Surgical management of windblown hand: Results and literature review

Abstract

Purpose Windblown hand is a congenital anomaly characterized by multiple hand deformities. The condition is extremely rare as shown by the paucity of cases reported in the literature. The deformities, which can result in a cosmetically unsatisfactory appearance and, if left untreated, maladaptive behavior, are progressive in nature. Consequently early treatment is necessary. Methods We operated upon 23 hands in 18 patients (age range at surgery 6 months to 16 years) at a tertiary care center over a period of 7 years. The patients were followed for an average period of 7 years. The surgical approach was chosen based on the severity of the condition according to Zancolli and Zancolli's classification [Hand Clin 1:443-456 (1985)]. Results According to the criteria of Wood and Biondi [J Hand Surg 15A:431-438 (1990)], of the 23 hands operated upon, 17 had excellent cosmetic results, and 15 had excellent functional results. The results were better in patients undergoing early surgery-before the age of 2 years. Relapse of the deformity to a lesser extent than the original condition was seen in two hands at the last follow up. Conclusion Definitive conclusions on this condition cannot be drawn due to limited experience in the surgical management of this rare condition. We believe that early surgical management is probably the best option available for the patient based on the results obtained. Early surgery and good post-operative compliance from patients can facilitate successful management of this rare condition with predictable results.

Congenital Ulnar Drift in a Surgeon

“…In 1932 Lundblom [3] proposed that there was a genetic cause which has been supported by demonstrations of familial occurrence in the literature (Fryns and de Smet [4]; Gavaskar and Chowdary [5]; Grunert et al [6]). Through these studies it has been widely accepted that windblown hand is inherited in an autosomal dominant manner with variable expression and penetrance.…”

Familial congenital ulnar drift/windblown hands: <em>Case report in 4 successive generations</em>

“…(Virchel E. Wood, 1990) (Kalliainen, 2003) Even though surgical correction creates near normal anatomical appearance and function, it does not exclude the chances of recurrence, especially when done very early in life. (Chowdary, 2009)…”

“…Although mostly acquired (Rheumatoid arthritis/Jaccourds arthropathy), possible familial type CUD of autosomal dominant inheritance is infrequently reported in literature (Chowdary, 2009).…”