Occasionally, a typical cleft hand has a central transverse or 'cross' bone. The growth of thes bone, sitting perpendicular to the cleft, produces a widening of the clinical defect with time. Often the bone articulates with the metacarpophalangeal joints of adjacent rays and in these cases, the joints must be repaired once the bone has been excised. The latter entails the reconstruction of capsular structures and the collateral ligament of the joints.
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