In Switzerland children’s referrals to my office with problems of the hands are more frequently related to traumas, and less frequently to general diseases (like cancer) or congenital malformations. Injuries to the hand represent about one third of the total visits made in a year in the office. Often, the ability of children to “masque” a trauma or bypassing the consequent functional loss, cause a delay in the diagnose and therapy. Most likely the best option is not surgical.
The difficulty for the parents to understand how the child feels with sometimes an underestimation of the initial trauma or a difficult interpretation of the radiological images are often the main reason of a delayed diagnose. After the diagnosis and a classic temporary unuseful research of the guilty everybody’s focused on the therapeutic strategy to be undertaken to save time. The hand from the first weeks of life is an essential organ both for the relationship with the mother and for the exploration of the new world that stimulates a continous learning. Thanks to the pinch thumb-index the manipulation of objects which is vital to grow up is guaranted. There are several malformations of the hand with different functional limitations, even with marked regional differences. The prevalence of congenital malformations is 1:2000 newborns.
The most common malformations are syndactyly (fusion of 2 or more fingers), the presence of one or more supernumerary fingers (polydactyly), the absence of one or more fingers (unilateral), the position in flexion of the finger (camptodactyly), the deviation on a side of the fingers (clinodactyly), a finger of reduced length (brachidactyly). Other conditions are associated with malformations of the lower limbs, face, kidneys or the heart.
In these children the functional defects affect the physical and brain development with problems in the social life.
An early intervention is mandatory. Around the first months of life, the brain becomes aware of the functions of the hand and learn to use it. An excessive delay may lead to a permanent exclusion of a particular function in the mindset with a consequent functional loss of development. The procedure or surgical procedures are only one step to correct this. But every surgical procedure has to be planned in advance in a program which also includes the management of complications. In most cases the pre- and postoperative care is characterized by the use of braces, with a preventive function, corrective or functional.
Furthermore, the presence in the team of a qualified psychologist / psychiatrist is topical in dealing with doubts, questions and emotions’ management. In principle they are useful for dealing with the impact of the malformation or trauma on the family balance and then to learn how to manage it.
Since the beginning of the Orthop. and Hand Surgery training, Dr.Lucchina has been interested in congenital malformations of the hand completing his scientific background at the Shriners’ Children’s Hospital in Philadelphia and continuing His long-lasting collaboration with his master for surgery hand, Prof. Marco Lanzetta, an internationally renowned expert in this field.