venous blood samples from 21 members of pedigree 1, 2 members of pedigree 2, and 2 members of pedigree 3 were collected. PCR-Sanger sequencing, microarray chip, fluorescence in situ hybridization (FISH), real-time PCR, and next-generation sequencing were employed to screen the mutations in the 3 families. The effect of the identified mutations on the finger (toe) abnormality were also explored.

RESULTSMicroarray and real-time PCR analysis has identified a duplication in all patients from pedigrees 1 and 3, which have spanned FKSG40, TLX1, LBX1, BTRC, POLL and FBXW4 (exons 6-9) and LBX1, BTRC, POLL and FBXW4 (exons 6-9) genes, respectively. A missense mutation of the TP63 gene, namely c.692A>G (p.Tyr231Cys), was found in two patients from pedigree 2. FISH analysis of chromosome 10 showed that the rearrangement could fita tandem duplication model. However, next-generation sequencing did not identify the breakpoint.

CONCLUSIONThe genetic etiology for three families affected with SHFM have been identified, which has provideda basis for genetic counseling and guidance for reproduction.

Chromosomes, Human, Pair 10 ; genetics ; Female ; Foot Deformities, Congenital ; genetics ; Genetic Testing ; Hand Deformities, Congenital ; genetics ; Humans ; Limb Deformities, Congenital ; genetics ; Male ; Mutation ; genetics ; Pedigree

Adult ; Female ; Foot Deformities, Congenital ; diagnosis ; genetics ; Hand Deformities, Congenital ; diagnosis ; genetics ; Humans ; Male ; Pedigree ; Young Adult