The Surgical Closure of Neglected Ulnar Deficiency of the Hand; Unclassified Phenomenon
Research Article
Abstract
Cleft hand classified as central deficiencies of the hand.
We present a patient who had cleft hand between the fourth and fifth ray at ulnar side which was not be classified in current classification of congenital hand deformities neither in central cleft hand anomalies nor ulnar deficiencies. Eventually we defined it as ulnar cleft hand.
Twenty-six years old man examination revealed fifth ray of the hand was divided from carpometacarpal joint to ulnar sides about forty-five degrees. The fifth fingers rotated to dorsoradial from Metacarpophalengeal joint about ninety degrees. Little finger was
hypoplastic and hypotenar side of the hand completely divided therefore the palm was narrow and shallow. Range of motion of distal and proximal interphalangeal joint was limited by ankylosis.
The aims of the surgery are to improve grasping function, to keep the palmar continuity and obtain acceptable cosmesis.
The cleft closure was performed with volar and dorsal skin flaps. Fifth metacarp released from flexor carpi ulnaris tendon, capsule and muscles. FCU was transferred distal of ulnar carpal bone, which seemed triquetro-hamate coalition bone.
We defined this deformity as ulnar cleft hand.
It is indisputable that treatment of congenital deformities before development ends will provide acceptable and more successful outcomes. At older ages, treatment of such rare hand deformities should be planned in stages with functional outcomes in mind according to patient’s needs while cosmetic appearance should be tackled at the second stage.