Thursday, December 26, 2013

Social Media

The last 6 weeks have been a little hectic and I have not been as timely as I would like with my posts. My goal is 1- post/ week and while that may not seem too difficult, it can be a challenge.  I will add a few new posts in the next week or so and will work as hard as possible in the new year to stay on track.

This brief post is to let the regular readers out there know that I am going to try to be better about linking my posts to social media venues including Twitter, Google+, and Facebook.  While I realize that some of you follow me on Blogger and some just check in from time to time, Twitter, Google +, and Facebook will offer another way to keep track of posts.

You can find me by name at Google +  and on Twitter- @congenitalhand

You can also find my updates on Facebook- Birth Abnormalities of the Hand and Arm.


Also, the best email address for questions (if you wish to avoid a general post) is congenitalhand@wudosis.wustl.edu


Thank you and Happy New Year!

Charles A. Goldfarb, MD

Friday, December 13, 2013

Symbrachydactyly, now what?

I have posted on symbrachydactyly several times in the past.  http://congenitalhand.wustl.edu/search/label/Symbrachydactyly

There are, by different symbrachydactyly classifications, 7 types:

  1. short finger
  2. cleft type (thumb and small finger present)
  3. peromelic (nubbins)
  4. monodactyly (only the thumb present)
  5. wrist bones present (but nothing more distal)
  6. wrist bones absent (ie, arm ends at the end of the forearm)
  7. transforearm (amputation at mid forearm level)
Nubbins, one of the classic findings in symbrachydactyly, can be present with any of these except the short finger type.  All can be associated with Polands syndrome (partial breast muscle absence with or without breast abnormality and chest wall abnormality) but the short finger variety is most commonly associated.  A recent manuscript offered a classification for Poland syndrome and confirmed that the most common finding in the hand was either no anomaly or 5 fingers but limited motion/ length.  http://www.ncbi.nlm.nih.gov/pubmed/22955538

One of my patients has a severe cleft type (almost a monodactyly type) of symbrachydactyly.  This is the original x- ray appearance.
Symbrachydactyly xray, severe cleft ype.


We treated him years ago with lengthening of the 5th metacarpal to allow functional pinch.  For several years he did well but now is limited by an inability to bring the thumb to the small finger ray.  Please note that we did not correct the thumb (despite the triangular shaped bone) because the deformity was helpful.
Symbrachydactyly after lengthening.  Note the longer 5th metacarpal.

Symbrachydactyly after lengthening.

Symbrachydactyly on right, normal hand on left.

We have discussed options with family including a surgery on the the 5th metacarpal (the lengthened bone) to angle it towards the thumb.  However, we have all agreed to attempt to treat this without another surgery at this point.  We will create a "post" to lengthen the small finger further (occupational therapy and prosthetics) to assess whether this helps functionally.  If it does (stay tuned for pictures), a formal prosthetic can be constructed.