Sunday, May 31, 2015

Exciting Times!!

The opening of a new hospital or major facility is unusual in our modern healthcare system.  It requires a great deal of planning, coordination, and plans for growth.  That is why it is so incredibly uncommon and exciting that TWO new pediatric facilities are opening right now in St. Louis.  TWO, both in the first week of June, 2015!

Saint Louis Childrens Hospital is opening a large outpatient facility about 15 miles west of the main St Louis Childrens Hospital.  It is called the CSCC- Childrens Specialty Care Clinic.  It is beautifully done, outside and inside, is 3 stories high and is 140, 000 square feet in size.  It will be the home to specialty clinics (thus, the name) including orthopedics and hand surgery as well as 3 operating rooms.  There will also be some pediatrician offices housed in the building.  We are excited because it will make the St Louis Childrens Hospital team of doctors more accessible for more people.

View from highway of St Louis Childrens Specialty Care Clinic (CSCC).

A recent picture of mine of a the St Louis Childrens Specialty Care Clinic (CSCC) from the west side.

The new St Louis Shriners Hospital is opening Monday June 1st, 2015.  Originally, in 1924, the Shriners opened in St Louis on the Washington University Medical School campus.  40 years later, we moved to Frontenac and now we are moving back to the Medical School Campus.  The practice of medicine has changed a great deal and the needs of the new hospital are different.  The 90,000 square foot, 3 story hospital has far fewer inpatient beds, more space for research, and lots of great space for taking care of patients.
New St Louis Shriners Hospital

New St Louis Shriners Hospital

Entry of the new St Louis Shriners Hospital

While both facilities are beautiful, what really matters is that we now have even better space for our patients- St Louis Childrens Hospital, St Louis Specialty Care Clinic (CSCC) and St Louis Shriners Hospital.  I am lucky to have the chance to work in all 3 facilities and look forward starting this week!

Charles A. Goldfarb, MD
My Bio at Washington University

Saturday, May 30, 2015

Stiff Fingers

Symphalangism is one type of finger stiffness;  I previously written about it here.  I wanted to share a few more thoughts.  In addition to the classification noted in my other post, I often think of symphalangism in terms of whether or not the fingers are short.  Whether the fingers are short or not, symphalangism is quite rare.

Flatt and Wood reported on symphalangism and divided it into 3 types (a long time ago- 1975, in the journal Hand)
- Symphalangism with normal length fingers (i.e. True Symphalangism)
- Symphalangism with short fingers (symbrachydactyly)
- Symphalangism with another syndrome like Aperts

The clinical examination is notable for the lack of motion of one or more of the interphalangeal joints- typically the proximal interphalangeal joint.  It can be one finger or it can be many fingers. Importantly, the normal creases of the fingers are not there in symphalangism.

The arrow is pointing to the top of the PIP joint of the pointer (index) finger.  Note the normal creases which demonstrate that the finger has been moving.
Kids with symphalagism lack the normal joint development and therefore lack motion and therefore lack the creases.  Here is one child with symphalangism affecting both hands.
Symphalangism.  This is the child attempting to make a full fist.  The PIP joints do not flex (bend) much.

The other hand in Symphalangism.  This is the child attempting to make a full fist.  The PIP joints do not flex (bend) much.
Also note the lack of creases on the tops of the fingers.
Careful review of the x- rays show that the PIP joints have not developed in symphalangism.

Lateral view (side view) of the hand and fingers.  The PIP joints have not developed in symphalangism.  The arrow marks the PIP joint of the long finger (middle finger).
Charles A. Goldfarb, MD
My Bio at Washington University

Sunday, May 24, 2015

World Congenital Forum

Once every three years, an international group comes together for approximately 3 days to discuss all things relevant to the care of children born with musculoskeletal differences.  In 2012, it was here in the United States, Dallas Texas to be specific.  In 2015, the 10th World Symposium on Congenital Malformations of the Hand and Upper Limb was held in Rotterdam, The Netherlands.  It also included a precourse on cerebral palsy.  There were more than 45 invited speakers, 50 free paper presentations, 70 posters, and much, much conversation about malformations, treatments, and research.  We were hosted by Christianne van Nieuwenhoven and Steven Hovius, plastic surgeons with a wonderful congenital program at Erasmus University in Rotterdam.  And WOW! it was quite a meeting.

Our hosts.  We had a delightful small group tour on Saturday.  This picture is in front of a statue of Erasmus.

I had the opportunity to present some of our work and enjoyed the back and forth regarding this information from the widely experienced audience:
1) Data from our study of the prevalence of congenital differences based on the New York State Congenital Malformation Registry.
2) Syndactyly
3) Central Synpolydactyly (poster presentation)

As always, there was a great deal of information shared and I learned much from my colleagues from all over the world.

This is my registration badge- I wanted to share the awesome logo.
I could also show you many sites from the beautiful city of Rotterdam, but the bridge is it most notable piece of architecture (at least to me).
Rotterdam's Erasmus Bridge

Thank you again to our hosts, Steven and Christianne.

Charles A. Goldfarb, MD
My Bio at Washington University