HS08 CONGENITAL HAND: THE DEFORMITY‐DEFICIENCY INDEX

Congenital hand is a complex and vast subject therefore classification is very necessary for the purpose of teaching, communication and guide treatment. The first comprehensive and yet user friendly classification was proposed by Swanson et al. in 1976. This classification based on etiopathogenic is popularly known as the ‘IFSSH 7 groups classification’. (I) Failure of formation: transverse or longitudinal (II) Failure of differentiation (III) Polydactyly (IV) Overgrowth (V) Undergrowth (VI) Amniotic band syndrome (VII) Generalized skeletal syndromes. However this classification was found not able to satisfactorily classify 20–30% of cases. Other classifications based on genetic defects, teratogenic sequence and syndromics were being introduced previously and continue to be used parallel with the IFSSH classification. Furthermore the classification continue to be besieged by multiple morphological types of deformity in a same hand. Ogino introduced the JSSH expanded classification to address some of the deficiencies of the IFSSH classification. For a beginner in treating congenital hand, it is indeed daunting, as the variations in morphology, the degree of severity and functional deficit even in the same diagnosis can be very different. It is usual to find further sub classifications. For the purpose of guiding treatment, I propose the concept of deformity/ deficiency index. Group I) The imbalance/ small in size II) Extra digits III) Mal positioned/ Mal-aligned IV) Poor/ No function V) Total absent. The residual functional decreases from group I to V. And similarly the reconstruction becomes complex and difficult.