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Cleft Hand

What is cleft hand?

Cleft hand is a deformity where the affected limb has missing digits, a V or U shaped cleft from where the digits are missing and other deformities.

What causes cleft hand?

Typical cleft hand deformity is genetically transmitted and children have a 1 in 2 chance of getting the deformity if either of parents has the deformity.

It can also occur as an isolated deformity and the atypical type is commonly seen in different syndromic clefts.

Does this condition impair the hand function?

Most of the cleft hands have reasonable function. The appearance of hand is different perspective. Some congenital deformities may not appear very bad but may cause severe functional impairment.

There is no pain associated with this condition and child usually learns most of the pinches and grasps with slight modification. Even severely deformed cleft hands can have excellent function.

How does one assess severity of the deformity?

Cleft hand deformity is part of longitudinal failure of formation (central). So typically the whole of the affected ray is missing, while the adjacent rays are normally developed. Depending on the number of absent rays and the condition of web between thumb and the index digit the severity of the cleft is determined. Mild cleft involves only the 2nd interdigital cleft and the thumb is normal. In the worst form the cleft merges with the first web and even the thumb may be absent leaving only little finger (ulnar post).

Can the deformity be detected prenatally?

Cleft hand deformity develops at the age of 5 – 8 weeks and occasionally it can be detected during routine USG examination, though it cannot be treated.

Are any tests required to detect extent of disease?

Diagnosis is usually made after careful physical examination. X rays are taken to assess underlying skeleton. The assessment of hand function and the tests for various muscles, ligaments, blood vessels and nerves are important parts of physical examination.

What all conditions can be associated with it?

It can rarely be associated with cleft lip and palate, foot abnormalities, encephalocele (protrusion of brain membrane), conditions affecting the heart and digestive systems, and sometimes deafness.

What are the goals of surgery and when do we do it?

In patients with very minor cleft no treatment is necessary or if performed it is only for cosmetic appearance. The aim of surgery in others is preserving hand function, having a thumb and good first web space, and closing the cleft.

What are the complications of surgery?

Apart from the regular complications following surgery, like possibility of infection, bleeding and scar; as the child grows sometimes there may be widening of cleft that may need secondary procedures.