Mead Minutes: A hand to heal
Dr. Tim Mead at work
Hello from the land of dust! The winds have been blowing and filling the air with a fine haze of brown. People cover up as they walk into the wind. I continue to sneeze and drink large volumes of water. Today, the winds are a bit quieter, but the sun’s strength appears unchecked. Welcome to Niger!
We have been keeping busy here as kids with deformities just keep coming. I had a young man in his late teens come in with a curved and twisted left lower extremity. The X-rays showed a 60-degree angulation of the joint with a very abnormal looking medial (inner side) condyle of the femur. Think: the joint is supposed to be roughly level; his had a steep angulation. This deformity shortens the limb and changes how the foot tracks.
We approached the femur first knowing there was some deformity of the tibia, but minor in comparison. He was too old and too big for both at the same time with the equipment we have here. The bone was exposed and cuts were made to allow a shift in position. Then, the pieces were stabilized in the new position. The kneecap tracked better, and the foot was pointing in the correct location. Bon!
On morning rounds, he was smiling despite the recent surgery. He liked the change. I did, too.
We see many angular deformities of the limbs. Some deformities are due to bone diseases; some, nutritional issues (such as rickets, Vitamin D/calcium deficiency); some are congenital; and many we are never sure the why it occurred. Some have names like Blount’s, named after a physician who described the problem and offered treatment. Most do not have a specific name other than a general description. Generally, we follow the orthopedic maxim: “If it is bent, make it straight.” Not rocket science for sure.
I also operated on a child with a problem that broke my heart. He was a young boy, and he was playing when he sustained a fracture of his distal (near hand) forearm. Usually, these types of injuries heal uneventfully. His did not. A very tight bandage had evidently been applied to “set” the bone. The bleeding from the fracture built up pressure and blood flow to muscles quit. Several muscles died leaving a stiff, poorly functioning hand. The infamous “bone setters” strike again.
Often, there is little you can do to assist these kids. This young guy did have some function, although, the fingers were contracted in the palm at rest. In other positions, you could passively stretch the fingers straight. The thumb was tucked in tight, narrowing the web. I generally write down what is functioning and what is needed as I plan an assault. We would try!
When the forearm was opened, you could see that some of the sublimis muscles and tendons looked pink and relatively healthy. These are the more superficial muscles that bend your fingers at the middle knuckle. Usually, the worst destruction is deep.
The deeper profundus muscles were no longer viable and appeared fibrotic. I elected to perform an “STP” muscle transfer. No, this is not named after a gas treatment product. “Sublimis To Profundus” gives the initials. You divide the profundus tendons up near where the muscle bellies used to be. The healthy sublimis muscles will be the motor, so you divide the tendons closer to the wrist. You create a single functioning tendon for each finger going all the way to the end joint: Sublimis muscle and its tendon to the profundus tendon. This method of joining the tendons gains length and allows the resting finger posture to be created in the normal cascade.
The thumb web needed deepening and a fibrotic muscle was released. A flap of skin was moved off the index finger and rotated into the hole. This allowed more room for grasp. Another tendon augmented the thumb power and addressed the thumb flexor. Done. Close everything, apply a dressing and splint, and it is coffee time! The hand at rest looked much better. Now, we pray the healing will be quick, and with exercises, the hand can gain some function.
In the developing world, few locations have the luxury of specialized hand therapists. We train our therapists and families as best we can. I am amazed just how well the kids do. Despite obstacles, most children develop a functioning hand and a big smile showing off their work. The change I am able to witness as the children go from a basically worthless hand, crooked foot or leg, contracted joints, or whatever, to the joy of function is the thrill of the journey. The changes do not reside merely in the body, of course. The spirit soars as hope returns. We celebrate God’s goodness in healing. After all, CURE is all about emotional, spiritual, and physical healing. We seek the trifecta always as we travel life in His grip.