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Amniotic constriction bands: a case series and proposed new classification system
Lucy E Homer1, Anuj Mishra, Paul McArthur
1Alder Hey Children's Hospital, Eaton Road, West Derby, Liverpool, UK.
Insights
Amniotic constriction bands, a rare birth defect, most commonly affect upper limbs. A new classification system is proposed to improve understanding and treatment of these limb deformities.
Area of Science:
- Pediatric Surgery
- Developmental Biology
- Orthopedics
Background:
- Amniotic constriction bands affect 1 in 15,000 live births.
- The Patterson Classification system is currently used.
- This condition can cause upper and/or lower limb deformities.
Purpose of the Study:
- To describe a case series of patients with amniotic constriction bands.
- To develop a new classification system for this condition.
- To analyze the incidence and presentation of amniotic constriction bands.
Main Methods:
- A case series was compiled from 1993-2012.
- Data from 37 patients with amniotic constriction bands were analyzed.
- A new classification system was developed based on anatomical location and depth.
Main Results:
- 37 patients were identified with amniotic constriction bands.
- Upper limb involvement was most common (17 patients).
- 17 patients had both upper and lower limb deformities; 28 underwent surgery.
Conclusions:
- Upper limb constriction bands are most frequent.
- Current nomenclature is inconsistent, hindering literature review.
- A refined classification for upper limb bands is proposed.
Introduction:
Amniotic constriction bands occur in approximately one in every 15,000 live births and is graded using the Patterson Classification system.
Methods:
A case series of all patients with amniotic constriction band that presented to Alder Hey Children's Hospital was compiled between the years 1993 and 2012, data was described and a classification system developed.
Results:
Thirty seven patients were identified. Of these 17 had amniotic constriction confined to the upper limbs and three of the lower limbs only. Seventeen had both upper and lower limb deformity. Twenty eight children underwent surgical intervention whilst nine to date have not.
Conclusion:
Constriction band of the upper limb was the most common with lower limb bands the least. There is no agreement on the nomenclature of this condition making amalgamation of the literature problematic. A more specific classification of upper limb bands has been suggested which includes anatomical location and depth of band.
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