Background: Congenital clasped thumb is a deficiency of active extension of the thumb with flexion and adduction deformity after the age of 3 months. In distal arthrogryposis, congenital clasped thumb is characterized by global metacarpo-phalangeal (MCP) joint instability; severe narrow 1st web space and palmar contracture. Objective: The present study aimed to describe patients' characteristics, and the results of treatment of congenital clasped thumb in distal arthrogryposis. Patients and methods: A total of 24 congenital clasped thumbs in 14 patients (9 boys and 5 girls) underwent release of tight first web space structures, Ghani flap, and MCP joint chondrodesis with or without flexor pollicis longus lengthening. There were 10 bilateral and 4 unilateral cases. The mean age of the patients was 4 years old (ranging from 3 to 5). Results: According to the parent parents of the participants, all patients were fulfilled with the thumb function and appearance. Union of the chondrodesis was achieved in 21 thumbs. There was statistically significant improvement of thumb abduction, rotation and opposition. Conclusions: The 1st web space contracture release, Ghani flap and MCP chondrodesis is a good surgical option for management of congenital clasped thumb in distal arthrogryposis.

Background: Although Monteggia fracture dislocation is a rare injury, representing less than 1% of pediatric forearm fractures, missed Monteggia injuries are common, representing up to 50% of the acute injury. Both the acute and the chronic Monteggia injuries have different treatment protocols. There is a gray zone between the acute and the chronic Monteggia fracture dislocation, which represents the period after 2 weeks of injury until the ulnar fracture union.Objective: This study aimed to identify the treatment protocol for this gray zone between the acute and the chronic Monteggia fracture dislocation. Patients and Methods: Sixteen subacute Monteggia fracture dislocation patients (10 boys and 6 girls) underwent either closed or open reduction of the ulnar fracture with internal fixation. The patient's mean age was 9 years. Inclusion criteria conditioned a patient with Monteggia fracture dislocation after two weeks of the injury and before the ulnar fracture union. Results: By the end of the follow-up, all patients resumed full elbow range of motion with no elbow pain or deformity. All radiological parameters, including the radiocapitellar line and the ulnar bow lines, were normal at the end of the follow-up, with no redislocation of the radial head. Conclusions: Unlike the acute injury, there is no role for conservative treatment in the subacute Monteggia fracture dislocation. And contrary to chronic Monteggia, all patients didn't need open reduction of the radial head. Level of evidence: level IV.