Pediatric Orthopaedic Conditions
Club foot :: Juvenile arthritis :: Septric arthritis :: Pediatric Fractures :: Pediatric Sports-Related injuries :: Developmental dysplasia of the hip (DDH) :: Neuromuscular Conditions :: Congenital Deformities of Lower Limb :: Congenital Hand Deformities
Club foot is a common foot deformity present at birth where in one or both the feet are turned towards an inward and downward position. It is more common in boys than girls. It is also called as talipes equinovarus.
Club foot is of two types:
- Postural or positional club foot – This occurs as a result of abnormal positioning of the fetus in the mother’s womb. The foot is flexible and can be moved to a near normal position after birth.
- Rigid or fixed club foot – In rigid form, the foot is rigid or stiff as the muscles at the back of the lower leg become very tight.
Although club foot does not cause any pain, it can affect the physical appearance and the child’s ability to walk. Children with club foot may have abnormal foot where,
- Foot may be slightly smaller than the normal
- The front of the foot may be twisted toward the other foot
- Stiff muscles in the lower leg which may affect range of motion
The exact cause of clubfoot is unknown. Genetic and environmental factors may have a role in developing the condition. Other congenital malformations such as spina bifida may also cause club foot.
Treatment options include:
Stretching and Casting – It is also known as the Ponseti method. The foot is manipulated into a correct position and a cast is placed to maintain that position. Repositioning and recasting is repeated for every 1 to 2 weeks for 2 to 4 months, each time bringing the foot toward the normal position. After realignment of the foot, it is maintained through splinting with braces to keep the foot in the corrected position. The brace is worn for 3 months following which it is worn only at night for up to 3 years, to maintain the correction.
Club foot repair – It is surgical repair of the birth defect which involves lengthening or shortening the tendons (tissues that help attaches muscles to bones) of the foot.
Osteotomy – It is a surgical procedure where a part of the bone is cut to shorten or lengthen its alignment. The procedure involves removal of a wedge shaped bone located near the damaged joint and the remaining bones are joined together and secured using the staples or pins.
Fusion or arthrodesis – It is a surgical procedure where two or more bones are joined or fused together. Bone for fusion will be taken from other parts in the body. Metal pins or plates may be used to hold the bones in position.
Juvenile arthritis is the term used to describe arthritis in children younger than 16 years. Juvenile arthritis is twice more common in girls than boys and the most common type is juvenile idiopathic arthritis (JIA). Juvenile idiopathic arthritis is an autoimmune disorder affecting the joints of the knee, hands and feet. It causes pain, swelling, stiffness, and feeling of warmth in the joints.
The probable causes of juvenile idiopathic arthritis include:
Autoimmune condition: This is a disorder in which the child’s immune system fails to recognize the body’s own tissues, the synovial cells in the joint, causing the body to attack and destroy the cartilage and bone. The reason for this condition is unknown.
Genetic factors: It is believed that some of the genes inherited by the child from the parents may increase the risk of developing juvenile arthritis.
Environmental factors: A viral infection can trigger the disease.
Signs and Symptoms
The most common symptoms of juvenile arthritis are pain and swelling in the joints with joint stiffness that may worsen in the morning or after bedtime.
Other symptoms include:
- Restricted movements of the affected joint causing your child to limp in the morning
- Fever or a skin rash if your child has systemic juvenile arthritis.
- Swollen lymph nodes of the neck or other areas of the body.
Your doctor will carefully examine your child for symptoms and collect medical and family history. In addition some diagnostic tests may be required to confirm the disease and disease sub-type. These include:
Blood tests: Blood is tested for anti-cyclic citrullinated (CCP) antibodies, rheumatoid factor, antinuclear antibodies, and erythrocyte sedimentation rate (ESR). Blood tests help to identify the type of juvenile arthritis and to rule out other diseases.
X rays: X-rays may be required to confirm any injury to the bone or unusual bone development.
Differential diagnosis: Certain other tests may be performed to exclude other conditions such as viral infections and physical injuries that may have similar symptoms to arthritis.
The treatment for juvenile arthritis is aimed at reducing the symptoms such as swelling and pain in the joints and preventing further complications. A combination approach of both medicine and physical therapy helps to improve the physical activities of your child.
