There are a variety of fetal limb anomalies, but as a pediatric orthopedic surgeon, the most helpful are the following disorders.
1, congenital clubfoot
2, Polydactyly/toe
3, congenital radial hypoplasia
4, Narrowing ring syndrome
5, short finger syndactyly
6, congenital hyperextension of the knee joint
7, central row hand and foot dysplasia (cleft hand and foot)
Among them, congenital clubfoot and polydactyly are the most common congenital deformities of the hands and feet, while congenital clubfoot, congenital radial hypoplasia, constricted ring syndrome and congenital knee hyperextension are time-limited in treatment, and the earlier they are treated, the better the results.
I. Congenital clubfoot
1.Overview.
Congenital clubfoot is a serious congenital deformity of the foot, which can be diagnosed at first sight after birth. 80% or more can be diagnosed by prenatal ultrasound examination.
Children born untreated or improperly treated become old clubfoot, which is a serious disability. Even if the shape is improved by surgery, the joint is stiff and weak, often accompanied by pain. After puberty, the pain increases and lameness appears.
2. Prenatal recommendations.
Congenital clubfoot can be part of a variety of syndromes. Prenatal ultrasonography reveals clubfoot and requires detailed ultrasound exploration to detect concomitant malformations. Genetic counseling for family history and chromosomal information is needed to clarify the diagnosis and differential diagnosis. Referral to a pediatric orthopedic surgeon for consultation is then required.
There is no way to perform prenatal intervention.
The mode of delivery depends on obstetric factors and concomitant malformations.
3. Postnatal treatment.
After birth, the child may be seen by a pediatric orthopedic surgeon after 7 days. About 10% of the prenatal ultrasound diagnosis of clubfoot can improve on their own after birth. Children diagnosed with congenital clubfoot need to be treated with the Pansetti method. The foot is first orthopedically manipulated, then immobilized in a cast, removed after 1 week, and again orthopedically manipulated and immobilized in a cast, usually 4 times, with 1-2 additional times depending on the situation. Generally, the fifth time, eligible children can perform Achilles tendon severing and lengthening, then manual correction, plaster fixation. 3 weeks later, the Achilles tendon healed, you can remove the cast. At this time, the foot has returned to normal, only some skin wrinkles, you need to immediately wear orthopedic shoes.
4.Support.
Congenital clubfoot within 4 years of age, are in the activity period, there is a tendency to recur. If orthopedic shoes are not worn, 80% of children will relapse. Usually, for the first 3 months, 23 hours of wear per day and 1 hour of free time. This decreases month by month, and by the age of 1 year, 12-14 hours of wear per day is sufficient for sleep only, with the rest of the day free to move around, wearing shoes or going barefoot. Adhere to the brace maintenance until 4 years of age, and regular follow-up until 18 years of age.
II. Polydactyly/toe
1. Overview.
Polydactyly/toe is the most common congenital malformation of the hands and feet, with a wide variety of types, which can also be diagnosed by prenatal ultrasonography.
After the child is born, most types, without treatment, have little effect on general gross function. In order to perform fine motor movements, surgery is required to improve function as well as to beautify the appearance. A few types, without treatment, can seriously affect the function of the thumb.
2. Prenatal recommendations.
Polydactyly can be part of a variety of syndromes. Prenatal ultrasonography reveals polydactyly and requires detailed ultrasound exploration to detect concomitant malformations. Genetic counseling for family history and chromosomal information is needed to clarify the diagnosis and differential diagnosis. Referral to a pediatric orthopedic surgeon for consultation is then required.
There is no way to perform prenatal intervention.
The mode of delivery depends on obstetric factors and concomitant malformations.
3. Postnatal treatment.
No special treatment is usually needed after the child is born. Some soft tissue polydactyly can be treated surgically in the neonatal period. A few thin-tipped polydactyly can be cut out and pressure can be applied to stop the bleeding.
I usually perform surgical treatment at 6-12 months of age because after 1 year of age, the child begins to walk and the fine motor skills of the hand begin to develop. Metacarpal (metatarsal) osteotomy orthopedic surgery can also be completed at this age at the same time. Osteotomy orthopedic surgery of the finger (toe) bones usually has to be done after 1 year of age.
4. Bracing.
A brace is usually not required for preoperative and postoperative polydactyly/toe surgery. In rare cases, a brace is needed to reduce the preoperative deformity and to avoid recurrence of the deformity after surgery.
Congenital radial hypoplasia
1.Overview.
Congenital radial hypoplasia is a rare forearm deformity that is easily diagnosed during prenatal ultrasonography.
After the child is born, due to thumb hypoplasia, thumbing occurs naturally in the index finger, which is able to partially compensate and complete some hand functions.
2. Prenatal recommendations.
Congenital radial hypoplasia is part of a variety of syndromes. Prenatal ultrasound findings of radial hypoplasia require detailed ultrasound exploration to detect concomitant malformations. Genetic counseling for family history and chromosomal information (caution should be exercised in performing cord blood puncture, as the fetus may be combined with a hematologic disorder with thrombocytopenia) is needed to clarify the diagnosis and differential diagnosis. Then, referral to a pediatric orthopedic surgeon for consultation is required.
There is no way to perform prenatal intervention.
Due to the lateral deviation of the hand to the radial side, a cesarean delivery is required to avoid difficult delivery.
3. Postnatal treatment.
After birth, the child should be orthopedically manipulated, then fixed in a cast, and finally maintained in a brace.
Usually the operation of “carpal bone centralization” is performed. If there is no preoperative orthosis, or if the lateral deviation of the radial side is obvious, an external fixation brace can be used to draw the orthosis.
