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 […]

Symbrachydactyly, now what?

I have posted on symbrachydactyly several times in the past. There are, by different symbrachydactyly classifications, 7 types: short finger cleft type (thumb and small finger present) peromelic (nubbins) monodactyly (only the thumb present) wrist bones present (but nothing more distal) wrist bones absent (ie, arm ends at the end of the forearm) transforearm […]

5- finger hand, follow- up

I have previously posted on the topic of the 5- finger hand.   This previous post summarized many of the key issues with this diagnosis. Here is the preoperative picture of one such child with a 5- finger hand.  Note the small extra thumb and the digits all aligned in the same plane. 5 […]

Challenges with Cleft Hand Reconstruction

When surgery is required for cleft hand, the goal is to create a maximally functional hand that is as “normal” appearing as possible.  While each child with cleft hand is different, usually we can create a hand that works well and looks good.  However, certain challenges exist after surgery related to hand anatomy.  A cleft […]

Trigger Thumb, Video

Most children with trigger thumb have a thumb stuck in a position of flexion.   It does not hurt but the thumb will not straighten.  While most kids function just fine, some activities may be difficult.  I have covered the basic in a previous post: In these cases of a locked trigger thumb, we typically, […]

Hand Society 2013

Last week was the annual meeting of the American Society for Surgery of the Hand in San Francisco.  As usual, it was a great meeting with an amazing collection of speakers giving paper presentations and courses on a variety of topics.  There were two presentations of congenital research from our institution (along with a number […]

Severe Radial Longitudinal Deficiency

As with most medical conditions, different children will be affected at different severities.  These differences can be notable such that two kids labeled with the same congenital difference may look completely different.  While this obviously matters to the family, it also matters to the physicians because once we sort out a diagnosis (sometimes easy, sometimes […]

Congenital Radial Head Dislocation

Congenital radial head dislocation is an unusual congenital anomaly of the elbow.  It is undoubtably present at birth but is rarely discovered until children get a bit older.  This is mainly because the limitations of radial head dislocation are not life- altering for most (including the motion limitations).  X- rays are usually the best way […]

Short Fingers- Brachydactyly

I have written several times about symbrachydactyly– that is short, webbed fingers.  This common condition is distinctive in appearance (although there are multiple different types).   I have actually written 10 posts that relate to symbrachydactyly. Brachydactyly, or short fingers, is a different condition as there are the normal 5 digits with shortening of […]

Even More Thoughts on Pollicization

Pollicization is the surgical procedure in which the index finger (typically) is used to create a thumb.  It is most commonly performed for children born without a thumb or with a markedly small, unstable thumb but can also be performed in post- trauma situations in the adult.  The importance of a good thumb can not […]

Trigger Thumb/ Trigger Finger

Trigger digits are common in the adult population.  It can be called different things including stenosing tenosynovitis but we really do not understand who gets it and why they get it.  The only population that seems to get trigger fingers more than everyone else are diabetics.  Adults with trigger finger (and it really can be […]

Mild Camptodactyly

Camptodactyly comes in different types based on age and severity.  I have written several times about camptodactyly including While there are different ways to consider camptodactyly, there are three basic types: infantile, adolescent, and camptodactyly associated with a syndrome (i.e., athrogryposis, etc.).  For most patients, camptodactyly affects the small fingers on both sides but may […]

Partial Syndactyly

I have written several times on syndactyly, most recently about an unusual case of thumb- index syndactyly I have also mentioned (but not discussed in great detail) partial syndactyly.  Partial syndactyly means that the fingers are joined together by a skin bridge without bony connection.  The skin bridge does NOT travel all the way to the […]

Thumb Index Syndactyly

I have posted a number of times about syndactyly.  The two basic posts include: and The long and ring finger are most commonly involved in syndactyly whereas the thumb and index finger are uncommonly conjoined.  There are several important points to consider regarding thumb and index finger syndactyly: 1) The syndactyly between the thumb and index […]

Extra Thumb

Radial polydactyly is also called split thumbor thumb duplication.  Or, an extra thumb if we really want to keep it simple.  Extra thumbs all share some similarities but each is really unique.  How most patients with radial polydactyly are similar        Both thumbs are smaller than the “normal” thumb should be.       Many […]