- Nonsteroidal anti-inflammatory drugs: Nonsteroidal anti-inflammatory drugs (NSAID’s) relieve the joint pain and swelling by blocking the substances that cause inflammation. These are the first line of medications prescribed.
- Disease-modifying anti-rheumatic drugs (DMARDs): These drugs are often prescribed along with NSAIDs to reduce pain, stiffness, and inflammation and slow down the progression of the disease.
- Corticosteroids: Corticosteroids are prescribed in moderate to severe cases of juvenile arthritis with inflammation of the heart sac, pericarditis, or for acute stages of arthritis. They are available as oral medications or in the form of injections. When only one or a few joints are affected, corticosteroid injections are recommended to provide quick relief from pain in the joint.
- Biologic agents or biologic response modifiers: These medications act by blocking the tumor necrosis factor (TNF) that causes inflammation.
- Physical therapy: Physical therapy programs involve a regular schedule of exercises added to your child’s treatment plan. Physical therapy helps to improve muscle tone and recover the motion of the joints. The use of splints may be recommended to guide normal growth of the bone and joints.
Surgery: Surgical intervention is usually not needed, but in severe cases of polyarticular juvenile arthritis, joint replacement surgery of the hips may be considered after bone growth is complete. Surgical correction may also be needed in conditions of marked leg length variations.
Septic arthritis, also called as infectious arthritis, is characterized by joint inflammation due to a bacterial or fungal infection that usually affects the large joints of the body such as knee or hip. Normally, fluid lubricating a joint, called synovial fluid, is aseptic in nature. But with septic arthritis, microbes can grow in the affected joint fluid and make the condition worse.
Based on the duration and severity of the septic arthritis, it is categorized as:
- Acute septic arthritis: It is more common, may develop suddenly and is considered more severe. The bacteria generally involved are staphylococcus or streptococcus.
- Chronic septic arthritis: It is less common, develops slowly and is less severe. The involved microorganisms are mycobacterium tuberculosis and candida albicans.
Septic arthritis may affect individuals of any age. Children below 3 years (infants) are often affected by septic arthritis as compared to children of age 3 to adolescence. Infants generally show more infection in the hip region.
Causes and risks factors
Septic arthritis may be caused due to infection of microorganisms such as bacteria, viruses, and fungi. The infection may spread either through the bloodstream, or by injury or even during surgery. Among the different causes, bacterial infection is the most common.
Risks factors for developing septic arthritis includes various conditions such as artificial joint implants, intravenous (IV) injection, immunosuppressant drugs, joint injury, joint arthroscopy or other surgery and also certain chronic diseases such as diabetes, rheumatoid arthritis, and sickle cell anaemia.
The common symptoms associated with septic arthritis are:
- Redness in the affected joint
- Swelling in the joint
- Joint pain that may get worse with movement
In severe cases, patients may not be able to move the limb of the infected joint, called as pseudo paralysis.
The diagnosis of septic arthritis includes examination of synovial fluid of the affected joint, blood culture, and X-rays.
Septic arthritis treatment includes specific antibiotics to treat the infection. Additional measures such as rest, keeping the joint motionless, elevating the joint and applying cold compresses may reduce symptoms. Certain exercises are also recommended for the recovery of the affected joint.
In cases of excessive accumulation of synovial fluid in the affected joint it is drained through a sterile needle. In severe cases, surgery may be employed for draining the infected joint fluid.
Fractures are more common in children due to their activities as well as their bone properties. Children are more active than adults and management of fractures in them also differs as compared to that in adults. Fracture occurs when the bone is subjected to excessive stress than normal. It is very common in children because of the presence of growth plate which is the area of the child’s bone that consists of cartilage cells that transform into solid bone as the child grows. Growth plate fractures occur more often because it is the weakest area in the bone.
Children with growth plate fracture may complain of pain and localized tenderness over the growth plate. There may or may not be any swelling or an obvious deformity. Clinical examination and X-rays will be required for diagnosis of a growth plate fracture.
