Congenital hand anomalies treatment by restoring normal tendon balance and NO Pinning. The Guided Growth evidence
Seance of wednesday 16 september 2026 (Communications libres)
DOI number : 10.26299/xf7r-as16/emem.2026.38.04
Abstract
For a long time, the treatment of congenital malformations involved transferring adult orthopedic surgical techniques to the pediatric hand: osteotomies for angular deviations and invasive joint procedures for stiffness. Surgical outcomes were poor due to an ignorance of growth mechanisms, which led us to propose a breakthrough concept termed "Guided Growth."
Observation of both normal and malformative anatomy reveals that while epiphyses produce growth, tendons direct it. Since pediatric malunions are naturally corrected only by the dynamics of balanced tendons, we undertook early tendon recentering and the treatment of epiphyseal anomalies, allowing congenital deformities to be corrected through growth as well. Tendon gliding must be promoted to enable dynamic realignment, and the use of pins must be abandoned. The "No Pinning" approach tolerates residual axial deviation, entrusting its correction to directed growth. This marks a disruption from "x-ray surgery." These principles have established themselves as Evidence-Based Surgery, which we have validated prospectively.
In this new appraisal of thumb duplications, cleft hands, and synpolydactyly, the palmar approach is mandatory. Observe: where are the tendons? Where are the epiphyseal malformations? Recenter, recreate pulleys, and cease pinning. Mobilize immediately; Directed Growth will do the rest. Follow these children until puberty, maintain a critical eye, and evaluate the accuracy of your predictions. Long-term outcomes are superior across all aesthetic and functional criteria.
Arielle Salon
Hopital Necker Enfants Malades Hospital and University, Paris, France
Observation of both normal and malformative anatomy reveals that while epiphyses produce growth, tendons direct it. Since pediatric malunions are naturally corrected only by the dynamics of balanced tendons, we undertook early tendon recentering and the treatment of epiphyseal anomalies, allowing congenital deformities to be corrected through growth as well. Tendon gliding must be promoted to enable dynamic realignment, and the use of pins must be abandoned. The "No Pinning" approach tolerates residual axial deviation, entrusting its correction to directed growth. This marks a disruption from "x-ray surgery." These principles have established themselves as Evidence-Based Surgery, which we have validated prospectively.
In this new appraisal of thumb duplications, cleft hands, and synpolydactyly, the palmar approach is mandatory. Observe: where are the tendons? Where are the epiphyseal malformations? Recenter, recreate pulleys, and cease pinning. Mobilize immediately; Directed Growth will do the rest. Follow these children until puberty, maintain a critical eye, and evaluate the accuracy of your predictions. Long-term outcomes are superior across all aesthetic and functional criteria.
Arielle Salon
Hopital Necker Enfants Malades Hospital and University, Paris, France