Description of Congenital Hand Anomalies: A Personal View

Abstract

A series of four congenital hand cases exhibiting central clefting are presented. The cases are morphologically similar and exhibit characteristics of both symbrachydactyly and central longitudinal deficiency. The cases demonstrate difficulties in classification by either the IFSSH classification system or the JSSH modification of it. An alternative descriptive approach to classification is suggested.

Congenital Upper Limb Deficiencies and Associated Malformations in Finland: A Population-Based Study

“…In problematic cases we followed principles introduced by Tonkin. 19 Also, in this classification brachysyndactyly and brachydactyly patients are included in the undergrowth category, rather than the central deficiency or transverse arrest category, which results in a higher number of patients in the undergrowth group. It is possible that some patients in the undergrowth category should have been classified as central deficiency or transverse arrest, and vice versa.…”

Epidemiology of Congenital Upper Limb Anomalies in 562 Children Born in 1997 to 2007: A Total Population Study from Stockholm, Sweden

“…However, some anomalies fit into several categories and some do not fit into any category. 18,19 The IFSSH classification has well-known drawbacks and there is an ongoing discussion on how to classify polysyndactyly, transverse arrest, symbrachydactyly, and phocomelia. 2,16,18 -26 The clinical entity of syndactyly consists of both cutaneous syndactylies and complex syndactylies with skeletal involvement.…”

Classification and Developmental Biology of Congenital Anomalies of the Hand and Upper Extremity

“…These conditions would move from their current categories of failure of formation (transverse), failure of differentiation, and duplication on the premise that they represent induction abnormalities rather than formation abnormalities. This proposal has not been universally accepted; critics argue that the differences between abnormal induction and abnormal formation are primarily semantic rather than actual 39 . Tonkin recognized that problems arise when attempting to incorporate our current understanding of causation into a morphology-based classification, and further contended that grouping according to such categories as failed formation, failed differentiation, or duplication may be inappropriate 39 .…”

“…This proposal has not been universally accepted; critics argue that the differences between abnormal induction and abnormal formation are primarily semantic rather than actual 39 . Tonkin recognized that problems arise when attempting to incorporate our current understanding of causation into a morphology-based classification, and further contended that grouping according to such categories as failed formation, failed differentiation, or duplication may be inappropriate 39 . He proposed focusing the classification purely on descriptive features, with the primary classification noting the location (i.e., arm, forearm, wrist, or hand) and subcategories listing the tissue involved (bone or soft tissue) as well as the specific morphologic features of the anomalies.…”