Once your doctor has confirmed the diagnosis of growth plate fracture, the treatment options will be discussed. If there is a non-displaced fracture in which the broken bone ends remain aligned in correct anatomic position, then casting is the treatment option. A reduction will be necessary if the fracture is displaced and is done under local or general anesthesia. A confirmatory X-ray will be taken to ensure correct positioning of the fracture ends after reduction. In certain cases, surgery may be required to reposition the growth plate fracture into healing position.
Your doctor will schedule a follow-up visit after few months during which X-rays will be taken to check for normal bone growth. If any growth disturbance or deformity is detected, further treatment becomes necessary.
Other types of fractures
- Torus/Buckle fractures: A torus or buckle fracture is one of the most common fractures that occur in children. It is because of end-to-end compression of the bone, which results in buckling or giving way of the sides of the bone.
- Greenstick fractures: This is unique fracture in children that involves bending of one side of the bone without any break in the bone.
- Toddler fracture occurs in young children when there is injury to tibia (shin bone). This fracture is not evident on an X-ray as they are undisplaced.
- Nursemaid elbow occurs when there is displacement of one of the bones (radius) in the elbow joint. It usually occurs in children younger than 5 years.
Early fracture management aims at controlling bleeding, preventing ischemic injury (bone death) and removal of sources of infection such as foreign bodies and dead tissues. The next step in fracture management is the reduction of the fracture and its maintenance. It is important to ensure that the involved part of the body returns to its function after fracture heals. To achieve this, maintenance of fracture reduction with immobilization technique is done by either non-operative or surgical method.
Non-operative (closed) therapy comprises of casting and traction (skin and skeletal traction).
- Casting-Closed reduction is done for any fracture that is displaced, shortened, or angulated. Splints and casts made up of fiberglass or plaster of Paris material are used to immobilize the limb.
- Traction-Traction method is used for the management of fractures and dislocations that cannot be treated by casting. There are two methods of traction namely, skin traction and skeletal traction. Skin traction involves attachment of traction tapes to the skin of the limb segment below the fracture. In skeletal traction, a pin is inserted through the bone distal to the fracture. Weights will be applied to this pin, and the patient is placed in a setting that facilitates traction. This method is most commonly used for fractures of the thighbone.
Open Reduction and Internal Fixation (ORIF)-This is a surgical procedure in which the fracture site is adequately exposed and reduction of fracture is done. Internal fixation is done with devices such as Kirschner wires, plates and screws, and intramedullary nails.
External fixation-External fixation is a procedure in which the fracture stabilization is done at a distance from the site of fracture. It helps to maintain bone length and alignment without casting.
External fixation is performed in the following conditions:
- Open fractures with soft-tissue involvement
- Burns and soft tissue injuries
- Pelvic fractures
- Comminuted and unstable fractures
- Fractures having bony deficits
- Limb-lengthening procedures
- Fractures with infection or nonunion
Fractures may take several weeks to months to heal completely. Children should limit their activities even after the removal of cast or brace so that the bone become solid enough to bear the stress.
The number of children participating in sports activities has been increasing over the recent years resulting in a substantial rise in the incidences of sports injuries. Even though there are several benefits of active participation in sports, including building up of self-confidence, physical fitness, and learning to work in a team, there is also a risk of sports-related injuries. The risk of having an injury increases by a lack of protective gear especially during sports activities such as boxing, wrestling and hockey.
Childhood sports injuries are injuries may either be accidental injuries or develop as a result of inadequate training or practice. The most common sports injuries in children are soft-tissue injuries and head injury.
Some of the common sports injuries in children include:
- Sprains and Strains: A strain refers to the stretching or tear of a muscle or tendon (tissue that connects muscles to bone) while a sprain refers to the stretching or tear of a ligament (tissue that connect adjacent bones).
- Growth plate injuries: Growth plate injuries result form a damage to the area at the end of the long bones (growth plate), of a growing child.
- Repetitive Motion Injuries: Repetitive motion injuries are caused by overuse of the tendons and muscles. It includes stress fractures and tendinitis (inflammation of the tendon). These injuries cause severe pain and discomfort.
- Heat-Related Illnesses: Heat-related illnesses include dehydration (loss of body fluids), heat exhaustion and heat stroke (characterized by hot dry skin, headache, and dizziness leading to vascular collapse, coma, and death).
