A brief post with lots of pictures and videos on two conditions that may cause less than five fingers. As I have previously written, there are 5 common causes. Parents have given permission. Diagnosis 1. Symbrachydactyly. This patient has a great thumb and nubbins past the metacarpals. However function is excellent. The child will likely […]
Category: Video
Pollicization Long Term
Hello all. I want to share a good result in a challenging pollicization procedure. This patient has radial longitudinal deficiency with a poor, very limited thumb (we call it type 4 hypoplastic thumb). The decision was made to excise the thumb and create a new one with the index finger (e.g., the pollicization procedure). We […]
Radial Deficiency Outcome
Radial deficiency (or radial longitudinal deficiency, RLD) is one of the most challenging conditions that I treat. We classify patients with RLD based on their bone development but that does not capture the underlying muscle and joint abnormalities. Reports on treatment including surgery have been mixed and that has led hospitals and doctors to have […]
Cleft Hand: Beyond the Basics
I have posted numerous times on cleft hand. (See other posts.) In my world, this is a still an unusual diagnosis and can be challenging as each child is somewhat different than the next. The early and late treatment of cleft hand, therefore, has to be considered for each child. Late treatment in cleft hand is […]
Hand Camp 2019- St. Louis Shriners Hospital
I realize that I post about Hand Camp nearly every year. Our St. Louis Shriners Hand Camp is really something special. But I do so for good reason- it is just so impactful for kids, families, staff, and me! Being outside the hospital setting allows a different kind of conversation and allows a different perspective for […]
Untreated Adult Hypoplastic (Small) Thumb
On occasion, an adult comes to my clinic for evaluation of one issue and a previously unrecognized issue is identified. This type of presentation can come in different varieties and, due to my particular practice type, often we find a birth anomaly that has not been recognized or treated. This patient is one very interesting […]
Distal arthrogryposis, before and after
Distal arthrogryposis is very different from AMC or other forms of arthrogryposis. By definition, distal arthrogryposis includes joint tightness (contractures) in the hands and feet. Here is an excellent Link from NIH. I have also previous posted on distal arthrogryposis, those links can be found HERE. I wanted to share some early results on a 5 year […]
Fixators for Lengthening. Fun?
External fixators are devices that rest outside of the skin. They can be used to stabilize broken bones (although not used very often for this purpose today) or to correct a short or angled extremity/ bone. We use fixators to lengthen small bones such as the thumb to allow pinch or to grow the forearm […]
Forearm Synostosis
The forearm typically has two bones, a radius and an ulna. The benefit of having two bones is that it allows the radius to rotate around the ulna. This means we can position the hand palm up and down. This is functionally helpful but not functionally mandatory as there are many ways to make up […]
Madelungs Deformity Surgical Technique
I have posted a few times on Madelung Deformity, as may be seen HERE. While there have been a number of surgical techniques recommended over the years, I believe that the dome osteotomy of the distal radius is the best option. That procedure was described well in this important MANUSCRIPT. Below is a brief surgical technique video […]
A New Thumb: Early Pollicization Outcome
Pollicization is one of my favorite surgeries for kids born with hand differences. This child is several months out from the pollicization procedure. He is using the new thumb as demonstrated in this video and the family (and the surgeon:)) are all very pleased with the appearance of the hand and thumb. While kids begin […]
Myoelectric Prosthetic Training for Kids
It seems clear to me that 3D printed myoelectric prostheses are the future for upper extremity prosthetics in all age group but especially for kids. These prosthetics can be customized, are developed/ fabricated quickly, can be replaced for a low price, and have so much potential. I am hoping and expecting real progress over the […]
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 […]
Untreated Cleft Hand
Cleft hand is one of the most notable birth anomalies of the upper extremities. The appearance is distinctive although function can be really well maintained. One of the founding fathers of the discipline of hand surgery, Sterling Bunnell, labeled cleft hand, “a functional triumph and a social disaster”. There are other names for cleft hand. […]
Radioulnar Synostosis
Radioulnar synostosis is the presence of a bony connection between the radius and ulna. I have previously blogged a few times on it HERE. While a synostosis can develop after a trauma, we typically discuss it when present from birth. The synostosis prevents forearm rotation but does not affect elbow or wrist motion (these are […]
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 […]
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 […]
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 […]
Great Rio 2016 Paralympic Video
Wow! Great Video Charles A. Goldfarb, MDMy Bio at Washington Universitycongenitalhand@wudosis.wustl.edu
3D Progress
I have posted several times previously on our work with 3D Printed Prosthetics, the posts are compiled here. Sydney is one of our patients who has been a big part of this process. She recently received the latest prosthetic version, a 3D Printed, Myoelectric device and fabricated for about $110. Today, there was a great deal […]
Newsworthy
Robohand I previously blogged about Robohand 2.0 Previous Robohand Post The group has now fitted one great patient with an unfortunate injury. She now has a powered prosthetic and she loves it! Check out this news story and video. Fox-2 News Story Here is another link with more information on the story from Washington University News […]
Robohand 2.0 (powered, 3D printed hand)
The Robohand has been getting an amazing amount of press in recent months. I have previously blogged on the topic Previous Prosthetic post with basic information. Since then, there has been a Kansas City Star article on the topic. As I previously mentioned, I had the opportunity to work with senior engineering students at Washington University, Biomedical Engineering […]
Media
A couple of news stories over the last week have highlighted children at the Shriners Hospital and St Louis Childrens Hospital. The first child is a Shriners Hospital patient and a part of a great family. Mom and all three children have thumb anomalies, although each individual is a bit different. We have been able […]
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: http://congenitalhand.wustl.edu/2013/08/trigger-thumb-trigger-finger.html In these cases of a locked trigger thumb, we typically, […]
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 […]
September 2012 Travels
It has been too long since I last blogged. Several catch- up blogs are on the way. In the meanwhile, I have been to several interesting events in the last month. First, we had our annual St Louis Shriners Hospital Hand Camp. There were approximately 18 children with their families, 10 junior counselors, and […]