Congenital and pediatric disorders of the upper extremity are typically seen in 2 per 1000 live births.1 Although they are rare, these pathologies are encountered in the practices of hand surgeons, pediatric orthopedic surgeons as well as pediatric upper extremity specialists. Because of the small size of the patient population, it can be difficult to perform larger scale studies to appropriately evaluate the outcomes of treatment techniques and identify common complications. However, as this field gains in popularity, more physicians are dedicating their practice to the care of the upper extremity in children. Advancements in surgical techniques and technology have certainly been made within this subspecialty, and this symposium of Techniques in Orthopaedics will highlight a selection of these advancements as well as review fundamentals of treatment of a number of pediatric and congenital upper extremity disorders.
Dr Sibbel provides an excellent assessment of the use of 3D modeling in the treatment of pediatric forearm deformities. This evolving technology has proved to have many useful orthopedic applications including aiding in complex deformity correction. Her article details the preoperative and intraoperative techniques to properly apply 3D modeling to this difficult pediatric pathology, which may be congenital or traumatic in origin.
In the section authored by Dr Goodell and Dr Bauer, the complex physical and psychosocial evaluation of a child with symbrachydactyly is described. Treatments, both operative and nonoperative, are reviewed with emphasis on the variety of phenotypes that are potentially encountered under the diagnosis of symbrachydactyly. Treatments discussed include syndactyly release, how to address digit instability and vascularized toe to hand transfers.
Drs Cabbad and Berger provide a thorough description of syndactyly; including the potential anatomic anomalies that accompany this congenital difference, a guide to patient selection and timing of treatment as well as a detailed review of the operative technique for both simple and complex syndactyly. The authors also describe a postoperative protocol for immobilization and potential complications associated with surgical treatment of syndactyly.
Dr Moeller provides a systematic description of clinodactyly and its association with other syndromes and occurrence in isolation. She analyzes the potential radiographic findings of this condition as well as ways in which to approach the correction of the resultant deformity based on the degree of angulation and the patient age. Dr Moeller also highlights the challenge of using evidence-based medicine in a field this small.
In the final article of this edition, Drs Zelenski and Shah discuss how to potentially improve the value delivery for children with congenital upper extremity differences. They discuss how to assess outcomes, including both clinical and patient satisfaction, and how to consider this information within the context of treatment of congenital and pediatric upper extremity disorders. Following their review, the authors suggest potential ways in which to improve the value of the care being delivered to these children.
I would like to sincerely thank all of the authors on their contributions to this symposium on Congenital and Pediatric Upper Extremity Disorders.
1. Little KJ, Cornwall R. Congenital anomalies of the hand—principles of management. Orthop Clin N Am. 2016;47:153–168.