Madelungs Deformity

Madelungs Deformity is a malformation of the distal radius which creates a deformity of the wrist.  It typically presents in adolescent females and often is bilateral.  Madelungs may be painful and may limit motion of the forearm and wrist.  There is a known genetic pathway for patients with a SHOX gene abnormality.   There genetics […]

Pollicization at 15 years

Pollicization, or the creation of a thumb from an index finger, is one of my favorite surgeries.  I like it so much because it allows me to accomplish my 2 primary goals for a child- making his or her hand function better and look better with a single operation.  I have written several blog entries […]

Symbrachydactyly of the Foot

Symbrachydactyly, or short webbed fingers, is a birth difference which almost always affects one arm.  I have blogged about this anomaly several times- this is a link to all relevant posts. One of the ways we differentiate symbrachydactyly from other anomalies is that it is almost always affects only one arm.  When more than […]

The Future of Prosthetics??

A National Public Radio (NPR) story has brought attention to 3-D printing and the world of prosthetics. Prosthetic limbs are tricky for any age patient and especially for children.  First, prosthetics are expensive and the growing child needs new prosthetics on a regular basis due to growth.  Second, prosthetics can be a challenge to […]

Traumatic Madelungs Deformity

Madelungs is a deformity of the wrist related to abnormal growth.  It is typically an inherited condition but may appear without any family members being affected.  I just realized that I have not posted on this condition and will blog more on the topic soon.  Today I want to write about one variety of Madelungs– […]

Camptodactyly, Unusual Cause

Camptodactyly is a flexion deformity of the finger, typically the small finger, and is typically caused by an imbalance between the flexors and extensors of the PIP joint.  There have been a number of specific causes identified including abnormal muscle insertion, a tight flexor digitorum superficialis tendon, and weak extensor tendons.  Most patients with camptodactyly […]

Clinodactyly Minimally Invasive Treatment

Clinodactyly is defined as a deviation of a finger.  Most commonly, it involves the 5th finger curved towards the ring finger but can also involve the thumb or any other finger.  We have reviewed clinodactyly previously In an established clinodactyly in an older child, treatment is based on functional limitations.  Therapy has never been proven […]

Toe Transfers

Symbrachydactyly may present in different forms although the thumb is typically well formed.  Reconstructive technique are varied and can include free toe transfers as I have previously written . I recently saw a symbrachydactyly patient back for followup 10 years after initial treatment.  We had, after a lengthy family discussion in 2003, treated the 9 month old patient […]


POSNA is the Pediatric Orthopaedic Society of North America.  It is a wonderful organization of orthopaedic surgeons who care for children with orthopaedic birth, acquired, and traumatic injuries.  It was founded around 1970 and has grown over the last 40 years.  I recently became a member of POSNA and attended my first meeting in Toronto […]

Cleft Hand Long Term Follow- up

Cleft hand, central deficiency, is an uncommon birth anomaly of the hand.  I have previously posted a few times on this interesting difference including one about surgery another about cleft hand in general and a few others as well.  I thought a long- term follow- up sequence of pictures might be interesting to share. We […]

Radioulnar Synostosis, revisited

Radioulnar synostosis has been previously discussed in this blog In that post, I discussed that in most cases, surgery was not necessary because kids typically function very well. However, sometimes that is not the case.  Most kids with radioulnar synostosis are diagnosed around age 7.  Sometimes it is picked up earlier but around age […]

Congenital Clasped Thumb

Congenital clasped thumb describes a condition present at birth (but potentially not recognized until 3-4 months of age or even later) in which the thumb is flexed into the palm.  Congenital clasped thumb may affect one or both thumbs but more commonly affects both.  Most newborns keep the thumb positioned in the palm for the […]

Pseudarthrosis of the Forearm

Pseudoarthrosis or, more commonly, pseudarthrosis literally translates to “false joint.”  The term Pseudarthrosis is used commonly in the situation of a fracture nonunion.  For example, if the shinbone, the tibia, does not heal after a fracture, a nonunion develops.  Eventually the nonunion will develop into a pseudarthrosis– related to motion between the bone ends.  There is fluid […]

