Cleft Hand
Cleft hand is a rare condition in which the center of a child's hand is missing a finger or fingers. Cleft hand makes up less than 5 percent of all congenital hand differences. Approximately one in 50,000 to one in 100,000 babies are born with cleft hand.
Cleft hand occurs when a child's hand doesn't develop properly during pregnancy. The condition can sometimes be detected on a routine prenatal ultrasound. After the baby is born, the deformity is visible.
Although cleft hand usually affects both hands, it can also occur in only one hand. Children born with cleft hand may also have cleft foot. All affected children, except those with very mild cases, need one or more surgeries, usually starting in their first year of life.
Why Choose US
Education Experience
I earned my MD in Surgery from Huazhong University of Science and Technology in Wuhan, China, in 2003. Later, I completed my PhD at Katholieke Universiteit Leuven in Belgium in 2008.
Professional Experience
I am currently an Associate Professor and Chief Physician of Hand Surgery at Wuhan Union Medical College Hospital. I supervise master's students and serve on the editorial boards of several journals, including the Chinese Journal of Experimental Surgery, the Journal of Foot and Ankle Surgery, and the Chinese Journal of Microsurgery.
Expertise
My expertise includes performing syndactyly release using the Pelnac artificial dermal substitute, which eliminates the need for skin grafting. This work was published in the Journal of Plastic, Reconstructive & Aesthetic Surgery in September 2023.
Cleft hand (also called ectrodactyly or split hand) is when the middle part of the hand develops abnormally. Babies with this condition are missing one or more central fingers on the hand. There are generally two types:
Typical cleft hand: V-shaped and usually missing or partially missing middle fingers. Both hands are usually affected, and sometimes the feet are, too. There is often a family history of this type of cleft hand.
Atypical cleft hand: U-shaped and usually involves only one hand. This type of cleft hand is not often inherited. Atypical cleft hand may be a symptom of Poland syndrome.
Congenital Hand Differences
Congenital deformities of the hand are common (occurring in 2.3 per 1,000 births) but most of these conditions are relatively minor, not affecting function.
Various inherited genetic anomalies have been classified:
Cleft Hand - Also called split hand, lobster-claw hand or ectrodactyly - is characterized by shortened or missing central fingers. It can also occur in the foot.
Polydactyly - And extra digit - is one of the more common malformations, usually affecting the thumb.
Syndactyly - Abnormal linkage between adjacent fingers - is most common between middle and ring fingers. The effect is referred to as “simple,” only the skin and soft tissue, or “complex,” bridging of bones and nails.
Trigger thumb or finger - Thumb more commonly - is an abnormality of the flexor tendon, causing it to be constantly bent inward or downward. It is fairly easily repaired surgically.
Symbrachydactyly - Short fingers - can vary in severity.
Thumb hypoplasia - A malformation of the thumb - can also vary in severity.
Generally, if surgical repair of these conditions is a practical option, the surgery is done after six months to two years of age.
How is cleft hand diagnosed
Cleft hand is diagnosed by your child's doctor after a careful physical examination. As part of the diagnosis, your child will have an X-ray to look for related problems with the bones of the fingers and hand.
Your child's doctor may also check for other conditions that are sometimes associated with cleft hand. These include:
Cleft foot
Cleft lip and palate
Ectrodactyly (split hand-split foot malformation)
Encephalocele (protrusion of brain membrane)
Conditions affecting the heart and digestive systems
Deafness (rare)
How is cleft hand treated
Not all children need surgery for a cleft hand, particularly if the condition is not too severe and they have good use of their hand. However, if your child's hand has significant functional or cosmetic problems, their doctor may recommend surgery.
There are many different surgical options to repair a cleft hand. The timing and sequence of procedures will vary from child to child. In general, the first procedure is usually done when a child is 1 year old.
The goals of surgery are to:
Close the cleft and make sure your child can use their hand effectively
Create a good working space between the thumb and index finger to allow for fine motor function
Reorganize the skin and soft tissue around the fingers
Stabilize or transfer the bones of the hand
Correct any deformities of the fingers or thumb
After surgery, your child will wear a long-arm cast stabilized by pins for about four to six weeks.
After the cast is removed, your child will wear a splint to bed for several weeks to maintain alignment and help reduce scarring. Occupational therapy will help your child achieve supple motion and developmentally appropriate use of the hand. Your child's doctor will monitor their progress regularly throughout their follow-up treatment.
What is the long-term outlook for children with cleft hand
The quality of the reconstruction of your child's fingers depends to a large extent on how severe the original difference was. As a result of surgery, you can expect your child will be able to grasp, pinch, and release objects with their fingers. Their hand should also look better and their fingers should be more aligned.
As your child grows, it's possible gaps and deformities may recur even after they were corrected by the original surgery. If this is happens, your child may need additional procedures.
Treatment Options for Symbrachydactyly
Symbrachydactyly is a congenital (present at birth) hand anomaly, which affects a single upper limb. It is not inherited. It is characterised by short, stiff, webbed or missing fingers. The underlying muscles, tendons, ligaments and bones are all affected.
Symbrachydactyly is graded from mild to severe but within each grade, the degree of severity can vary enormously.
At the milder end of the spectrum, the hand has slightly short, mobile fingers with minor webbing. The hand bones (metacarpals) and some of the finger bones (phalanges) and the thumb are present.
In moderate cases most or all of the finger bones are missing and small nubbins of skin and soft tissue are present where the fingers would have developed. The forearm and hand may also be shorter. The thumb is usually present, but may or may not be shorter than usual.
