Congenital anomalies of the upper extremities
Congenital malformations of the hands of about 7% of all diseases of the upper extremities.
Absence and hypoplasia of the upper extremity – severe pathology, fortunately it is rare. Variants of underdevelopment of the upper extremities are different.
Fokomeliya or Amelia – an anomaly of development in which the upper limb is missing completely, or there is no shoulder and forearm, and hand moves away from the shoulder and under-developed flippers like a seal. Sometimes, instead of a brush on the shoulder immature leaves only one finger. This condition is called peromeliya. Surgical treatment of such anomalies are not very promising. Patients are usually well trained to use the abnormal limb. Prosthetics is performed to correct a cosmetic defect.
Ektomeliya – complete absence of one or two limbs or parts of limbs. In the absence of limb prosthesis. In partial – is sometimes required surgical correction.
Hemimelia – an anomaly of development at which the lower part of the missing limb (hand or wrist and forearm), and the upper parts of normally developed. Treatment consists of prosthetics.
Congenital anomalies of the individual segments of the upper extremity.
Congenital synostosis of the forearm bones or radioulnarny synostosis. Found this anomaly development is not often. In utero the radius and ulna bones of the forearm combined bridge, which subsequently ossifies. Jumper occurs in the upper arm and can be of different length. More common in boys. The child does not turn a hand at the wrist, but flexion and extension of the elbow kept. This situation greatly complicates the patient's life, even his self.
Treatment initially is conservative and in the development of hand. Some patients may well adapt to this defect. If you can not develop a hand, surgical treatment is applied. With a slight adhesion of cut produce it at a rate of more than 4 cm seam to resort to the removal of the radial bone. Surgical treatment is performed at the age of 3 years.
Congenital clubhand. Congenital clubhand violation occurs when the muscles of the forearm or radial hypoplasia, less ulna.
Ulnar clubhand develops, if the elbow of the forearm muscles are underdeveloped, the ulna is missing completely or partially. 4.5 The simultaneous hypoplasia of fingers, the bones of the metacarpus and the wrist to the ulnar side. Brush with the state turned sharply to the ulnar side (laterally), its function is broken.
Radiation clubhand. This anomaly develops in the absence of the radius. The defect may be bilateral. Simultaneously, underdeveloped muscles of the forearm with radiation of the first finger of the hand, wrist bone with radial side. The brush is tilted toward the ulna (medially), its function dramatically impaired, and in the absence of the first finger brush can not be gripping objects.
Treatment of congenital Kosorukov. Treatment of congenital Kosorukov involves many steps. Immediately after the birth of a child is prescribed massage, remedial gymnastics. To correct joint contractures plaster bandages are applied. The first operation performed at age 2. Then, may need additional surgery.
Chronic subluxation of the wrist (Madelung's disease). It is rarely found an anomaly in which there is a malformation of the wrist joint. The deformation progresses gradually to 12-14 years is noticeable. Pain in this disease there. There shtykoobraznoe curvature of the brush, which is gradually increasing. Limited movement in the wrist joint. Treatment operative. Produce sections of bone resection, with subsequent fixation of needle. Then a plaster bandage for one month, after which the prescribed physical therapy and exercise therapy.
Syndactyly. This is an anomaly of development in which there is complete or incomplete fusion of one or more fingers together. Hand function is disturbed. There is a cosmetic defect. Fusion may be soft tissue if only soft tissue spliced, and bone. Fusion of the fingers is normally developed simple. Complex fusion occurs when the fingers are fused distinct developmental defects.
The most common cutaneous syndactyly. At the same time the fingers are spliced throughout. Most often fused third and fourth fingers. The membranous form occurs when the fingers are spliced together in a skin bridge swimming membrane. In the form of syndactyly of bone fused fingers for one or all of the phalanges. Occasionally nerazedinenie terminal phalanges – end-fusion.
Treatment of syndactyly. Conservative treatment is not used. Fingers separated by surgery. Soft tissue syndactyly ordinary share at the age of 6 months. Operate complex defects after one year. The fingers were separated, and the lack of tissue recovered through brushes or tissues with skin grafts. After surgery, a plaster splint, and then prescribe physical therapy and exercise therapy.
Polydactyly. Polydactyly is a congenital abnormality of the fingers, which is from 6 to 10.Chasto occurring polydactyly – a split of the first finger, which may be full, or only the nail phalange bifurcated. Surgical treatment. Abnormal fingers removed.
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