The treatment of extra toes and toe syndactyly often involves the hand surgeon given the overlap in treatment strategies between hand and foot. As I have previously blogged, I typically avoid reconstructing toe syndactyly unless it involves the first web space (ie, the great toe). While there are exceptions to this approach, the risks of […]
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Hand Society (ASSH) 2023 Travels
The ASSH Annual Meeting was in Toronto this year. As usual, it was a fabulous meeting and its always great to connect with friends from across North America and the world. There were very good pediatric sessions throughout the week! We had a fantastic Pediatric Hand Study Group (PHSG) meeting. The group continues to grow with a goal […]
Digital Lengthening
Shortened digits are a common concern of parents when their child is born with a difference. For most kids, lengthening does not make sense as it will not improve function or appearance. However, for some kids, the procedure can make a big difference. The most common situation is amniotic constriction band in which digits are […]
Bone Lengthening in Olliers Disease
I have been curious about ChatGPT and so I wanted to share an encounter with artificial intelligence. Honestly, I am impressed. The complete response: “Ah, I see. Multiple enchondromatosis, also known as Ollier’s disease, is a rare, non-hereditary skeletal disorder characterized by the presence of multiple benign tumors called enchondromas. Enchondromas are growths of cartilage […]
Mirror Hand, The Elbow & Ulnar Dimelia
Mirror hand, or ulnar dimelia as it is technically known, is one of the most striking birth differences of the upper extremity (there is also a lower extremity similar condition). There is a duplication of the ulnar half of the forearm and hand. This can present in the hand only (with a normal forearm) or […]
Cleft Hand vs Symbrachydactyly, Cleft Type
Both cleft hand and symbrachydactyly may present in different ways, which can make it difficult sometimes to understand the difference. Symbrachydactyly presents in 4 types for the hand: cleft type (the point of this post), monodactyly type (only a thumb), short finger type, and peromelic (just nubbins). I have previously posted about symbrachydactyly here, here, […]
Travels: World Pediatric Project, Barbados
WPP The WPP is a wonderful organization that I have worked with for more than 15 years. Based on Richmond, Virginia and Saint Louis, Missouri, it is focused on the global health of kids in many areas including orthopedic surgery. When I first became affiliated, kids with major orthopedic issues came to St Louis for […]
Murderer’s Thumb
Murderer’s thumb is one name for brachydactyly, type D. The is a short, round distal phalanx of the thumb and may be one on side or both. The nail looks wide relative to the overall length of the thumb. Other common names include stub thumb and club thumb (not to be confused with the medical […]
Understanding the Specifics of Upper Extremity Birth Differences, Part 2
It has been far too long since my post on the “Why” of Birth Differences. I apologize and I know at least some of you have been awaiting this post. No excuses but I am now on a new platform and the transition took time. This is Part 2 in which I will review some of the […]
Sprengel Deformity Outcome
Sprengel deformity is the presence of a high- riding shoulder blade (scapula). I have previously blogged about it HERE (although it has been awhile). Sprengel deformity is uncommon although the exact incidence is unclear. It can be associated with a number of conditions including Klippel Feil (cervical spine vertebrae fusions), scoliosis, and other less common conditions (although all […]
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 […]
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 […]
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 […]
Exciting Times!!
The opening of a new hospital or major facility is unusual in our modern healthcare system. It requires a great deal of planning, coordination, and plans for growth. That is why it is so incredibly uncommon and exciting that TWO new pediatric facilities are opening right now in St. Louis. TWO, both in the first […]
Stiff Fingers
Symphalangism is one type of finger stiffness; I previously written about it here. I wanted to share a few more thoughts. In addition to the classification noted in my other post, I often think of symphalangism in terms of whether or not the fingers are short. Whether the fingers are short or not, symphalangism is quite […]
Triphalangeal Thumb
The normal thumb has two bones- 2 “phalanges”- which makes it different from the three bones of the fingers. Occasionally, we see a thumb with 3 bones- 3 “phalanges”- and we call it a triphalangeal thumb. I have previously blogged about different aspects of the triphalangeal thumb– 5- finger hand and another on the Five finger hand. Also, […]
Recent Publications, April 2014
I have been asked to regularly add to my blog recent publications which are important for children with congenital hand anomalies. Here are 3 publications from the last few months. These 3 publications are all in in the Journal of Hand Surgery. Transverse Bone in Cleft Hand This manuscript details our findings in comparing two […]
The Wrist in Arthrogryposis
Arthrogryposis is different in every child. While there may be a classic appearance- internal rotation of the arms, elbow straight (extended), wrists flexed, and limited finger and thumb motion- the variability between kids makes treatment a challenge. I have previously commented on arthrogryposis and general treatment concepts (my own thoughts guided by my experience and […]