Stealth

Steering is a severe deformation, the main feature of which is a persistent deviation of the hand toward the missing or underdeveloped forearm bone: in the absence of the radius, the manus vara, in the absence of the ulnar, is the elbow of the manus valga. With congenital slanting, the bone, muscular, vascular and nervous systems of the upper limb are affected, which is expressed in gross functional and anatomical disorders.

ICD Code 10

Q68.8. Other specified congenital musculoskeletal deformities.

What causes stealth?

Often there is a combination of congenital slanting with the developmental defects of other organs and systems, which allows attributing this disease to the category of embryopathies.

How is it manifested in harshness?

Beam helmet

The brush and forearm are perforated, form a different size (from blunt to acute), an angle open to the inside (hence the name - manus vara), i.e. Absent or underdeveloped radius. The brush is underdeveloped, flattened due to the absence of the first finger and metacarpal bone, rarely - II and III fingers, proximally displaced in relation to the head of the ulna projecting to the rear. The forearm is shortened and curved by convexity to the dorsal side. Noticeable hypotrophy of the muscles of the forearm and shoulder.

Limited mobility and strength of fingers as a result of contracture of one degree or another. The brush is unstable. Rotational movements are possible around the distal segment of the ulna. Rotational movements of the forearm are absent, movements in the elbow joint are limited.

Deformation accompanied by underdevelopment of the radial nerve and radial artery.

Elbow slovenliness

The forearm is also pierced, but with a deflection of the hand towards the underdeveloped ulna, ie. Outside (mantis valga). The brush is deformed, often underdeveloped or missing III, IV and V fingers with the corresponding metacarpal bones. The forearm is curved and shortened, observing muscle hypotrophy.

Flexion and extension of the brush are not limited, the grasping function is preserved. Comparison with the articular surface of the radius provides sufficient stability of the brush when gripping and holding objects.

The shape of the elbow joint is changed, the movements in it are limited or absent, which is due to dislocation of the head of the curved radius or its synostosis with the humerus.

Diagnostics

X-ray picture basically corresponds to clinical manifestations of deformation. With radial and ulnar congenital armor, regardless of the severity of the disease, with the age of the child, functional disorders increase, which is due to an increase in the existing deformation and the progression of rigidity.

[1], [2], [3]

How is it handled?

Conservative treatment

From the 1st month after birth, conservative treatment is recommended, aimed at stretching the shortened and contracted soft tissues with the removal of the brush to the position along the forearm axis. To this end, apply gradual corrective gypsum dressings with a change in 7-10 days, depending on the age, massage, therapeutic gymnastics. After correcting the deformation, a plastic tutor is used to hold the brush, preferably a thermoplastic material - a polyvik. With age, plastic tires are left only for the night, in the daytime they use individually manufactured medical devices. However, after a permanent passive correction ceases, a relapse occurs.

[4], [5], [6], [7], [8], [9],

Surgery

Only surgically, it is possible to eliminate deformation and achieve stabilization of the hand with improvement of functions, exclude relapse. Many ways of surgical treatment of congenital slanting have been proposed. In order to prevent an increase in deformity and rigidity, surgical treatment should be started from the age of 8-12 months. Planning the stage of surgical interventions. The most important stage in the treatment of patients with congenital stealth is surgery aimed at expanding the functionality of the brush with radial armor and the functionality of the elbow joint with ulnar surgery.