Genetics and malformations of the hand

Syndactyly and intracranial arteriovenous malformation: case report

A case of a 14-year-old boy with syndactyly of all limbs and intracranial dural arteriovenous malformation (AVM) is presented. A failure of differentiation of cerebral vessels, possibly at 3 weeks gestational age, is discussed along with several alternative theories relating to the pathogenesis of dural AVMs. The embryogenesis of syndactyly, occurring as an arrest of normal interdigital tissue regression at 5-7 weeks gestational age, is also reviewed. It is postulated that a single common intrauterine environmental insult of vascular origin occurring during the second month of gestation, is the reason for their simultaneous manifestation.

Fibrous dysplasia of a metacarpal: a case report

Monostotic fibrous dysplasia limited to the hand has not been described previously. We report a case of fibrous dysplasia of a thumb metacarpal in a black man.

Deformities of the hand and wrist with ulnar deficiency

Deformities of the hand and wrist in 26 upper limbs of 20 patients with ulnar deficiency were studied. In eight limbs the ulna was totally absent. In the remainder it was severely or moderately hypoplastic. Abnormalities of the digits were present in all affected limbs. There was ectrodactyly in 25 hands. The thumb was hypoplastic in 21 hands and totally absent in five. Digital deformities also included syndactyly (14 hands) and delta phalanx (six hands). Early syndactyly release, pollicization, and rotational osteotomy of the metacarpals improved hand function in many of these patients. In only three of 26 limbs was there more than 20 degrees of fixed ulnar deviation at the wrist. In 16 patients the distal ulnar "anlage" was not removed. None of these patients developed ulnar deviation of the wrist or progressive deformity at the wrist during growth. Resection of the distal ulnar "anlage" does not appear to be warranted, unless there is progressive deformity of the wrist or elbow or increased bowing of the radius.