Causes of sports injuries
The causes of sports injuries in children include:
- Slow reaction time: The slower reaction time in growing children makes them susceptible to sports related injuries
- Poor training or practice
- Lack of adequate protection gear such as mouth guards, headgears for respective sports
- Insufficient stretching or warm-up exercises before playing
The sports injuries in children can be acute injuries or overuse injuries.
- Acute injuries: Young children may develop minor bruises, sprains and strains. Teenagers are likely to sustain more severe injuries such as broken bones and ligament tear. Acute injuries most commonly occur due to a lack of proper protective equipment during sports activities.
- Overuse injuries: These injuries occur because of continuous stress on the bones and muscles from repetitive movements of a particular joint. The most common types of overuse injuries are:
- Anterior knee pain: It refers to pain in the front of the knee, below the kneecap associated with swelling because of inflammation of the tendon or cartilage.
- Little League elbow: It causes pain in the elbow because of repeated throwing action and may be associated with a difficulty in extending the arm.
- Swimmer’s shoulder: It causes pain and swelling of the shoulder because of stress from repetitive movements of the shoulder during activities such as swimming or throw ball.
- Shin splints: It leads to pain and discomfort in the front of the legs due to continuous running or overtraining.
- Spondylolysis: This condition is characterized by chronic low back pain due to repeated stretching of the back muscles and is common in children who engage in sports such as football, weightlifting, gymnastics and wrestling.
The factors associated with an increased risk of sustaining a sports injury, in children, include:
- Growth spurt phase (period of rapid growth during adolescence): During this period, the elasticity of the bone is reduced due to rapid bone growth, which predisposes the bone to injury
- Improper use or lack of protective equipments and unfavorable environmental conditions increase the risk of injury Poor nutrition: Lack of a healthy diet predisposes a child to injury
Treatment for sports injuries depends on the nature of injury. The most common treatment recommended for sports-related injury is rest, ice, compression and elevation (RICE). H
- Rest: Avoid activities that may cause injury.
- Ice: Ice packs can be applied to the injured area which will help to diminish swelling and pain. Ice should be applied over a towel to the affected area for 15-20 minutes four times a day for several days. Never place ice directly over the skin.
- Compression: Compression of the injured area helps to reduce swelling. Elastic wraps, air casts, and splints can accomplish this.
- Elevation: Elevate the injured part above heart level to reduce swelling and pain.
Some of the measures that are to be followed to prevent sports related injuries include:
- Follow an exercise program to strengthen the muscles
- Gradually increase your exercise level and avoid overdoing the exercise
- Ensure that you wear properly-fitted protective gear such as elbow guards, eye gear, facemasks, mouth guards, and pads, comfortable clothes, and athletic shoes before playing any sports activity which will help to reduce the chances of injury
- Make sure that you follow warm up and cool down exercises before and after sports activity. Exercises will help to stretch the muscles, increase flexibility, and reduce soft tissue injuries
- Avoid exercising immediately after eating a large meal
- Maintain a healthy diet which will nourish the muscles
- Avoid playing when you are injured or tired. Take a break for sometime after playing.
- Learn all the rules of the game you are participating in
- Ensure that you are physically fit to play the sport
Developmental dysplasia of the hip (DDH) or Hip dysplasia is a condition which is seen in infants and young children as a result of developmental problems in the hip joint. The femur (thigh bone) partially or completely slips out of the hip socket causing dislocation at the hip joint. It is most common in first born baby with family history of the disorder. The exact cause for hip dysplasia is not known. Genetic factors play an important role in causing this birth defect. DDH can be mild or severe and can affect one or both hips. It is more common in girls and usually affects the left hip. DDH does not cause any pain and so the condition may not be noticed until the child starts to walk.
The common symptoms of hip dysplasia include:
- Position of the legs may differ (dislocated hip may cause leg on that side to turn outwards)
- Restricted movement on the side of hip dislocation
- The leg may appear shorter on the side where hip is dislocated
- Skin folds of fat on the thigh or buttocks may appear uneven.