Family Challenges

I just read a very interesting article in Money Magazine, May 2013 issue.   It is called “Paying for Finn” and is written by Jeff Howe.  The article details the challenges in caring for a special needs child.  A child such as Finn on the autism spectrum brings different challenges than most children with birth […]

Small thumbs

Small thumbs are a part of radial longitudinal deficiency– the official name is hypoplastic thumb meaning underdeveloped thumb.  Sometimes this is an isolated problem and sometimes it is associated with abnormalities of the forearm and wrist (radial longitudinal deficiency)- A small thumb can be on one hand or both but most of the time the […]

Trisomy 8

There are number of different varieties of chromosomal disorders in which there is an extra chromosome, leading to a total of 47 chromosomes instead of the typical 46 (23 pairs).  The most notable trisomy is Downs Syndrome, Trisomy 21.  The more common other trisomies include Trisomy 18 (Edwards syndrome) and Trisomy 13 (Patau syndrome).  Finally, […]

Great Update

Here is a nice update on our patient- Erickson- born with 3- arms.  Amazing story, more amazing kid.  Also, very interesting blog.

L1 Syndrome and the Thumb

L1 Syndrome is a rare condition that primarily affects the nervous system including the brain but also the nerves to the arms and legs.  The name L1 syndromecomes from the name of the altered L1CAMgene.  Alterations in this gene affect the L1 protein which then affects nervous system development.  L1 Syndrome is passed to children […]

The 5- Finger Hand

The 5- finger hand is a rare anomaly in which there is no thumb, but rather 5 digits in the same plane (i.e., in a row) without a thumb.  That means each digit has three bones (whereas the thumb normally has two bones).  This is important because the normal thumb function is not present because […]

Toe syndactyly, more thoughts

I have previously posted on toe syndactyly with an example of a surgical case. While this was a fascinating case with a very satisfying outcome, it is unusual.  Most cases of toe syndactyly involve the lesser toes (toes 2-5) and have little functional or appearance issues.  This type of toe syndactyly involving the lesser […]

Ulnar deficiency, considerations for surgery

I have previously written several times about ulnar deficiency.  I would like to provide some additional thoughts on function, limitations, and possible ways that a surgeon can help.  First, I want to state again that most kids with ulnar deficiency do not need surgery.  Function is typically good although there can be some notable limitations. […]

Extra Digits

Polydactyly, or extra digits, is likely the most common type of birth abnormality affecting the hands.  Extra digits come in many different varieties, from complex extra digits affecting the thumb to small nubbins affecting the pinky.  In many cases of extra digits affecting the pinky, a simple surgery or simple suture around the extra digit […]

Toe Syndactyly

Syndactyly, or abnormal joining of the digits, is most commonly considered to involve the hands.  This is most likely for two reasons: hands matter more than feet to appearance and hands with syndactyly are more affected functionally than are feet with syndactyly.  In most cases, syndactyly of the toes affects the 2nd and 3rd toes, […]

Amazing People

I will try to share links to interesting people and news stories as I become aware. Here is a new link.  I do disagree with the diagnosis (amniotic constriction band)- instead, based on what I can see, it looks like symbrachydactyly. Here is one such link to an amazing basketball player (near and dear […]


I hope the blog has been helpful for patients and families.  My goal is a weekly post and while I am not always successful at this target, I feel like I have been pretty good at regularly sharing my thoughts.  My efforts on this blog have made me realize how hard people work to regularly […]


I have previously posted on clinodactyly but recently performed several surgeries so I though adding a few more pictures and thoughts might be helpful.  There are two types of clinodactyly: isolated and associated with a syndrome.  Isolated clinodactyly is common in the general population but is very well tolerated and usually ignored.  In fact, many […]

Toe Transfers

There are 2 types of toe transfers for children born with hand deficiencies: vascularized complete toe transfer and non vascularized transfer of a toe phalanx (i.e., just the bone).  Vascularized toe transfers are considered for children with absent digits, typically in cases of symbrachydactyly (or transverse arrest) or amniotic constriction band.  One or two toes […]