الفهرس 
INTRODUCTION
EFFECT OF DMPA ON BONE DENSITYOnly 14 pages are availabe for public view
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Abstract
Congenital malformations of the hand encompass myriad deformities, all of which carry different functional and cosmetic implications for the patient and parents. Congenital malformations occur with relative frequency. In 1982, the Congenital Malformations Committee of the International Federation of Societies for Surgery of the Hand reported an incidence of approximately 11 anomalies per 10,000 population. These data were accumulated in seven centers located in the United Kingdom, Japan, and the United States. A similar incidence was reported earlier by Conway and Bowe (1 per 626 live births). A more recent study from Western Australia by Giele et al. reported an incidence of 1 in 506, with 46% having another nonhand anomaly. The most commonly encountered anomalies of the hand are polydactyly, syndactyly, congenital amputations, camptodactyly, clinodactyly, and radial clubhand. Approximately 10% of patients with congenital anomalies of the upper extremity have significant cosmetic or functional deficits.
Treatment for a child with a congenital hand deformity may be sought at birth or later in the child’s development. Involvement may be unilateral or bilateral; the anomaly may be an isolated condition, or it may be a single manifestation of a malformation syndrome or skeletal dysplasia. Early evaluation by a hand surgeon usually is desirable, not because of urgency to begin treatment, but to help parents with their concerns. Parents usually have considerable anxiety concerning the appearance of the hand, the future function of the hand, and the possibility of subsequent siblings being similarly affected; they also may feel a sense of guilt. To inform the parents adequately and to dispel as much anxiety as possible, it is helpful for the surgeon to be familiar with the modes of inheritance and the preferred treatment and prognosis of each condition. Although specific considerations and indications for surgical and nonsurgical treatment are discussed for each individual condition, the amazing ability of children to compensate functionally for deformity should be remembered.