Classification of Congenital Deformities

Question 1

What is the importance of congenital hands classification?

Answer 1

Forms the basis of communication with other colleagues/surgeons
Allows comparison of outcomes

Question 2

Which classification system is used to classify congenital hand conditions?

Answer 2

Swanson Classification based on work published between 1960 and 1970

Combined embryogenesis with morphology and appearance in this classification

I - IV occur in weeks 4-8 of development: F of formation, F of differentiation, duplication and undergrowth

V-VII occur after week 8 of development: Overgrowth, Constriction bands and Miscellaneous

Question 3

What are the shortcomings of the Swanson’s classification?

Answer 3

Inability to classify conditions that fall in more than one classification.

Differentiating between transverse arrest, brachysyndactyly and symbrachydactyly
(previously termed atypical cleft hand) can be difficult - undergrowth, F of formation or F of differentiation?

Question 4

What led to the development of the OMT Classification?

Answer 4

Consensus - solid foundation of basic sciences including embryogenesis to allow better classification of congenital hands

Question 5

What does OMT stand for in the OMT Classification of Congenital Hands?

Answer 5

Oberg, Manske and Tonkin

Question 6

When was the Swanson Classification officially replaced with the OMT Classification for Congenital hands?

Answer 6

In 2013 recommended by the IFSSH Committee

Question 7

What is the OMT Classification of Congenital Hands based on?

Answer 7

Developmental axes and Timeline with 3 yearly updates with new knowledge

Question 8

How is the OMT classification divided?

Answer 8

1. Malformations
2. Deformations
3. Dysplasia
4. Syndromes

Question 9

Are there any similarities between Swanson’s and the OMT classification of congenital hands? Can you describe a transition?

Answer 9

I OMT: Malformation
I-III Swansons: F of formation, F of differentiation and Duplication

II OMT: Deformation
VI Swanson’s: Constriction bands

III OMT: Dysplasia
V Swanson’s: Overgrowth

IV OMT: Syndromes occur prior to the development of the upper limb altogether

Question 10

Describe the up-to-date OMT Classification.

Answer 10

OMT App

Question 11

What may be the difficulties in implementing the OMT classification worldwide?

Answer 11

Surgeons must learn embryology to be able to understand and use the system

Different people will classify conditions differently | Enter the classifications differently on to the database

E.g Cleft hand vs ulnar longitudinal deficiency
Or
Distal phocomelia vs ulnar longitudinal deficiency

Question 12

What may be a way to classify congenital hands in the future?

Answer 12

Based on genetic coding

Question 13

What is the importance of embryology for parents of children with congenital hand differences?

Answer 13

Clelland et al 2021
Important to parents to understand the embryology
The more serious the conditions the more parents wanted to know why things go wrong.