Saturday, September 29, 2012

"Simple" Extra Digits

An extra finger on the pinky side of the hand is one of the most common birth anomalies of the hand.  The official name is ulnar polydactyly or postaxial polydactyly.  It is typically seen in African Americans and is usually passed on as an autosomal dominant trait.  OMIM has numerous details: http://omim.org/entry/174200?search=postaxial%20polydactyly&highlight=postaxial%20polydactyly

In caucasians, it is unusual and may be associated with a syndrome, such as Ellis Van Creveld,  among others.  http://omim.org/entry/225500?search=postaxial%20polydactyly&highlight=postaxial%20polydactyly

We can help rule out an associated syndrome.

Small extra digit, a postaxial polydactyly.



Another view of the extra digit prior to surgical excision
Hand surgeons such as myself often do not see these patients with small extra digits because they may be treated in the newborn nursery.  In these situations, the extra digit is "tied off" such that the blood supply is blocked and the finger necroses (turns black) and eventually falls off.  The process is typically non painful and usually is a successful treatment.  The small side effect with this treatment is that there will be a skin lesion at the site of the previous attachment, essentially what appears to be a wart.
Small "wart" after "tie off" procedure for ulnar polydactyly

Another example of skin lesion after a "tie off" procedure for ulnar polydactyly



For that reason, when I am able to see patients with postaxial polydactyly in the office, I offer two treatment options: the office based "tie- off" procedure and a formal surgery.  The surgery is quite small and offers an appearance benefit.  It is a very different surgery than reconstruction of other extra digits, such as radial polydactyly.  http://congenitalhand.wustl.edu/2012/05/difficult-extra-thumbs.html

Either way, most patients with this anomaly do wonderfully.

Thursday, September 27, 2012

September 2012 Travels

It has been too long since I last blogged.  Several catch- up blogs are on the way.  In the meanwhile, I have been to several interesting events in the last month.

First, we had our annual St Louis Shriners Hospital Hand Camp.   There were approximately 18 children with their families, 10 junior counselors, and a variety of therapists and volunteers from the hospital.  This 3- day camp at a rural lodge is an amazing experience for all involved.  The camp participants, those with notable hand deformities, are able to interact with others like themselves, experience new activities such as archery and wall climbing, and learn from the junior counselors.  My favorite part has become the group discussions- one with parents alone and another with parents and the junior counselors.  The exchange of information and advice is amazing!  Here are a few pictures and one video from the weekend.

Eli, a long time patient and friend, demonstrating how a to use a bow with radial deficiency 


The following video shows the same two campers with below elbow amputations (symbrachydactyly) successfully climbing an impressive wall (written and appreciated by someone who struggled up the same wall).  Check it out and look carefully at the climbing technique!

video

The other event was the annual meeting of the American Society for Surgery of the Hand, in September in Chicago.  As always, the meeting was a great chance for hand surgeons from across the world to congregate and learn from one another.  I had the opportunity to help lead (with Don Bae from Boston) a 4.5 hour Precourse on Congenital Hand Anomalies.  We had a great panel of speakers from the United States as well as Australia (Dr Tonkin) and South Korea (Dr Baek).  The exchange of information was amazing.  The only disappointment was that our room was not large enough to seat the entire audience!

http://www.assh.org/AnnualMeeting/AnnualMeeting2012/program/precourses/Pages/Pre10.aspx