In normal hip, the head of the femur (thigh bone) fits well into the socket (acetabulum) whereas in hip dysplasia, the socket and femoral head are not congruent because of their abnormal development. During hip examination, the doctor may also look for the difference in range of motion of the hip, presence of uneven skin folds around the thigh and difference in leg length from side to side. In infants less than 6 months, an ultrasound may be advised to confirm the diagnosis.
The treatment for DDH depends on both the age of the child and severity of the condition. The aim of treatment is to keep the femoral head in good contact with the acetabulum so that the hip can develop normally. A pavlik harness may be used to keep the hip in flexion and abduction may be advised. Only when conventional treatment is not effective, surgery to put the hip back into place may be advised.
A neuromuscular disease is a disorder that affects the muscles and its nervous control. Neuromuscular disorders are the conditions caused by impaired neuronal activity of the nerves that control the voluntary muscle activities. Children’s with neuromuscular disorders often experience muscle pain or weakness, muscle twitching, cramping, numbness and tingling, muscle stiffness causing joint deformities and sometimes difficulty in swallowing and breathing. Neuromuscular disorders in children may be present at the time of birth or may be developed at later stages of life. Abnormality of different components of the lower motor neuron may cause different disorders.
Abnormality of peripheral nerves and muscles
Cerebral palsy: Cerebral palsy occurs in infants or in early childhood that affects body movements, balance, posture, and muscle coordination. It is the result of damage to one or more brain parts that controls muscle movements. Babies with cerebral palsy may delay in reaching, developmental stages such as sitting, rolling, crawling, or walking.
Treatment includes physical therapy, occupational therapy, use of specialized equipments, and medications to reduce spastic movements and prevent seizures. In some cases surgery may be necessary to cut few nerves from the spinal cord
Abnormalities of the Neuromuscular Junction
Myasthenia gravis: Myasthenia gravis is an autoimmune disorder in which your child’s immune system makes antibodies to block that signal. It blocks the messages sent by the brain to the muscle. Children’s with myasthenia gravis often have trouble in eye and eyelid movement, facial expression and problems with chewing, swallowing and holding up their head. Medications are used to help improve neuromuscular transmission and increase muscle strength. Sometimes, thymectomy, the surgical removal of the thymus gland helps to reduce the symptoms.
Congenital myasthenic syndrome (CMS): This condition causes generalized weakness of voluntary muscles and muscle fatigue involving all the muscles controlling mobility, eye movement, swallowing and breathing.
Abnormalities of the Peripheral Nerve
Charcot-Marie-Tooth disease: Charcot-Marie-Tooth Disease (CMT) is a genetic nerve disorder that affects your peripheral nerves. The condition is caused by a defect in the genes for proteins that is found in the structure and function of either the peripheral nerve axon or the myelin sheath. Patients with this condition often have muscle weakness and wasting as well as some loss of sensation in the feet, lower legs, hands and forearms and may involve foot deformities.
Dejerine-Sottas disease: It is an inherited neurological disorder that causes slow development of early motor milestones. Progression of the disease varies and is often associated with pain, weakness, numbness, and a tingling, prickling or burning sensation in the legs.
Inflammatory myopathies are a group of muscle diseases that involve chronic muscle inflammation and muscle weakness. It is an autoimmune disorder in which the body’s white blood cells are attacked by its own immune system. Patients with inflammatory myopathies may have slow but progressive muscle weakness that begins in the proximal muscles.
Dermatomyositis: Dermatomyositis is characterized by reddish or purplish skin rashes, hard, painful calcium nodules under the skin, muscle pain and tenderness, and progressive weakness of the muscles of the hips, thighs, and upper arms, upper part of the back, shoulders and neck muscles.
Polymyositis: Polymyositis involves inflammation of the skeletal muscles of both sides of the body. Symptoms such as progressive muscle weakness of neck and throat, shoulder, hip and thigh may occur.
Muscular dystrophy refers to group of hereditary diseases that weakens the muscles associated with movements. Muscular dystrophy is caused by defective genes. It is caused due to genetic deficiency of the muscle protein called dystrophin. There is no specific treatment for any form of muscular dystrophy but certain medications, physical therapy and assistive devices can slow the progress of some forms of muscular dystrophy. Tendon release surgery is performed to relieve contractures. Muscular dystrophy can occur at infancy or childhood. Major forms of muscular dystrophy may include:
Duchenne muscular dystrophy – It is the most common kind of muscular dystrophy affecting only boys, between the ages of 2 to 6. It is characterized by generalized muscle weakness and muscle wasting first affecting the muscles of the hips, pelvic area, thighs and shoulders and eventually involving all voluntary muscles.
