Surgery for congenital hand deformities

There are several different types of congenital hand deformities ranging from minor deformities that may not significantly impact your child's life, to deformities that may affect your child's ability to perform everyday tasks.

Some of the most common types of congenital hand deformities include:

Extra digits (polydactyly)

This is the most common type of hand deformity and occurs when there are more than five fingers on one hand.

The extra finger is often made of soft tissue without bones and can easily be removed. Some extra digits may contain bones without joints or more rarely, are a fully-formed finger.

Babies may be born with one or more extra fingers and the condition can affect one or both hands. The condition is equally common in boys and girls.

Types of polydactyly include:

• Preaxial polydactyly - is where there is an extra thumb. This condition is more common in Caucasians. It is normally treated with surgery
• Postaxial polydactyly - involves having extra digits on the little finger side of the hand which may be fully formed fingers or small stumps. It is most common in Black populations. It can usually be treated with surgery
• Central polydactyly - is less common than other types of polydactyly and occurs when there are extra digits between the central fingers. Central polydactyly can usually be treated with surgery.

Fused fingers (syndactyly)

This is a common congenital hand deformity and occurs when two or more fingers are joined together and appear 'webbed'. It occurs when the fingers fail to separate in the womb and usually affects the middle and ring fingers.

Syndactyly is twice as common in boys as in girls and commonly runs in families. The condition often affects both the fingers and toes. It is normally corrected with surgery before eighteen months of age.

Types of syndactyly include:

• Complete syndactyly - the fingers are joined all the way to the fingertips
• Incomplete syndactyly- the fingers are joined part of the way to the fingertips
• Simple syndactyly - the fingers are joined together by skin and soft tissue
• Complex syndactyly - the finger bones are fused together

Underdeveloped hand (symbrachydactyly)

Symbrachydactyly can cause short or missing fingers, webbed fingers, or a short forearm. It is a rare condition and affects boys and girls equally. Treatment for symbrachydactyly varies according to how severe it is.

It is sometimes treated with surgery.

• Mild symbrachydactyly - the fingers are short with minor webbing. The hand bones, some of the finger bones, and the thumb are present
• Moderate symbrachydactyly - most of the finger bones are missing. The thumb may be present but is often short
• Severe symbrachydactyly - There are no fingers. There may be a partial thumb or no thumb

Club hand

Club hand occurs when one of the bones that make up the lower arm (the radius or ulna) is partially or completely missing. The forearm is often shorter than usual, and the hand turns inwards causing limited movement in the wrist. There are two types of club hand depending on the bone that is affected:

• Radial club hand - typically causes a short forearm and a hand curved towards the thumb side of the hand. Surgery to straighten the bones and fix the tendons is usually performed between six and twelve months of age
• Ulna club hand - is less common than radial club hand and causes the wrist to bend towards the little finger. The thumb may be deformed or absent. The condition may be treated with exercise and splinting, or in some cases, surgery

Cleft hand (ectrodactyly)

This is a rare condition where the middle part of the hand develops abnormally and one or more of the central fingers are missing making a V or U-shaped cleft in the centre of the hand.

• Typical cleft hand - the hand is V-shaped, and the middle fingers are missing or partially missing. It usually affects both hands and may also affect the feet. This type of cleft hand often runs in families
• Atypical cleft hand - the hand is U-shaped, and the middle fingers are missing or partially missing. Atypical cleft hand affects one hand and doesn't usually run in families. It may occur as a symptom of other conditions such as Poland syndrome

Small (hypoplastic) thumbs

The thumb may be small and not fully formed or absent. Surgery may involve reconstructing the thumb and tendons or removing the hypoplastic thumb and converting the index finger into a thumb.

Trigger thumb

This is a condition involving the tendons in the thumb that makes it difficult for the child to bend their thumb. It sometimes resolves without treatment by about a year of age, but in some cases, surgery may be needed to release the tendon.

At your first consultation, your child will usually be seen by a consultant hand and wrist surgeon or an orthopaedic consultant.

Your consultant will discuss your child's symptoms and perform a physical examination. They may order scans including X-rays, CT scans, and MRIs to check the bones and soft tissues of your child's hand and wrist.

Your consultant will discuss the best treatment options for your child based on the physical examination and the results of any tests or scans. They may refer you to a specialist hand therapist, a physiotherapist, or occupational therapist who specialises in conditions affecting the hand.

If surgery is an option, your consultant will explain the type of surgery required, any potential risks and complications, and what kind of outcome you can expect from surgery.

Why is this first consultation so important?

At Circle Health Group, your first appointment is where we get to know you and your child, make a diagnosis, and recommend a suitable treatment. It's also where we can discuss your expectations for treatment and encourage you to ask any questions you may have.

We understand that when your child needs medical treatment, it can be a worrying and at times overwhelming experience. It is very important to us that you are as well-informed and comfortable as possible before, during, and after your child's treatment, so please ask your consultant any questions you may have.

Treatment for your child’s hand deformity will depend on several factors including:

• Your child’s age, general health, and medical history
• The type of hand deformity
• How severe the deformity is
• How well your child tolerates medical procedures, medications, or therapies
• Your expectations for treatment
• Your preferences and opinions regarding treatment

Treatment may be surgical or non-surgical.

Some non-surgical options for treatment include:

• Limb manipulation and stretching
• Splinting
• Physiotherapy to strengthen muscles, correct muscle contractures
  and improve the function of the hand
• Use of prosthetics (an artificial hand or fingers)

Surgery is a common treatment for hand deformities and is normally done as early as possible.

