Surgery for Macrodactyly

Macrodactyly is an uncommon birth condition of the upper extremity.  I have posted several previous times on macrodactyly: Macrodactyly PostMacrodactyly Post 2 Macrodactyly means ‘large finger’ and sometimes is referred to as local gigantism.  My other posts have discussed different facts about the diagnosis including why this may happen but here I would like to […]

Simple Surgery for Symbrachydactyly

I have posted on several times on symbrachydactyly, with one post HERE.  Each child with symbrachydactyly, and really any birth difference of the upper extremity, is unique. No matter their bony and soft tissue deficit, their family situation and functional needs must also be considered.  So even if two kids look similar, I believe that musculoskeletal […]

Clasped Thumb Follow Up

I have posted several times on clasped thumb, a rare condition in which the muscles that straighten the thumb are slow to develop and the thumb rests across the thumb.  It must be differentiated from several other diagnoses included trigger thumb and spastic thumb (in which the tight muscles pull the thumb down).  Here are […]

Patient Pollicization Testimonial

Gracie is an 11- year old who had a pollicization 3 months ago for her hypoplastic (small) thumb. Compared to the typical patient treated with a pollicization, Gracie is unusual because she was much older at the time of her surgery.  Gracie’s age at the time of surgery does bring a few challenges mainly because […]

Surgery Ecosystem

There are many factors for families to consider as they choose a surgeon and a hospital.  There is no perfect path to making these choices but some factors that I believe are important include: 1) Surgeon.  I have previously blogged about choosing-your-childs-surgeon  and this is a key factor for consideration.   I believe that the surgeon […]

Buenos Aires IFSSH Meeting

It was my pleasure to attend the 50th anniversary meeting of the IFSSH- the International Federation of Societies for Surgery of the Hand.  This international organization meets every three years (previous meetings in South Korea and India, next meeting in Germany) with a weeklong exchange and dialog on hand surgery.  I was pleased to have […]

ASSH Annual Meeting 2016

I recently returned from Austin Texas, site of the American Society for Surgery of the Hand Annual Meeting.  This was the first time the meeting was held in Austin but I am sure we will be back.  I thought the overall meeting was really well done with a great mix of scientific content and review […]

Hand Camp 2016

Once a year, Hand Camp is held in Pitosi, Missouri at Camp Lakewood.  This is a wonderful opportunity for 15 kids with hand and arm differences to come to camp with their entire family (parents, siblings).  The kids get a chance to meet and socialize with kids with similar brith differences but also work with […]

Great Rio 2016 Paralympic Video

Wow!  Great Video Charles A. Goldfarb, MDMy Bio at Washington Universitycongenitalhand@wudosis.wustl.edu

Choosing Your Child’s Surgeon

Choosing a surgeon for your young child with a birth difference of the upper extremity can be challenging, stressful, and confusing.  There is no simple equation to simplify this process but there are a few factors which might help. Bedside manner.   When a family chooses a surgeon for their child with a birth difference of […]

Making a More Functional Hand

I have written numerous times in this blog about the importance of improving function for kids born with hand differences.  Function can be made better through therapy, through splinting, or through surgery. Whenever possible, we want to improve appearance as well.  There have been several investigations that found that kids born with hand differences are […]

Skin Contracture and Z-plasty Correction

The field of hand surgery was developed around the time of World War II combining the fields of orthopedics (care of bones, joints, tendons, muscle), plastic surgery (care of skin, soft tissues, and nerves) and vascular surgery (care of blood vessels).  Given the very complex anatomy of the hand, wrist, and forearm, the concept of […]

Extra Digits: functional and social considerations

Today, children born with extra fingers or toes (polydactyly) are typically treated with excision and reconstruction of the hand or foot.  There are multiple reasons for the surgical approach. First, the extra digit does not provide a functional advantage. The digits are rarely fully formed or fully functional.  Second, the extra digits can cause problems with […]

Rebuilding the Mirror Hand

Mirror hand is an incredibly rare birth difference of the hand and upper extremity.  I have previously blogged about this diagnosis, specifically regarding how limbs form and how birth differences come to be- find the post HERE.  But I have not previously written about the reconstruction or rebuilding of the mirror hand.  And there is very […]

Cerebral Palsy Article Link

I recently wrote (with help) an article for Hand Clinics on Cerebral Palsy treatment.  While I generally write scientific papers (that review patients to help with future care), occasionally I will write a review that summarizes our knowledge- that is this chapter regarding tendon transfers.  Thank you to my coauthors of this manuscript, Anchal Bansal […]

Fingernail Bump

As a hand surgeon, I am often asked questions about fingernails- whether related to irregularity (bumps, pain, swelling) of the nails or pain.  Most of these are minor or temporary issues and there are several excellent reviews on the internet including bundoo, medscape, and others.  Most of the issues on this list are infections including paronychia, felon, and […]

Thumb Deformity

The thumb is vital for high level hand function.  The concept of the opposable thumb- the thumb that can meet the fingers for pinch and other high level function- has been said to separate man from at least some of our primate ‘relatives’.  In the growing child, the thumb is key for exploring the world […]

Bent Finger: Surgery for Camptodactyly

I have blogged several times on camptodactyly as it is a common finger anomaly and I have received regular requests for information on the topic.  Those posts can be found HERE and HERE and HERE and HERE.    The popularity of the topic camptodactyly can be seen with the large number of comments and questions on the last link. The […]

Clasped Thumb.