Becker muscular dystrophy – This form is similar to duchenne muscular dystrophy. It generally occurs between the ages of 2 and 16 but can appear as late as age 25. Children’s with this condition show generalized weakness and wasting of the muscles of the hips, pelvic area, thighs and shoulders, enlarged calves and heart complications.
Emery-Dreifuss muscular dystrophy – The condition usually appears from the childhood to early teen years and affects only males. It is characterized by weakness and wasting of shoulder, upper arm and shin muscles and may also cause joint deformities and heart complications.
Facioscapulohumeral muscular dystrophy – Onset usually occurs in the teens to early adulthood and affects both men and women. The condition causes weakness and wasting of muscles around the eyes and mouth, and of the shoulders, upper arms and lower legs.
Myotonic muscular dystrophy – Myotonic muscular dystrophy (MMD) is also called steinert’s disease. Muscular dystrophy may begin from birth through adulthood and rarely occurs in the newborns. The condition causes inability to relax the muscles and muscle weakness.
Congenital muscular dystrophy – It is a form of muscular dystrophy that is present at birth. The condition is characterized with generalized muscle weakness and joint deformities.
Motor neuron diseases
Spinal muscular atrophy is an inherited disease that attacks the nerve cells called motor neurons characterized by progressive muscle degeneration and weakness.
Infantile progressive spinal muscular atrophy: Infantile progressive spinal muscular atrophy (SMA Type1) is the most severe form and the infants with this type may have poor muscle tone, progressive weakness, and lack of head control, trouble swallowing and sucking, and breathing problems.
Intermediate spinal muscular atrophy: Children’s with intermediate spinal muscular atrophy (SMA type 2) may have weakness in arms, legs, upper and lower torso, and often have joint deformities.
Juvenile spinal muscular atrophy (SMA type 3): Juvenile spinal muscular atrophy (SMA type 3) is the least severe form of the disease and is characterized by weakness in leg, hip, shoulder, arm and respiratory muscles.
Congenital deformities of the lower limbs are the developmental disorders which are present at birth and cause alteration in the shape and appearance of the legs. The exact cause for this is not known. There are several factors such as genetic factors which influence the fetal growth in the womb and teratogenic drugs and chemicals that can cause congenital deformities. Some of the congenital deformities of the lower limb include:
Congenital talipus equino varus (club foot): Congenital clubfoot is the most common and obvious of all the foot deformities. The feet become twisted inwards in such a way that top of the foot comes in place where the bottom should be. The initial treatment for clubfoot is the use of non-surgical methods such as serial manipulation and casting using the Ponseti method, taping, physical therapy and splinting, continuous passive motion with a machine. Surgical correction is done in severe cases which may include release of soft tissue and joint contractures, tendon lengthening and fixation of temporary pins in the foot.
Congenital hip problems: Congenital hip problems that can affect children are of two types namely:
- Femoral anteversion: Femoral anteversion is the condition in which the femur (thigh bone) becomes twisted inwards causing the child’s knees and feet to turn inwards giving the “pigeon-toed” appearance. It is most commonly evident when the child’s age is in between 4 and 6 years. Often no treatment is required as the defect is self-correcting. Surgical treatment may be considered if the condition is severe and the child is above the age of 8. The surgery called, femoral derotation osteotomy is done which involves cutting the femur bone and rotating it to bring it to correct position.
- Developmental dysplasia of the hip: Developmental dysplasia of the hip (DDH) is a condition which is seen in infants and children as a result of developmental problems in the hip joint. The femur partially or completely slips out of the hip socket causing dislocation at the hip joint. Pavlik harness is used in newborns and infants of age less than 6 months in order to hold the hip joint in place during growth of the child. Surgical treatment for this condition includes closed reduction with hip spica casting and open reduction.
