Saturday, October 27, 2018

Severe Radial Deficiency- No slowing this kid down!


The absolute best part of my job is meeting so many great kids and great families.  What other job allows daily inspiration, with each day being a bit different with a new story, a new set of expectations exceeded, and many, many smiles.

This is the abbreviated story of one amazing child and family with a great attitude and desire to participate in anything and everything.  I will start with a few pictures and then a short video.  The patient has severe, bilateral radial longitudinal deficiency, a common blog post as can be seen through this LINK. 

Radial Deficiency, left hand.   Marked wrist deviation.  There is prominence of the ulna head.

Radial deficiency, left hand.  Note the floppy thumb and straight index finger.

Radial deficiency, right hand.  Marked wrist deviation.  There is prominence of the ulna head.

Right radial deficiency again with floppy thumb.


Radial deficiency xray.  Not wrist deformity/ absent ulna.
Radial deficiency xray.  Not wrist deformity/ absent ulna.




















And here is a video of the radial deficiency patient stringing beads which requires both large object grasp and fine manipulation- both of which can be compromised in radial deficiency. Every patient is different based on wrist motion, thumb presence/ motion, and finger motion.  This patient has marked wrist limitations and deviation, a thumb that does not help, and stiffness of the index and middle fingers.  Function in this patient with radial deficiency is largely from the ring and small fingers.





After lengthy discussions, we planned surgery to improve function without a significant risk of compromise.  This patient was treated with a bilobed flap to improve straightening of the wrist and improve mobility without stiffening the wrist.  This procedure also allows maintenance of finger function in a good position.  By allowing some radial deviation, the ring and small fingers (the key ones for his function) stay well aligned.

Bilobed flap for radial deficiency.  These 3 pictures show the planned flaps.

Bilobed flap for radial deficiency.  These 3 pictures show the planned flaps.

Bilobed flap for radial deficiency.  These 3 pictures show the planned flaps.

After bilobed flap with temporary metal pin.  Not improved alignment of the radial deficiency.

Improved alignment after bilobed flap with flaps rotated and excellent coverage for radial deficiency.

Another view of bilobed flap for radial deficiency.
We are very happy with his outcome.  Here are some videos demonstrating no boundaries and impressive skill!!




                                                    Baseball.  No problem!




                                                   Golf.  Again, no problem!!





                                                   Getting a hit!  No problem.



                                                   And tennis.  Look out!


Talent recognizing talent.  This is so awesome and does not get old!  Watch his throwing motion.

I have a great job.  I get to interact with amazing kids and families.  Just take a look.  I look forward to everything this kid will tackle in life and will always bet on him to succeed.

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


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