Abstracts Of Selected Articles
(The following abstract from the June 1964 issue of BIRTH DEFECTS is reprinted with the permission of the National Foundation-March of Dimes.)
CONGENITAL DEFORMITIES. Postgrad. Med. J. 40(463):275-279, May 1964.
Patterson, T. J. S. (Dept. Plast. Surg. , The United Oxford Hospitals, England. )
A review of malformations in the upper extremities discusses their incidence, etiology, classification, co-occurrence with multiple defects in the same limb or other systems, syndactyly with normal or abnormal digits, flexion contracture and lateral displacement problems, the absence of parts, the ring constriction syndrome, Polydactyly, and gigantism.
Noting that there is one upper limb defect in every 626 live births, only 5% of hand deformations are said to be inherited either in identical form across several generations of direct transmission or in irregular phenotypes, given a heritable disposition. Parental retrospection of suspicious episodes in pregnancy generally fails to reproduce relevant material before the seventh week of gestation, by which time the hand is already formed.
Absence of the pectoralis major is the commonest single associated congenital deficit in muscle, often on the same side as the hand deformity, and the local condition of the affected hand usually reflects serious involvement of surrounding tissues. Intervention before age 5 is preferred to very early surgical correction, since the eventual muscle atrophy or joint stiffening is probably a proper part of the defect itself and not a consequence and since any child is equally as able to develop novel movements after surgery by school age as he is to develop abnormal movements to compensate uncorrected defects in early infancy.
Early prosthesis to coincide with normal development is recommended only if therapy compels it, but later fitting is often obligatory for cosmetic reasons, particularly during adolescence. (sic)
Syndactyly with or without skeletal anomalies is cited as the commonest single defect, although often associated with other malformations, and relevant surgical indications are mentioned. Corrective principles and anatomic variations for positional anomalies, structural absences, excess tissue deformation, and ring constriction are discussed. (14 references)