Exellent Result of a Mirror Hand Anomaly Treatment

Mohamadreza Guity1, MD; Kaveh Bashti2, MD; Arash Sharafatvaziri*3, MD 1. Department of Orthopetic Surgery, Tehran University of Medical Science, Tehran, Iran 2. Department of Orthopetic Surgery; Shiraz University of Medical Science, Shiraz, Iran 3. Division of Orthopetic Surgery, Khatamol Anbiya Hospital, Tehran, Iran Received: Apr 04, 2012; Accepted: Oct 11, 2012; First Online Available: Jan 02, 2013 The authors report a case of ulnar dimelia deformity in an eleven month old boy and the subsequent successful surgery of this deformity. The second digit has been pollicised and the first and third digits have been amputated. We followed the patient for about two years and observed proper functional outcome and acceptable appearance. The ulnar dimelia deformity is an extremely rare congenital anomaly. This anomaly is formed by duplication of ulna and ulnar side of hand and absence of radial components[1,2]. Few orthopedic surgeons will face with this anomaly and no particular surgeon has gained enough experience to delineate clearly the best method of treating so many complex problems associated with this deformity. The patient was an eleven month old boy who was the only child of a consanguineous marriage. There was no family history of congenital anomaly and there were no other abnormalities. The hand had seven well formed fingers dangling from palm (Fig 1). All fingers were approximately on the same plane and there was no thumb and no syndactyly. Pre and postaxial fingers had similar figures. Thenar prominence was absent. Wrist had flexion deformity and total range of motion of elbow was between 10 and 80 degrees. The shoulder range of motion was acceptable and scapula was not hypoplastic. Radiogram showed Fig. 1: Gross view of the hand two ulnar bones which were faced to each other in proximal portion and articulated with distal humerus separately. There were 4 carpal and 7 metacarpal bones. Considering that the second finger had better function than the others based on parents’ observation, this finger was used for classic pollicization (Transfer of a digit on its neurovascular pedicle with shortening, transposition and rotation of the digit). The first and third fingers were amputated and the skin used for reconstruction of the web (Fig. 2). Following the surgery the limb was put in long arm spica cast for two weeks and then in short spica for additional two weeks. The parents were informed thoroughly about the importance of