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DOI: 10.1055/s-0044-1781444
Grading Congenital Anomalies of the Hand for Defining Outcomes and Improved Patient Communication: A Practical Approach
Congenital anomalies of the hand present a wide array of clinical challenges due to their diverse nature. Each case can significantly differ in terms of anatomical involvement, severity, functional impairment, and associated conditions. As a result, treatment plans must be highly individualized, balancing surgical interventions, physical therapy, and sometimes prosthetics or adaptive devices. Some cases may require multiple surgeries over time, especially as a child grows, while others might benefit from noninvasive management strategies. This diversity necessitates a multidisciplinary approach and careful long-term planning to optimize functional outcomes and patient quality of life.
Defining outcomes early in the management of congenital anomalies is essential. Early outcome definition guides the treatment strategy, setting realistic expectations for both health care providers and patients. It enables tailored interventions suited to the specific anomaly or deformity, considering functional and aesthetic goals. This proactive approach can also help in monitoring progress effectively, adjusting treatments as needed, and ensuring that all interventions align closely with the desired outcomes, ultimately leading to improved patient satisfaction and functional results.
Effective communication with patients or caregivers is necessary in these conditions, which often require long-term, complex treatment plans, including surgeries and rehabilitation. Clear communication ensures that patients and their caregivers fully understand the diagnosis, treatment options, and potential outcomes. It helps in setting realistic expectations, which is vital for emotional and psychological preparedness. Additionally, effective dialogue fosters a stronger patient–clinician relationship, enhances adherence to treatment plans, and ultimately leads to better overall patient satisfaction and outcomes.[1]
Congenital hand anomalies have been classified in many ways, for example, the Swanson classification, the Oberg–Manske–Tonkin (OMT) classification, while hand functional outcomes are scored using the Disabilities of the Arm, Shoulder, and Hand (DASH) score, QuickDASH score, etc.[2] [3] [4] [5] However, conveying the severity of the anomalies or deformity to a patient is always a challenge for the caregiver.
Recognizing the challenges in consistently evaluating and communicating the complexities of hand anomalies and deformities, we are proposing a novel grading system ([Table 1]) to bridge this gap.
Note: This grading system aims to assist health care providers in categorizing congenital hand anomalies, aiding in communication, planning treatment strategies, and setting realistic expectations for outcomes, and would be beneficial in both clinical and educational settings.
Our aim was to empower health care providers (particularly hand surgeons) with a simple tool that goes beyond anatomical descriptions or complex scoring to offer a framework for informing clinical decision-making, streamlining communication, and setting realistic expectations for patients.
The Hand Anomalies and Deformity (HAnD) grading system is based on two key factors: characteristics and treatment outcome. It grades anomalies on a scale from I (mild) to IV (profound), with grade III (severe) further divided into A and B subcategories for nuances in complexity and associated syndromes ([Fig. 1]).
These deformities will often need additional physical therapy to achieve optimum function. The system outlines the expected functional and cosmetic outcomes for each grade. This system thus helps health care providers accurately classify and communicate the nature of the hand condition to the patient or the caregiver.
Some additional features of the HAnD grading system include the following:
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Emphasis on function: The system prioritizes the impact of the deformity on hand function, aiding in treatment planning, and setting realistic expectations for patients.
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Consideration of associated syndromes: Recognizing the presence of associated syndromes like Apert's syndrome allows for a more holistic approach to management.
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Focus on treatment feasibility: The system acknowledges the limitations of surgical intervention for severe anomalies, guiding treatment decisions toward maximizing the remaining function.
Publication History
Article published online:
18 March 2024
© 2024. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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