Clasped thumb is an uncommon diagnosis in which the thumb is held in the palm.  While there are several potential reasons for this positioning, in many cases it is simply due to a delay in muscle development of the thumb extensors.  Over time, those muscles (EPB and EPL) can (but may not) strengthen sufficiently to allow […]

Finger Flexion Deformity

I have previously posted several times on camptodactyly, a condition with a stiff, bent finger.  Those posts can be viewed HERE.  Camptodactyly is relatively common compared to other birth differences of the hand and upper extremity as it can be seen in isolation (i.e., not associated with any other conditions) or in association with cleft hand, […]

Amazing Function in Arthrogryposis

I have blogged many times on arthrogryposis as can be seen HERE.  Our goal as upper extremity (hand) surgeons is to use therapy and surgery to improve function.  The real purpose of our interventions is to allow independent function such as eating, writing, toileting, etc.  There are a series of surgeries which we have found helpful […]

Meetings

I have been away from this blog for too long.  I have been traveling a bit and want to share some information about the meetings I have attended.  I hope and expect to get back to regular blogging this week! POSNA Annual Meeting 2016 POSNA is the Pediatric Orthopaedic Society of North America.  This organization […]

Finger at Risk- Amniotic Constriction Band

I have previously posted on Amniotic Constriction Band.  I post again on the topic as it is common and sometimes early surgery can be helpful. This child was born with an abnormality of the hand including a markedly swollen finger.  There are several important findings in these 2 pictures. Amniotic constriction band with swollen finger. Amniotic […]

3D Printed Prosthetic Design

The 3D printed prosthetic( 3DPP) has captured the attention and the imagination of both the general public and the parents of kids with birth and acquired limb loss.  In my opinion, the public envisions the 3D printed prosthetic (3DPP) as a futuristic solution which will eventually become completely life- like.  The parent sees it as a practical, […]

Surgery for Olliers Disease

Multiple enchondromatosis is also known as Olliers Disease.  In this disease, at least 2 cartilage tumors known as enchondromas grow in different bones.  Initially, we tend to watch the growths, but sometimes surgery is necessary.  I have previously blogged about Olliers as part of a post on MACRODACTYLY.  There are number of sites that provide good, […]

Camptodactyly- bent finger- treatment with splinting

Camptodactyly is the Greek word for bent finger- specifically flexed so that straightening the finger at the middle joint is not possible.  I have blogged about camptodactyly several times before- read those posts HERE and HERE.  Therapy is the first line treatment for camptodactyly.  And it usually works.  But therapy has its limits and if the finger is […]

Separating joined fingers: A Case Demonstration of a New Strategy

Surgery to separate joined fingers has been largely unchanged for 40 years.  This post is meant to share case pictures and details on this new strategy. Syndactyly, or the abnormal joining of the fingers, is one of the most common birth anomalies of the hands and feet.  In our recent assessment of birth anomalies in NY […]

Not the Typical Thumb and Wrist

Radial Longitudinal Deficiency (RLD) has a wide range of presentations from a small, unstable thumb to major bone and soft tissue problems of the entire upper extremity.  And yet, despite this wide range, most kids have a somewhat predictable appearance within a couple of different categories.  I have shared my thoughts on these variations HERE, numerous […]

Prosthetics: 3D Printed vs Task Designed

The Shriners Hospitals have long been known for Prosthetics.  Each hospital in the system has expertise for both upper and lower extremity prosthetics.  As I have mentioned in previous blog POSTS, there is a great deal of new, exciting progress in the field.  We continue to work here at the Shriners Hospital in St Louis and St […]

More on Amniotic Constriction Band

I have posted several time previously on Amniotic Constriction Band as can be found HERE.  There is also reasonable information on the web as can be found at Wikipedia and NORD and HERE. However, I do believe that it is helpful to share case examples. Here is a 6 month old with Amniotic Constriction Band that was urgently treated for a […]

Cleft Hand Reconstruction

I have posted a number of times on cleft hand, or central deficiency as can be found HERE.  To me, cleft hand is one of the most interesting diagnoses as kids with it may look and function very differently from each other despite have the same diagnosis.  Some of my other posts highlight these differences between […]

A New Year filled with Hope

Happy New Year! My hope for 2016 is much progress towards our understanding of birth differences of the upper extremity.  My primary resolution is to continue our research in St Louis at Washington University, St. Louis Childrens Hospital, and the Shriners Hospital for Children.  We have a number of exciting projects underway including: The CoULD […]