Inherited cause of in utero digital malformations

Abstract

Amniotic band sequence (ABS) is common birth defect of incompletely understood origin. Here we describe a case of ABS in a child with paternally inherited Ehlers-Danlos syndrome, vascular type (vEDS). This is the third reported instance of ABS associated with paternally inherited vEDS in the medical literature. The two main theories of ABS formation are the extrinsic and intrinsic. The extrinsic theory states that placental tears form fibrous cords that wrap around the fetus; the intrinsic states that poor vascularisation in the fetus leads to necrosis of distal extremities. We believe this case supports extrinsic theory as it shows that as an amnion weakened by vEDS in fetal components is associated with ABS.

Keywords: congenital disorders; genetics; orthopaedics; paediatrics.

Figure 1

Patient’s complex hand malformations after one surgery.

Figure 2

Patient’s palmar crease pattern.

Figure 3

Patient’s less malformed hand after one surgery.

Figure 4

Patient’s palmar crease pattern.

Figure 5

Patient’s foot malformations; note absence of fifth digit.

Figure 6

Patient’s foot malformations; note absence of second toenail.