Any parent would be eager to see that his/her baby is in healthy status when the child is born. They would count the fingers and toes of the baby. If the child does not have a perfect set of 10 fingers and 10 toes, that would usually upset them of the abnormality. Dr. Mohd Iskandar Mohd Amin, Consultant Orthopedic, Hand and Micro surgeon at Pantai Hospital Kuala Lumpur says that seven in 1,000 babies are born with congenital hand deformities worldwide.

Thirty percent of congenital hand deformities are caused by genetic abnormalities, while 10 percent are linked to environmental causes. The remaining 60 percent happens for no known reason.

Dr. Iskandar says that the most common type of congenital hand deformity is caused by developmental problems while the baby is in the womb.

The common types of deformities are:

Syndactyly (failure of separation)

It has two categories – simple syndactyly (fusion of soft tissues between the two fingers) and complex syndactyly (fusion of soft tissues and bones of two fingers).

Polydactyly (duplication of extra finger)

It has three categories – Type 1 (an extra finger is attached by the skin and nerves), Type 2 (the extra finger is attached to the bone or joint of the little finger) and Type 3 (a completely formed and functional extra finger attached to the hand).

Brachydactyly (undergrowth)

The thumb of the fingers is usually small and underdeveloped. Some fingers may be missing.

– Macrodactyly (overgrowth)

The thumb, index finger or forearms are abnormally large due to overgrowth of bone and soft tissue.

– Constriction Band Syndrome

The fingers become malformed because of constriction by the fibrous bands of the amniotic sac which were entangled with the fetus’ fingers in the mother’s womb. Sometimes, the bones, muscles and tissues are joined together like a flower bud.

Dr. Iskandar mentions the irony is that the child often does not feel the hands are abnormal until he/she enters school and undergoes societal pressure. He adds that children being amazingly versatile are usually able to manage their daily life even with their deformed fingers or hands.

He explains; “the parents and the grandparents are the ones who are most distressed when they have children with congenital deformities. They wish to know whether it is hereditary and whether the siblings will have the same deformity.”Another anxiety is about whether the child will have normal function and it will be a cause for undergoing ridicule in later life.

Microsurgery for congenital hand deformities remains a highly specialized surgical or sub-specialty as the surgeon needs to have in-depth knowledge of orthopedics, neurology, plastic surgery and neurosurgery.Undergoing counseling by the parents and grandparents before the surgery is vital to better manage their expectations. It is also good to talk to support giving nurses and parents who are in similar circumstances to share their thoughts, fears and tears.

Dr. Iskandar says that usually surgery helps to improve the appearance of the hands, such as removing an extra thumb or pinky finger.He elaborates, “In some cases, surgery is done to enable the child functioning of the hand, for instance, when a child is having flower bud fingers needing a thumb and forefinger to manage buttons and zippers best. However, sometimes it is not possible to make a child’s hand ‘normal’, but he/she can function well with it, at least.”
In order to reduce physical and psychological scarring, usually surgery is performed within the first two years of the child’s life. It also enables new hand to function with full potential and for new growth and development.

Sometimes congenital hand deformities are a part of other conditions, i.e. Appert Syndrome, an underdeveloped face, nose and skull bone or Holt Cram Syndrome, often accompanied by congenital heart disease.In such situations, it is necessary to correct the other underlying problems first as they are life-threatening issues.

Source: The Nation