Johns Hopkins All Children's Hospital

A DIFFICULT CONDITION Not long before Andrew's first birthday, his parents were referred to Lee Phillips, M.D., a pediatric orthopedic and hand specialist at Johns Hopkins All Children's Hospital. He fully diagnosed Andrew's condition and had good news to share. "Andrew was born with a condition called radial longitudinal deficiency," Phillips explains. "It causes either an underdeveloped or absent thumb, and sometimes a shortened or absent radius, which is the bone on the thumb-side of the forearm." Radial longitudinal deficiency is a spectrum of congenital changes to the arm and hand. e condition presents differently in each child and is often associated with other medical issues. Fortunately this was not the case with Andrew. It was likely that surgery followed by a short course of occupational therapy was all he would need. "We were nervous when we learned this can sometimes involve other developmental deficiencies, but Dr. Phillips was extremely thorough in his assessment of Andrew's case," Anthony explains. "After numerous tests, he determined that Andrew's condition was limited to his arms and hands." UNCOMMON SURGICAL EXPERTISE Phillips and the physician who originally referred Andrew to him discussed the treatment options in depth and recommended a pollicization of the left index finger to create a fully functional thumb on his left hand. "For a pollicization, after you remove the non-functioning thumb, you shorten the index finger and reposition it where the thumb should be. e joints of the index finger are used to recreate all of the joints of a thumb," Phillips continues. "e muscles are reconstructed so that Andrew can have a fully functioning thumb created from his index finger. Andrew's age was ideal for the surgery as younger kids are more likely to adapt to their new thumb." "Andrew was referred to me because of the skills I acquired during my pediatric hand fellowship at Texas Scottish Rite Hospital and my experience performing this particular surgery," Phillips explains. "It is available at a limited number of hospitals." e procedure went very well, with the nursing team providing the anxious parents with updates. Phillips was able to give excellent news post surgery to Andrew's parents. "As with any parents of a child going in for a medical procedure, we were nervous," Megan says, "but the medical staff at Johns Hopkins All Children's were unbelievably caring. Knowing that he was in the capable hands of professionals dedicated to the care of children helped put us at ease. ey even blew bubbles on the way to surgery to make him smile and presented him with a Certificate of Bravery." Andrew's left hand was in a cast for five weeks. e bandages were removed during the summer and almost immediately he began to bend the thumb. While there might be some fine- tuning as he begins to use his thumb, it is likely this will be the only surgery he needs. "Most children who have this operation think of the pollicized digit as their thumb," Phillips says. "e literature supports that a pollicized digit functions much more normally than efforts to reconstruct an unstable thumb and preserve all the digits. Most people at a glance do not notice there are fewer fingers. All they see is an appropriately positioned and functioning thumb and a normal cascade of fingers." at's certainly the case for Andrew. "His recovery has been phenomenal," Phillips says. "Parents are rightly concerned about sacrificing a finger to create a thumb, but the benefits are amazing." "We have been to several occupational therapy sessions at Johns Hopkins All Children's and are doing daily exercises at home," says an enthusiastic Megan. "His progress is noticeable on a daily basis." To learn more about pediatric hand surgery and limb restoration at Johns Hopkins All Children's, visit HopkinsAllChildrens. org/Ortho. Andrew's left hand before surgery, left, and afterward, right e fact that Andrew's thumb was not functional a little over two months ago and now he can move and use it is incredible to us. —MEGAN, ANDREW'S MOM " " Johns Hopkins All Children's, in collaboration with Children's Orthopaedic and Scoliosis Surgery Associates, is recognized as the top children's orthopedic program in Florida by US News & World Report for 2016-2017. Limb Restoration Fall 2016 15

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