Seven-Year old Gains Hand and Arm Function with Limb Lengthening Technique Using Toe Bone
With a complex microsurgery that has never before been performed in the United States, surgeons Ryan Katz, MD, and James Higgins MD, from the Curtis National Hand Center (CNHC) at MedStar Union Memorial Hospital have advanced the treatment of congenital radial dysplasia, known as “radial club hand.” The groundbreaking approach uses bones, a joint, and growth plates from the patient’s foot. The boy, Lal Ding, who will turn eight on New Year’s Day, now stands on the threshold of his new life with a functioning right arm and hand.
As in most cases of radial club hand, Lal was born without a thumb, a significantly shortened forearm, and a hand that was bent dramatically toward the thumb-side of his wrist. Traditionally, this problem would have been treated by surgically centralizing the hand on the wrist and fixing it in a straighter position. Though such a classic approach temporarily improves the overall hand aesthetic, it does not improve function, it impairs future forearm growth, and does not stand the test of time – often resulting in deformity recurrence.
Helping Lal achieve the best functional and aesthetic result was a three-stage process that began with a pollicization procedure that had successfully repositioned his index finger to serve as a thumb. The next step involved using a distraction device to extend the length of the forearm, straighten the wrist and create a space in which the joint and growth plates from the child’s second toe can be transplanted.
In September, Simo Vilkke, MD, a Finnish microsurgeon and architect of the new technique, travelled to Baltimore to collaborate with the CNHC surgical team for the third and most complex stage – the toe transfer. At that time, the child’s second toe with its vascular supply, was removed and transferred to the arm to definitively straighten the wrist and provide new growth plates and a joint to allow for balanced longitudinal growth and wrist motion. This case is unique in that the vascularized toe was used to construct a full length radius – restoring for the child a two-bone forearm.
Lal’s arm has gained nearly two inches in length; is now straighter, balanced, healed and growing as he grows. This New Year’s Day, as Lal celebrates his birthday, he and his family can look forward to a future bright with new potential, opportunity, and hope.
For more information on the Curtis National Hand Center or the MedStar Union Memorial Hospital, please visit medstarunionmemorial.org.
Since 1975, people all over the world have placed their hands in ours – The Curtis National Hand Center. From repairing traumatic injuries to treating repetitive motion injuries, arthritic conditions and congenital differences, our goal is to restore the patient’s use of the hand, wrist, arm, elbow and shoulder to the greatest degree possible. Our long history of experience, outstanding medical staff, and state-of-the-art facilities combine to create a treatment center that is the first choice in caring for the hand or arm, no matter how common or complex.
Today, The Curtis National Hand Center is recognized as the largest, most experienced hand center in the nation. In fact, the hand center was designated by Congress as the National Center for the Treatment of the Hand and Upper Extremity.