Failure of formation of

parts
Muhammad Sobri Maulana, S.Ked, CEH, OSCP, OSCE
Outline Anat Fisio Definisi Etio
Embri Faktor Risiko

Diagnosis
Klasifikasi
komplikasi

Tatalaksana
prognosis
 Bones of the Wrist

◦ 8 Carpal Bones

 Bones of the Hand

◦ 5 Metacarpals

◦ 14 Phalanx Bones

 Ligaments:

◦ Complex series of ligaments that bind the

carpal bones to one another, to the ulna &
radius, and to the proximal metacarpals

◦ Wrist: UCL & RCL

◦ Volar aspect of wrist is Transverse Carpal

Ligament

◦ Each Joint in the fingers has MCL & LCL

Thompson, J. Netter’s Concise Orthopaedic
ligaments Anatomy. 2nd Ed. USA: Elsevier Saunders. 2010.
 • Motions of the Wrist
 Extrinsic  Flexion
Extension
muscles: originate

 Radial Deviation
outside of the hand  Ulnar Deviation
• Motions of the
Fingers
 Intrinsic  Flexion
Muscles: originate  Extension
Abduction
inside of the hand 
 Adduction
• Motions of the Thumb
 Opposition
 Flexion
 Extension
 Abduction
 Adduction

Thompson, J. Netter’s Concise Orthopaedic Anatomy. 2nd Ed. USA: Elsevier Saunders. 2010.
Thompson, J. Netter’s Concise Orthopaedic Anatomy. 2nd Ed. USA: Elsevier Saunders. 2010.
Embriology
•Upper limb buds --> 4 weeks
•Mesodermal --> covered by ectoderm
• AER (Apical Ectodermal Ridge)
• Located at the distal aspect --> required for growth in a proximal to
distal direction
• ZPA (Zone of Polarizing Activity)
• Posterior lim bud - anterior-to-posterior limb development , through
Sonic Hedgehog
• Nonridge ectoderm / Wingeless-type (Wnt)
• Controls patterning dorsal-ventral axis
• Required for alignment of the limb

Choi M, Sharma S, Louie O. Chapter 89 Congenital Hand Abnormalities. In: Beasley RW, Aston SJ, Barlett SP, Gurtner GC, Spear
SL. Grabb & Smith's Plastic Surgery. 6th edition. Wolters Kluwer health : Lippincott Williams & Wilkins. 2007 p. 875-876
 Choi M, Sharma S, Louie O. Chapter 89 Congenital Hand Abnormalities. In: Beasley RW, Aston SJ, Barlett SP, Gurtner GC, Spear
SL. Grabb & Smith's Plastic Surgery. 6th edition. Wolters Kluwer health : Lippincott Williams & Wilkins. 2007 p. 875-876

Classification
•Transverse
•Longitudinal
• Preaxial
• Postaxial
• Central
• Intercalary
 Radial Club Hand / Preaxial
• 1 in 55000 births
• Sporadic and unilateral, males, common right
side
• Associated congenital cardiac pathologies,
abdominal pathologies and haematologic
diseases
• Surgical Reconstruction
• Manifestation
• Shortened forearm with radial deviation at the wrist
• Pathology
• Preaxial side of the limb
• Partial or total absence of radius
• Surgical reconstruction after 6 months of age
Choi M, Sharma S, Louie O. Chapter 89 Congenital Hand Abnormalities. In: Beasley RW, Aston SJ, Barlett SP, Gurtner GC, Spear
SL. Grabb & Smith's Plastic Surgery. 6th edition. Wolters Kluwer health : Lippincott Williams & Wilkins. 2007 p. 875-876
8
Classification of radial dysplasia
•Type and
characteristics

Choi M, Sharma S, Louie O. Chapter 89 Congenital Hand Abnormalities. In: Beasley RW, Aston SJ, Barlett SP, Gurtner GC, Spear
SL. Grabb & Smith's Plastic Surgery. 6th edition. Wolters Kluwer health : Lippincott Williams & Wilkins. 2007 p. 875-876
Ulnar Club Hand / Post axial
•Quite rare
• Male, unilateral, left side
• Unknown
• Pathology
• Defect in the ZPA (Cole and Manske)
• Anatomic finding
• Short, bowed radius with a hypopastic or absent ulna
• Management
• Excision of the ulna anlage
• Creation of a one-bone fore-arm
• Humerol osteotomy

Choi M, Sharma S, Louie O. Chapter 89 Congenital Hand Abnormalities. In: Beasley RW, Aston SJ, Barlett SP, Gurtner GC, Spear
SL. Grabb & Smith's Plastic Surgery. 6th edition. Wolters Kluwer health : Lippincott Williams & Wilkins. 2007 p. 875-876
10
Cleft Hand – Cleft Foot

•Absence of central ray

of hand or foot
•Reconstructive
surgeries

Choi M, Sharma S, Louie O. Chapter 89 Congenital Hand Abnormalities. In: Beasley RW, Aston SJ, Barlett SP, Gurtner GC, Spear
SL. Grabb & Smith's Plastic Surgery. 6th edition. Wolters Kluwer health : Lippincott Williams & Wilkins. 2007 p. 875-876
11
 Cleft Hand – Central Deficiency
•Typical
• Deep V-Shaped central defect secondary to hypoplasia
• Association with foot clefts : common
•Atypical
• U Shaped defect secondary to absence of the index, long and
ring fingers
• Unilateral and inheritance
• Association with foot clefts : rare
• Management
• Upton Modified

Choi M, Sharma S, Louie O. Chapter 89 Congenital Hand Abnormalities. In: Beasley RW, Aston SJ, Barlett SP, Gurtner GC, Spear
SL. Grabb & Smith's Plastic Surgery. 6th edition. Wolters Kluwer health : Lippincott Williams & Wilkins. 2007 p. 875-876
 Phocomelia : Intercalary
•Intervene Segment of the limb : Absent
•Missing
•Cause : thalidomide
•Surgery not always indicated

Choi M, Sharma S, Louie O. Chapter 89 Congenital Hand Abnormalities. In: Beasley RW, Aston SJ, Barlett SP, Gurtner GC, Spear
SL. Grabb & Smith's Plastic Surgery. 6th edition. Wolters Kluwer health : Lippincott Williams & Wilkins. 2007 p. 875-876
Referensi
•Choi M, Sharma S, Louie O. Chapter 89 Congenital Hand
Abnormalities. In: Beasley RW, Aston SJ, Barlett SP,
Gurtner GC, Spear SL. Grabb & Smith's Plastic Surgery.
6th edition. Wolters Kluwer health : Lippincott Williams
& Wilkins. 2007 p. 875-876
•Thompson, J. Netter’s Concise Orthopaedic Anatomy.
2nd Ed. USA: Elsevier Saunders. 2010.