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Application of the IFSSH(3)-classification for congenital anomalies of the hand; results and problems
L De Smet1, G Matton, S Monstrey
1Dept. Orthopaedic Surgery, University Hospital Pellenberg, K.U. Leuven, Belgium.
Insights
The International Federation of Societies for Surgery of the Hand (IFSSH) classification effectively categorizes hand anomalies. This study refined the classification, proposing adjustments for specific conditions like triphalangeal thumbs.
Area of Science:
- Orthopedics
- Developmental Biology
- Medical Classification Systems
Background:
- Accurate classification of congenital hand anomalies is crucial for diagnosis and treatment planning.
- Existing classification systems may require refinement to encompass the full spectrum of hand malformations.
- The International Federation of Societies for Surgery of the Hand (IFSSH) classification provides a framework for categorizing these anomalies.
Purpose of the Study:
- To evaluate the applicability and propose modifications to the extended IFSSH classification system for hand anomalies.
- To identify specific anomalies that require reclassification or further definition within the IFSSH system.
- To improve the diagnostic and therapeutic utility of the IFSSH classification.
Main Methods:
- A retrospective analysis of 1013 hand anomalies in 925 hands from 650 patients was performed.
- The extended IFSSH classification was applied to categorize the identified anomalies.
- Statistical analysis was used to assess the classification's ease of use and identify areas for improvement.
Main Results:
- Associated anomalies were identified in 26.7% of patients.
- The IFSSH classification was straightforward in 86% of cases, with difficulties in 6.6% and impossibility in 7.8%.
- Specific recommendations were made for including Madelung deformity, Kirner deformity, congenital trigger digits, and triphalangeal thumbs within the classification.
Conclusions:
- The extended IFSSH classification is a valuable tool for categorizing hand anomalies, though some modifications are proposed.
- Refinements, particularly regarding radial/ulnar deficiencies and longitudinal deficiencies, enhance its clinical applicability.
- The study highlights the need for continuous evaluation and adaptation of classification systems in hand surgery.
Abstract:
The extended classification proposed by the IFSSH was used to classify 1013 hand anomalies in 925 hands of 650 patients. We found associated anomalies in 26.7%. The classification was straightforward in 86%, difficult in 6.6% and not possible in 7.8%. In group I the radial and ulnar deficiencies, limited to the hand and without forearm deficiencies should be included. Group II was the most important group including 513 anomalies. We propose to include in this group the Madelung deformity, the Kirner deformity and congenital trigger fingers and trigger thumbs. Triphalangeal thumbs are a problem, we suggest to list this anomaly in group III and to consider it as a duplication in length. It is not always possible to evaluate the (transverse) absence of the fingers or hand. Longitudinal deficiencies (group IIB), symbrachydactyly group (V) and amniotic bands (group VI) occasionally develop a phenotype similar to the genuine transverse deficiency (group IA).