Common surgical procedures to correct hand deformities include:

Syndactyly surgery (syndactyly release)

This is a procedure to correct syndactyly where two or more fingers are joined together. During the procedure, the surgeon uses zig-zag shaped incisions to separate the fingers and wrap the skin around the separated fingers. This technique reduces scarring and allows for greater movement of the fingers. Sometimes, skin grafts may be used if there is not enough skin to cover the space between the fingers.

Syndactyly surgery is usually performed at around one year of age, though it may be done at six months if the thumb or little finger is affected.

Polydactyly surgery

This is surgery to correct hand deformities where one or both hands have extra digits.

For ulna polydactyly, the extra little finger may be surgically removed, or if there is no bone present, a suture or clip may be tied around the extra digit to reduce blood flow so that the digit falls off. This is done shortly after birth.

For radial polydactyly, a single thumb is reconstructed using the two duplicated thumbs. In some cases, if the thumb is small and non-functional it may be removed.

For central polydactyly, the soft tissues, joints, tendons, and ligaments of the hand are reconstructed. This may need more than one operation.

Club hand surgery

Club hand doesn't always require surgery and can often be treated by splinting the hand, stretching exercises, and physiotherapy.

If surgery is needed, the type of procedure depends on how severe the condition is.

In some cases, bones and soft tissues are lengthened using pins and an external fixator. The pins are adjusted as the bones and soft tissues lengthen and heal over a period of one or two months. Surgery may also be performed to release tightness in the wrist.

Symbrachydactyly surgery

Mild symbrachydactyly often doesn't need surgery, but in moderate to severe cases, surgery may be performed to improve the appearance and function of the hand. There are two types of surgery used to treat symbrachydactyly.

Distraction augmentation manoplasty involves three stages. The first stage of this surgery is a phalangeal transfer where bones from the toes are transferred to the soft tissue sacks to create four short fingers that can move at the knuckle joint.

In the second stage, called distraction lengthening, the bones are cut and attached to rods and pins that are gradually moved away from each other. The gap between the bones is then filled using a bone graft taken from the hip or foot and the finger bones are fixed with wires and left to heal.

The third stage of surgery is to deepen the web spaces between the fingers to allow greater movement.

Toe to hand transfer is another option to treat symbrachydactyly. It involves transferring one or two toes (the second toe from each foot) onto the hand creating a hand with one or two digits that can pinch against the thumb.

In cases of symbrachydactyly where surgery is not an option for medical reasons or personal preference, an artificial (prosthetic) hand or fingers may be used to improve the appearance of the hand and allow basic functions such as holding a cup or pencil.

Most congenital hand deformity surgery is performed when your child is very young. What you need to do to prepare for surgery depends on the type of surgery your child is having. Your consultant will explain the procedure fully before your child's surgery including what happens before, during, and after the procedure. Be sure to ask your consultant any questions or discuss any concerns you may have about your child's surgery.

What happens during congenital hand deformity surgery depends on the type of surgery your child is having and varies according to your child’s individual case. Talk to your consultant about what will happen during your child’s surgery.

Recovery from congenital hand deformity surgery depends on many factors such as the type of surgery, your child's general health, and whether there were any complications during the surgery.

Treatment for congenital hand deformities normally lasts for many years and most children require long-term care and treatment. Your child will probably have many follow-up appointments with your consultant to ensure the hand is growing properly. In some cases, further surgery may be necessary.

After surgery, your child may have their hand immobilised in a splint while it heals.

Your child will be referred to a hand therapist and have ongoing physiotherapy to improve muscle strength, flexibility, and hand function. They may see an occupational therapist to help with tasks like brushing their teeth, getting dressed, and grasping objects.

Like any surgery, there are some risks associated with surgery for congenital hand deformities. Your consultant will discuss all the possible risks and complications of surgery before your child's procedure. It's important that you ask your consultant any questions you may have at this time. This will help put your mind at rest and allow you to make an informed decision.

General risks of surgery include:

• Bleeding
• Infection
• Complications of anaesthesia
• Scarring

Risks and complications of surgery for congenital hand deformities include:

• Nerve damage
• Bleeding
• Infection
• Stiffness
• The surgery may not achieve the desired result

We answer some of your most commonly asked questions about surgery for congenital hand deformities

What is the most common congenital deformity of the hand?

The most common type of congenital hand deformity is polydactyly, a condition where there are extra digits on one or both hands. Worldwide, about one in every 500 babies¹ are born with polydactyly of the hands or feet.

Can a deformed hand be fixed?

Whether or not a deformed hand can be fixed depends on the type of deformity your child has, and how severe it is. Most congenital hand deformities can be treated with surgery. A consultant hand surgeon will be able to assess your individual case, provide treatment options and discuss the long-term outlook for your child.

Can hand deformities be passed on?

Some congenital hand deformities such as syndactyly (when two or more of the fingers are joined together) often run in families. The majority of congenital hand deformities do not run in families and have no known cause.

How are hand deformities treated?

How hand deformities are treated depends on the type of deformity, how severe it is, how it impacts your child's life, your child's general health, and your preferences and expectations for treatment. If your child has a congenital hand deformity, make an appointment with a specialist hand consultant as soon as possible to ensure your child gets the correct diagnosis and the best possible treatment.

At Circle Health Group we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant best suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private en-suite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about surgery for congenital hand deformities, book your appointment today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in December 2022. Next review due December 2025.

1. Treatment options for symbrachydactyly, NHS
2. Congenital Hand Conditions, The British Society for Surgery of the Hand
3. Treatment of Common Congenital Hand Conditions, PubMed
4. Children with Congenital Hand Anomalies & Malformations, healthy children.org