Congenital anomalies of the top extremities are caused by violation of normal formation of extremities in the pre-natal period. Often the cause of congenital anomalies of the top extremities remains to the unknown. Congenital amputations, an underdevelopment, shortening of one or both hands, existence of a congenital false joint, amniotic banners, a kosorukost, a fokomeliya, a kampomeliya, the abnormal number of fingers of a brush or their union belong to congenital anomalies of the top extremities. Treatment of congenital anomalies of the top extremities is more often surgical. Prosthetics and training of the child in use of an abnormal extremity is important for self-service and in life.
Congenital anomalies of the top extremities
Congenital anomalies of the top extremities are caused by violation of normal formation of extremities in the pre-natal period.
The greatest value when developing congenital anomalies of the top extremities has influence of teratogenny factors (infectious diseases, alcohol intake and some medicines, ionizing radiation) on 3-7 weeks of pregnancy. Often the cause of congenital anomalies of the top extremities remains to the unknown.
The classification of congenital anomalies of the top extremities accepted in traumatology and orthopedics is rather conditional. Difficulties during creation of uniform classification are caused by a big variety of defects of development. Often found congenital anomalies of the top extremities can be classified as follows:
- congenital amputations of the top extremities;
- malformations (partial underdevelopment) of separate segments of the top extremities;
- congenital shortening of the top extremities;
- excess growth of the top extremities or their segments;
- amniotic banners;
- congenital false joints.
The first three groups (partial underdevelopment, congenital amputations and congenital shortening) unite in group of reducing defects (the defects caused by a stop of formation or a growth inhibition of separate parts of a skeleton).
Group of cross reducing defects of extremities which characteristic sign, unlike longitudinal defects, is total absence of the lower department of an extremity. Heavy pathology. Meets rather seldom. Congenital amputation at any level is possible: shoulder, forearm, brush, phalanxes of fingers. The extremity comes to an end with a stump. If the end of a stump settles down not at the level of a joint and is formed by a tubular bone, in process of growth of the child quite often there is a deformation of a stump caused by the uneven growth of a bone and soft fabrics.
The bone grows quicker, the stump becomes pointed, there is a danger of injury of skin by the pointed end of a bone. In such cases the reamputation is shown. If the child continues to grow, the stump is formed by many soft fabrics for the prevention of repeated development of a complication. Treatment of this pathology consists in prosthetics of an extremity. Reconstructive operations for expansion of opportunities of the subsequent prosthetics and ensuring bigger functionality of an artificial limb are in certain cases carried out.
Total absence of an extremity. Lack of extremities on both sides is possible (abrakhiya) or unilateral lack of an extremity (monobrakhiya). The humeral belt on side of the absent extremity is deformed and underdeveloped. Treatment consists in carrying out corrective operations and the subsequent prosthetics.
Congenital anomaly of the top extremities at which in whole or in part there are (proximal) departments of an extremity, close to a trunk. The brush is attached to a trunk or to underdeveloped proximal department of a shoulder. The extremity on appearance reminds flippers of a seal, than and the second name of this malformation is caused. The brush at a fokomeliya can be normally created or rudimentary (incomplete, underdeveloped). If one finger departs from a trunk instead of a normal brush (underdeveloped or completely created), pathology is called a peromeliya. As a rule, children study to use the deformed extremity in the volume sufficient for self-service. Prosthetics is carried out for the purpose of elimination of cosmetic defect.
The congenital anomaly of the top extremities relating to group of longitudinal reducing defects of which the underdevelopment of separate segments of the top extremity along its longitudinal axis is characteristic. The underdevelopment of one of bones of a forearm or anomaly of development of muscles of a forearm can be the cause of a congenital kosorukost.
The beam kosorukost (the pathology caused by an underdevelopment of a beam bone) meets more often an elbow kosorukost. Defect can be unilateral or bilateral. Defect of a beam bone is combined with an underdevelopment of the first finger, muscles of a forearm and bones of a wrist from the beam party. At this pathology the brush of the child is inclined knutr. Function of a brush is reduced, capture of objects is complicated because of an underdevelopment of the first finger.
The elbow kosorukost is caused by an underdevelopment or lack of an elbow bone that is confirmed when carrying out a X-ray analysis. Is followed by an underdevelopment of muscles from elbow side of a forearm. The underdevelopment of bones of a wrist and pyastny bones from the elbow party, absence or an underdevelopment of the IV-V fingers is possible. The brush of the child is inclined knaruzh, function of a brush is reduced.
Treatment of a congenital kosorukost long, multi-stage, has to be carried out by the orthopedist from the first days of life of the child. To children under 2 years appoint physiotherapy exercises and massage, apply special plaster bandages for correction of contractures. Surgeries are carried out after the child is 2 years old. The quantity and the nature of operations depend on expressiveness of pathology. At impossibility to provide sufficient restoration of function of an extremity and for elimination of cosmetic defect prosthetics is carried out.
The congenital anomaly of the top extremities which is followed by splitting of a brush. Allocate a typical ektrodaktiliya at which deep splitting of a brush is followed by lack of one or several fingers, and sometimes – and one or several pyastny bones. The second kind of this anomaly of development – an atypical ektrodaktiliya at which the anatomical structure of a brush is almost not changed and a crevice is unsharply expressed and has an appearance of the increased interdigital interval.
Tactics of treatment is chosen depending on expressiveness of pathology. Conservative therapy includes physiotherapy exercises, massage and imposing of plaster bandages. At preservation of function of the first finger reconstructive operations are performed.
Congenital anomaly of the top extremities of which absence, an underdevelopment or the expressed shortening of phalanxes of fingers is characteristic. Conservative therapy (LFK, massage) is directed to development of muscles and a linking of a brush. At the expressed brakhidaktiliya perform reconstructive operations.
Increase in number of fingers. Polidaktiliya can be characterized by full and incomplete development of additional fingers. Treatment is quick, consists an additional finger at a distance.
The union of several fingers among themselves carries the name a sindaktiliya. More often the second and third fingers grow together. The union of all soft fabrics, an union of bones or formation of a skin membrane between fingers is possible. At the age of 2-3 years to the child fingers of the child divide in the surgical way.
Congenital anomaly of the top extremities at which increase in some segments is observed (more often – fingers) or all extremity.
Curvature of tubular bones of the top extremities (humeral bone and/or bones of a forearm). In certain cases with age deformation of extremities disappears independently. If the curvature is not leveled, carry out surgical correction.