Dissection and analysis of a complex cadaveric hand dysmorphology

Abstract

Introduction: Major embryonic hand development occurs in approximately the fifth week of gestation. The normal course of limb development can be affected by environmental or genetic factors leading to various congenital anomalies. The variability and severity of the anomalies could lead to functional deficits, truncated development, or absence of development. The present study aimed to investigate the anatomical composition of a cadaveric limb presenting with a complex congenital hand malformation. Materials and methods: Plain film x-rays and CT scans were obtained prior to dissection of the hand. Then forearm and hand dissections were completed. Digital images were captured throughout the dissection process. Results: Imaging and dissection revealed normal osteology of the distal radius, ulna, carpal, and phalanx of the first digit. The second, third and fourth digits were truncated, brachydactyly, with syndactyly of the distal phalanx and integument of these digits. Interestingly, the fifth digit presented with clinodactyly. Examination of the flexor and extensor musculature revealed an abnormal distribution pattern as well. The proximal and distal attachments of the flexor and extensor tendons of the first and fifth digits appeared relatively normal. The extensors of the second, third, and fourth digits attached to the base of the metacarpals. The distribution of the flexor digitorum superficialis and profundus appeared to interweave with each other and have an altered insertion pattern, with some digits lacking all or some of the typical tendons. Conclusions: Based on the osteology and neurovascular results we suspect the congenital malformation observed was symbrachydactyly.

Keywords

• Syndactyly
• Brachydactyly
• Symbrachydactyly
• Congenital hand malformation
• Dissection
• Anomaly