In the severe cases there is either a partial thumb or no thumb and no fingers.
The cause of symbrachydactyly is unknown. One possible cause might be an interruption of the blood supply to the developing arm at four to six weeks of pregnancy. There is no link to anything the mother did or did not do during pregnancy. There is also no increased risk of having another child with the same condition or that your child will pass the condition on to his or her children.
It occurs in approximately 1 out of 32,000 births.
Without any surgical treatment, overall hand function is usually good because symbrachydactyly affects one hand with the other being normal. Most children use their unaffected hand as their dominant hand with the affected hand assisting. Surgery therefore aims to upgrade performance in the affected ‘assisting' hand. In many cases, children can still grip with the affected hand although fine motor skills might be a problem.
Also, children are very good at adapting to their condition, and can usually achieve most tasks. There are some things that can be more difficult, particularly with a more severely affected hand. These include some activities that need both hands, for example, hooking up a zip, managing brakes on a bike, using a knife and a fork together, holding paper when cutting with scissors, and playing some musical instruments. Some of these tasks can be managed with special equipment.
What Are the Symptoms of Cleft Hand
Cleft hand occurs when a child's hand doesn't develop properly during pregnancy. The condition can sometimes be detected on a routine prenatal ultrasound. After the baby is born, the deformity is visible.
Although cleft hand usually affects both hands, it can also occur in only one hand. Children born with cleft hand may also have cleft foot. All affected children, except those with very mild cases, need one or more surgeries, usually starting in their first year of life.
Not all cleft hands look the same. Typically, the center portion of the hand is missing a finger or fingers and there's a V-shaped cleft in that space. Less often, clefts occur on the thumb side or the little finger side of the hand.
Cleft hand is congenital, meaning babies are born with the condition. It develops during pregnancy when the bones of the hand are forming. The exact cause is unknown, but scientists and doctors are learning more and more about the possible genetic causes (passed from parent to child).
Cleft hand is diagnosed by your child's doctor after a careful physical examination. As part of the diagnosis, your child will have an x-ray to look for related problems with the bones of the fingers and hand.
Not all children need surgery for a cleft hand, particularly if the condition is not too severe and they have good use of their hand. However, if your child's hand has significant functional or cosmetic problems, their doctor may recommend surgery.
There are many different surgical options to repair a cleft hand. The timing and sequence of procedures will vary from child to child. In general, the first procedure is usually done when a child is 1 year old.
After surgery, your child will wear a long-arm cast stabilized by pins for about four to six weeks.
How Cleft Hand Deformities Are Treated
A cleft hand deformity is a physical defect that is characterised by missing fingers or incorrect development in the hand at birth. This congenital defect usually occurs in the centre of the hand and forms a v-shaped cleft in affected children.
Cleft hand deformities occur when a child's hands do not properly develop in the womb; that is why it is known as a congenital birth defect. The deformity is caused by genetic abnormalities that are usually hereditary and requires surgical attention to repair.
Though cleft hand deformities often occur in the centre of the hand, they can sometimes form on either the thumb or little finger side of the hand too. In addition to a cleft hand, some children may be born with a number of other genetic complications like a cleft lip or defects in the feet, but this is not always the case. Cleft hand deformities are often present in both hands. Sometimes, however, the deformity can be isolated to one hand.
Severe cleft hand deformities can prevent a child from learning a number of mobility skills and leading a normal life. If left untreated, a child can grow up unable to write, play sports and do other activities that require hands. This can affect children psychologically and, in turn, socially too.
Dr can perform surgery to improve the appearance and function of cleft hands in serious cases. This process involves x-raying the hands to determine what type of deformity is present and to examine the bone, nerves and tissue structure of the hands.
Once Dr understands the anatomy of the affected hands, he will determine the best way to go about closing the cleft between the fingers. Surgery is performed when the child is about a year old, however, if they have a progressive cleft that will get worse over time, the operation will be performed earlier.
During the surgery, Dr will improve the position of the bones and tissue of the hands to ensure that the child can use them effectively. The child will have to wear a cast for some time afterwards, and engage in physical therapy, to learn how to use their reconstructed hands.
What Causes Congenital Hand Differences
A fetus's arms and hands form between the fourth and sixth week of pregnancy. Any disruption of this process can lead to a congenital hand difference. There are many factors that can affect the development of the human hand. These are generally divided into genetic factors and environmental factors.
Genetic factors play a role in hand and arm formation. Genes contain instructions for the growth and function of each cell in the body. They're passed on to children from their parents but can also change (mutate) on their own.
In the case of hand differences, the genetic changes generally occur for no apparent reason. Less common are changes that run in families.
Environmental factors include infections and the use of certain drugs. These drugs include thalidomide (a drug used to treat nausea) and some drugs used for chemotherapy. Environmental factors may cause a breakdown in otherwise healthy tissue. The breakdown can alter the developmental process and lead to a difference in hand formation.
Some hand differences can be explained by these factors. Others have no known cause. In some cases, the hand difference is an isolated event. In other cases, the difference is part of a syndrome that affects multiple parts of the body.
Depending on the type and severity of your child's hand difference, they may have no trouble adapting and functioning. However, other children will experience issues without treatment. Complications of congenital hand differences may include:
Developmental delays.
Trouble with basic self-care and daily living activities.
Limitations on certain sports and other activities.
Emotional and social issues.
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