Function in Radial Deficiency

Radial longitudinal deficiency is both a functional challenge and an appearance issue.  Different surgeons have developed different strategies based on these challenges and the lack of a ‘perfect’ surgery.  My philosophy is to consider different surgeries, based on the child.  I will consider centralization (typically with a period of external fixator distraction prior to the […]

Trigger Thumb and Fingers

Trigger thumb is one of the more common reasons for kids to present to my office.  While uncommon in the general population, for hand surgeons who treat children, trigger thumb is quite common.  And, thankfully, kids do quite well with this condition.  Some will improve on their own without surgical intervention and others require surgery […]

Extra Thumb Reconstruction

I have posted a number of times on radial polydactyly- aka split thumb, extra thumb, etc- HERE.  This is a common birth anomaly and the decision for surgery is usually straightforward.  Sometimes surgery is also straightforward while other times the reconstruction can be quite challenging.  And, about one out of three patients with radial polydactyly will […]

Families, Choices, and Untreated Triphalangeal Thumbs

One of the benefits to my taking care of kids with birth anomalies of the upper extremity is the opportunity to really come to know the patient and the family, often over many years.  This is magnified when more than one child is affected.  This is one of the best things about my practice (and […]

Three thumbs

Radial polydactyly (duplicated thumb) is an uncommon condition in the general population- I have blogged about kids with extra thumbs a number of times.  Those posts can be found HERE.  Extra thumbs come in a wide variety of patterns, some of which are captured in the Flatt Classification (previously called the Wassel Classification) as shown in […]

Mission Trip

I wanted to share the experience of my first Mission Trip.  I went with the World Pediatric Project (WPP), a wonderful organization with which I have a long relationship.  I have cared for many of their patients in the US but have not traveled with them (or any other organization).  Their website, which can be […]

Ulnar Deficiency Follow Up

Hand surgery is a great subspecialty.  I am able to interact and treat many patients and I am rewarded in seeing my patients get better.  However, there is a downside which is that I rarely follow patients long term.  Typically, I am able to see them, provide treatment (whether that be therapy, injection, or surgery) […]

Surgery for Camptodactyly

Camptodactyly is the bent (flexed) position of a finger.  I have previously blogged about camptodactyly HERE, but wanted to share my updated surgical strategy. Surgery is considered for camptodactyly when therapy is not expected to be effective or if therapy has failed to lead to improvement.  It is absolutely my preference to always begin camptodactyly treatment […]

Macrodactyly, Syndactyly, and Keloid

Macrodactyly is very rare, even at centers such as ours that evaluate and treat many kids with birth anomalies of the upper extremity.  Macrodactyly is a difficult condition to research as there is so much variability in presentation- fingers may be dramatically large, moderately large, or only slightly larger than the expected finger size.   Treatment […]

Travel and News

Happy 2018!  I hope it is a great one for you and your family. Well, I already have one resolution for 2018- blog more consistently.  I am not meeting my goals and hope to do better in this new year. A few things to share. I had a wonderful trip to Japan as guest speaker […]

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 […]

Syndactyly Revision Surgery

I enjoy performing surgery to correct syndactyly because it is a reliable procedure with high patient, family, and physician satisfaction.  But, as with any surgery, there are complications and adverse events that can happen in the short term or at longer follow- up.  The risk of complications related to syndactyly surgery is very low.  It includes […]

First Pitch World Series

Hailey Dawson has been in the news over the last few months as she seeks to throw the first pitch in all the Major League Ballparks.  Well, she took a big step tonight on the biggest stage- the World Series!  World Series Story.   What a great story which helps to raise awareness of birth differences of […]

The 5 Finger Hand

The 5 Finger Hand is a rare congenital hand difference which I have written about in this blog once before, HERE..  It is, as it sounds, the presence of 5 fingers, all in the same plane, instead of 4 fingers and a shorter (2 phalanx), palmarly placed thumb.   The challenges of the 5 Finger Hand […]

Hand Camp 2017

One of the highlights of my year is Hand Camp.  Each year (see previous posts), I have shared a brief post but for those of you without a Hand Camp experience, I will briefly describe.  This is a camp run by the Shriners Hospital team including the occupational therapists, recreational therapists, social workers and nurses.  […]

Cleidocranial Dysplasia

Cleidocranial dysplasia is a rare birth condition most notable for the lack of collarbones (or small collarbones- clavicles).  While this is recognizable, other findings include abnormalities of the teeth as well as delaying closing of the fontanelles (skull bone deficits).  This is an autosomal dominant condition related to the RUNX2 gene but importantly, it is […]

Hypoplastic Thumb Reconstruction

Patients with a small thumb- a hypoplastic thumb- often have functional limitations due to limited muscle development and a lack of joint stability.  Therapy is always the first line of treatment but is often unsuccessful with this anomaly.  We therefore often proceed with surgical reconstruction.  I have previously blogged about the surgical choices and recently […]

Thumb Reconstruction in Action

My favorite day of the month is our ‘big’ clinic at the Shriners where my partner and I see patients all day (no surgery).  It is such a pleasure to see new and followup patients with so many different rare conditions.  I learn at each of these clinics because patients show me (and sometimes tell […]

Hand Anomalies and Adoption

Adopted Kids and 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.  https://travel.state.gov/content/adoptionsabroad/en/about-us/statistics.html I am fortunate to see many families with newly adopted children.  It is one of the most enjoyable parts of my practice.  Sometimes I […]

Media Links

I would like to share a few media links which I have enjoyed.  The first is from the New York Times- LINK– on the 3D printed prosthetic.  Interesting read and highlights some of the information we have also shared: My Blog’s 3D printed information. Additionally, the St Louis Post Dispatch recently shared a great story about […]

Phocomelia

Phocomelia is defined as ‘seal limb’- a birth anomaly (i.e., congenital malformation) in which the hands are essentially attached to the chest.  There may be a short bone connecting the hands to the chest, either a forearm bone or arm bone, but not both.  Phocomelia is incredibly rare and really became a recognized abnormality in […]

Anesthesia- Do we know the risk in a child?

Recently, there has been much discussion regarding anesthesia in the child.  The concern is appropriately about safety- do we know when it is ‘safe’ to allow anesthesia for children.  There have been a large number of studies on this topic and recently the FDA voiced concerns.  I will try to summarize the issues and our […]

Pediatric Hand Study Group 2017

I recently traveled to Philadelphia for the annual meeting of the Pediatric Hand Study Group (PHSG).  This group is composed of hand surgeon and therapists who are committed to caring for kids born with hand differences.  The meeting was excellent as usual and the hosts included the surgeons from Childrens Hospital of Philadelphia and the […]

The Hand in Multiple Epiphyseal Dysplasia

Multiple Epiphyseal Dysplasia (MED) is an uncommon anomaly of the bone and cartilage at the ends of the bones (epiphyses) in the growing child.  There are 6 primary types of Multiple Epiphyseal Dysplasia. All are transmitted in an autosomal dominant fashion except type 4. EDM1 is caused by a heterozygous mutation in the gene encoding […]

The Crooked Thumb

The process of limb development is truly amazing and unbelievably complex.  Developmental biologists and scientists help to explain these processes and our knowledge grows day by day.   As I explain to parents, what is truly remarkable is not that there is a child born with a limb difference but rather that it happen so […]

The Arthrogryposis Thumb

I have previously written many times about arthrogryposis and several years ago focused on the thumb– see Link.  As with every part of arthrogryposis, each child is affected differently.  But the thumb is affected, the position of the thumb can really make a big difference.  Consider these points: 1) The thumb normally provides about 40% of […]

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, […]