Because the ulna is gradually bent and the hand is still laterally deviated to the radial side, and the wrist joint is stiff and the movement is limited, some doctors no longer do the surgery of carpal bone centration, but only soft tissue adjustment surgery.
4. Braces.
Children need to be orthopedic after birth, and then wear braces to maintain them. Whether it is carpal centration surgery or soft tissue adjustment surgery, braces are needed after surgery to avoid or reduce recurrence.
IV. Narrowing ring syndrome
1.Overview.
Narrowing ring syndrome is a manifestation of amniotic band syndrome in the limb and can be diagnosed during prenatal ultrasonography.
After the child is born, a narrowing ring is visible in the limb and swelling may occur in the distal limb. Sometimes, the finger ends are juxtaposed or amputated.
2. Prenatal recommendations.
Polydactyly can be a part of amniotic band syndrome. Antenatal ultrasonography reveals the amniotic band and requires detailed ultrasound exploration to detect concomitant malformations. If it is found to be residual around the umbilical cord or limb, with the potential for death or amputation, fetoscopic amniotic band release is required. Genetic counseling for family history and chromosomal information is required to clarify the diagnosis and differential diagnosis. Referral to a pediatric orthopedic surgeon for consultation is then required.
Prenatal intervention is performed by fetoscopic amniotic band release.
The mode of delivery depends on obstetric factors and concomitant malformations.
3. Postnatal treatment.
After the child is born, mild amniotic band contracture requires amniotic band release; if the fetal limb is almost truncated, debridement surgery is required; the most common is constricted band deformity, and constricted band excision is feasible; finger end merging, merging finger separation is feasible.
4.Support.
Children usually do not need to use braces, unless combined with other deformities.
V. Short fingers (toes) and fingers (toes)
1.Overview.
Short finger (toe) and finger (toe) is a finger or toe transverse dysplasia, can be diagnosed in prenatal ultrasonography.
After the child is born, short fingers and toes have a greater impact on function, and short toes and toes have a smaller impact.
2. Prenatal diagnosis.
Short-fingered (toe) syndactyly can be part of a variety of syndromes and requires detailed ultrasound exploration to detect concomitant malformations. Genetic counseling for family history and chromosomal information is needed to clarify the diagnosis and differential diagnosis. Referral to a pediatric orthopedic surgeon for consultation is then required.
There is no way to perform prenatal intervention.
The mode of delivery depends on obstetric factors and concomitant malformations.
3. Postnatal treatment.
After the child is born, short toes usually do not require surgery and have little impact on the function of the foot. Parallel toes can be performed parallel toe separation surgery. Short toes require different surgical methods according to different types: syndactyly separation, cleft closure; free toe bone grafting; free toe grafting.
4. Braces.
The child usually does not need a brace unless other deformities are combined.
It is possible for the child to use a prosthesis to improve function.
VI. Congenital knee hyperextension
1. Overview.
Congenital hyperextension of the knee is fetal in nature and can be diagnosed by prenatal ultrasound.
Untreated congenital hyperextension of the knee can lead to knee retroflexion and make treatment difficult.
2. Prenatal diagnosis.
Congenital hyperextension of the knee can be part of a variety of syndromes and requires detailed ultrasound exploration to detect concomitant malformations. Genetic counseling for family history and chromosomal information is needed to clarify the diagnosis and differential diagnosis. Referral to a pediatric orthopedic surgeon for consultation is then required.
There is no way to perform prenatal intervention.
The mode of delivery depends on obstetric factors and concomitant malformations.
3. Postnatal treatment.
After the child is born, depending on the degree of limited knee flexion, the child may be manipulated to flex the knee, gradually until the knee flexion is normal. If the knee flexion is normal, the child can be corrected without manipulation. If the effect of manual correction is not good, a plaster cast can be added to maintain the effect and gradually corrected in stages.
The child may have a combination of hip dysplasia and therefore needs to be routinely screened for hip dysplasia.
If combined with hip dysplasia, congenital clubfoot, etc., can be corrected at the same time.
4.Support.
The Pavlic sling is worn after manual improvement of knee flexion to prevent knee hyperextension and maintain knee flexion.
Wearing Pavlic sling helps to treat hip dysplasia.
Seven, the central column hand and foot dysplasia (cleft hand, cleft foot)
1.Overview.
Central column hand-foot dysplasia, also known as cleft hand and cleft foot deformity, can be diagnosed by prenatal ultrasonography.
Cleft foot deformity has less impact on walking function and rarely requires surgical treatment.
Cleft hand deformities have a variable effect on hand function. If the tiger mouth is normal, it has little impact on the function of the hand; if the tiger mouth is narrow, or there is no tiger mouth, it has a greater impact on the function of the hand.
2, prenatal diagnosis.
Central column hand-foot dysplasia can be part of a variety of syndromes and requires detailed ultrasound exploration to detect concomitant malformations. Genetic counseling for family history and chromosomal information is needed to clarify the diagnosis and differential diagnosis. Referral to a pediatric orthopedic surgeon for consultation is then required.
There is no way to perform prenatal intervention.
The mode of delivery depends on obstetric factors and concomitant malformations.
3. Postnatal treatment.
After the birth of the child, cleft hand deformity can be determined by the timing and plan of surgery based on the cleft, tigers, syndactyly, and transverse bones. Early indications for surgery are syndactyly, especially thumb syndactyly, and transverse bones that cause progressive widening of the cleft.
Cleft foot deformity usually does not require surgical treatment.
4. Bracing.
Central column hand-foot dysplasia usually does not require bracing.