Sunday, December 3, 2017

Adoption and Radial Polydactyly

In 2015 (the most recent year with statistics available), there were 5647 children adopted to parents in the USA.  About half of those were from China.  See link HERE.

I am fortunate to see many families with newly adopted children.  In addition, I often have the chance to assess x-rays and clinical information for families before their trip overseas.  My review is often helpful for families as I can often provide a 'translation' of the medical information and realistic expectations regarding their child’s function, special needs, and need for additional surgery or therapy. 

Adopted children are brought to see me for one of three reasons:
1) To assess an upper extremity difference that has not been treated
2) To assess an upper extremity difference that has been treated, perhaps well and perhaps in a less than ideal way
3) To generally assess the child.

These kids and families are some of my favorite to treat.  The joy that the families bring and their interest in learning more about their new child’s upper limb difference is powerful.  I also find that parents of an adopted child have a very realistic and practical approach to their child's challenges.  There are added complexities in treating newly adopted kids including the social aspect of the adoption.  The adopted child takes time (variable) to adjust to the new home environment, their new family including new brothers and sisters, etc.  While there may be a notable limb difference, we typically do not rush to treat the patient.  We might institute therapy or splinting but our primary goal is to give the families as much time as needed to limit any additional ‘trauma’ that surgery might bring.  We do recognize that some families are eager to move forward but patience is typically our goal. 

The pictures below are of a newly adopted 4- year old child who was born and treated in China.  It appears that she was born with radial polydactyly (extra thumbs on each hand) and these extra thumbs were treated with excision alone.  While she functions reasonably well, there is an appearance difference on each side.  The left thumb has a big ‘bump’ which can be sore with pressure.  The right side is somewhat stiff and is angled.  Motion is limited on both sides but more so on the right.

Intervention is completely based on the desires of the family. Typically, we give the family and child time (as noted above) to adjust and truly assess how much the deformity is affecting function or quality of life.


Right thumb polydactyly after treatment overseas.

X-rays of right thumb polydactyly after treatment overseas.
Left thumb polydactyly after treatment overseas. Note the bump on the outside of the thumb.

X-rays of left thumb polydactyly after treatment overseas.  See the bump representing the site of the extra thumb removal.

We are embarking on a new study to assess the differences in families of children with birth differences of the upper extremities to help better understand how perceptions vary. We will share our results when we have completely analyzed the data.


 Charles A. Goldfarb, MD
My Bio at Washington University
congenitalhand@wudosis.wustl.edu