Congenital genu varus (bowed legs): Bowed legs are seen in children below 2 years. It is a normal variation in the appearance of the legs and gradually improves by the age of 3 to 4 years. Night splints may be given or osteotomy can be performed in severe cases.
Leg length discrepancy: Leg length discrepancy is a condition in which one leg is shorter than the other leading to problems in posture and walking pattern. There may be associated pain in the back, hip knee or ankle. It can be corrected by a reconstructive procedure called limb lengthening during which the deformed bone is lengthened by replacing the lost bone. The deformity can be corrected using minimally invasive surgery and may require a hospital admission of 1-2 nights.
Congenital hand deformities are deformities of the hand or any part of hand that are present at birth. These deformities can be particularly disabling as the hands are important for the child for its interaction. Congenital hand deformities may be as simple as digital disproportion or may be the complete absence of a bone. Congenital deformities may be developed because of injury, diseases conditions or may be present during birth because of any abnormalities during the growth in womb. It should be treated at an early stage before the problem becomes severe.
Types of Congenital hand deformities
Type I- Failure of digit formation
These deformities occur due to problems occurring during development of baby in the womb.
- Radial and Ulnar ClubHand Deformity: This type of deformity involves all the tissues resulting in a short thumb, or complete absence of the thumb, and underdeveloped muscles and ulnar bone.
- Thalidomide related deformity of limbs: Thalidomide is a drug used for morning sickness in pregnant women which is currently banned for use because of its teratogenic effects i.e. severe birth defects in children such as incomplete or abnormal development of upper and lower limbs.
Type II- Failure of differentiation
In this type of deformity the soft tissues or the bones of the fingers fail to separate. These types of deformities require surgical correction, and usually surgery is not recommended until the second year of life.
- Syndactyly: It is the most common deformity in which two or more fingers are fused together. Simple syndactyly involves fusion of only the soft tissues of fingers whereas complex syndactyly involves fusion of both soft tissues and bones of the fingers.
- Contractures: Contractures may result by improper differentiation of cells which may cause abnormal pulling of the digits as in congenital trigger thumb where the child may not be able to extend the thumb straight.
Type III- Duplication
Duplication is the abnormality where a child will have extra digits in the hand. The condition is called polydactyly and in many cases the extra digit would be the little finger.
Type IV- Overgrowth
Overgrowth or macrodactyly is the excessive growth of a digit causing abnormally large digit. Macrodactyly is a rare condition and most commonly affects the index finger. Surgery is complex and may have poor outcomes. Amputation may be recommended in many cases.
Type V- Undergrowth
Undergrowth or brachydactyly is the condition of underdevelopment of fingers or thumbs and may present with small digit which may be because of missing muscles, underdeveloped or missing bones, and complete absence of a digit. Surgery may not be recommended in all individuals.
Type VI-Constriction ring syndrome
The abnormality occurs because of a constricting band of tissue around a finger or arm that interrupts the blood flow to the digit and the normal growth of the tissues. Constriction ring syndrome is often associated with other congenital abnormalities such as clubfoot, cleft lip, cleft palate, or other craniofacial anomalies.
Type VII- Generalized abnormalities and syndromes
These types of deformities are acquired and may occur due to injury or disease.
Your pediatric orthopedic doctor performs physical examination to determine child’s hand conditions. X-rays may be required to see if there is any fracture or to check the condition of joint surface.
Your doctor may suggest the following treatments based on your child’s age, health conditions, cause of the condition, and tolerance to specific medications, procedures, or therapies. Early correction of the deformities allows for normal development and function of hand and prevents the development of permanent deformities.
Some of the treatment options include:
- Limb manipulation and stretching is done to increase the movement of a restricted area to bring back the normal motion by eliminating pain and other symptoms.
- Skin grafting, a procedure in which part of hand that has a missing skin is attached or replaced with skin that is either removed from different part of the own body.
- Use of prosthetics, an artificial device that replaces the missing bone in hand
- Splinting of the affected limbs
- Physical therapy is recommended to help increase the strength and function of the hand
- Various surgeries are performed to correct the abnormalities including reduction and fixation of broken bone, drainage and debridement, micro-surgical replantation, skin flap, tendon and nerve repairs, arthroplasty, and fasciotomy.