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GCC Special Edition 2017

The Child with bilateral Ectrodactyly

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The Child with bilateral Ectrodactyly

The C.T.E.V Clinic I have on Mondays is extremely busy, not just because of the number of

Clubfoot children, but also because it is the first day of the week, and the clinic is situated

right at the centre of the Orthopaedic Consultation room for Women and Children. It is

always crowded with many emergency patients who are in desperate need of medical

attention. It was on a Monday afternoon like this in February, that a determined

grandfather; and a resigned and quiet mother came to the clinic with a tightly swaddled

bundle and sat down opposite us.

I checked their OPD ticket, and saw that the child had unilateral clubfoot, affecting only his

left foot, and had been referred to us by a PGT (Post Graduate Trainee). I started making the

file, and asked where they were coming from and how long it had taken them to reach. The

mother answered shakily and stayed quiet. Her father helped us fill in the rest of the details

required to enrol the child. The baby’s name was Priyanshu Karmakar. “Priyanshu” meant

“The first ray of sunlight”. He was 3 months old when I enrolled him. When it was time to

take the pictures, I noticed that Priyanshu also had a cleft lip, cleft palate and bilateral

ectrodactyly. Ectrodactyly, or lobster hands, as it is commonly known, is a deficiency or

absence of one or more central digits of the hand or foot. It is also known as split hand/split

foot malformation. I understood the reason for the mother’s subdued disposition.

We started counselling the pair. We told them about the procedures involved; the casting,

the possibility of a minor operation called a tenotomy, and the free FABs which we will give

them. The mother seemed a bit more at ease once we explained everything and answered

all their questions. For Priyanshu to lead a normal and healthy life, he required a proper

treatment plan which included all his deformities. I took him and his mother to the nodal

officer of that hospital, and explained the situation. After a thorough examination, and a

few consultations with other members of the department, he gave us a diagnosis plan. The

plan was to get the foot completely corrected and in the FAB before Priyanshu went in for

his first surgery to fix his cleft lip and cleft palate. His first surgery was also scheduled to be

in May, or June, at the latest. He would be six or six and a half months old at that time, and

the doctors felt that that would be the ideal time to start working on his cleft lip and cleft

palate. Once those were fixed, they would start working in the bilateral Ectrodactyly.

While the first plaster was being applied, I went and spoke to the grandfather and mother,

and reassured them, that with regards to his Clubfoot condition, they had nothing to worry

about; and I would be ready to provide any help and support required for the other more

complicated surgeries. I reminded them that they needed to be very diligent and come to

the clinic every week, according to the date given to them, and they also needed to take

care of the plaster making sure that it stayed clean and dry, aware of the visibility and

condition of the toes for signs of any potential problems. They promised to do their best.

The pair were the first ones to arrive every Monday, never missing a single week. Soon, I

saw the grandfather nodding in approval of the progress, and the mother smiling and being

a lot more responsive. After 7 casts, he had a tenotomy. There was a complication with the

plaster, and the plaster around the heel and ankle got a reddish tint and turned soft. The

mother had kept a cool head, brought him back on Monday, and we reapplied the cast.

What had happened was, that while Priyanshu was crying, he had banged his plastered foot

too hard on the bed frame, causing the tenotomy cut to reopen and bleed, which resulted in

the plaster softening.

I gave him his first FAB on 8th May, right on schedule to start getting the reports ready for

his first surgery to correct his cleft lip. He was admitted to the Paediatric Plastic Surgery

Ward on the 11th, to start getting the necessary tests and reports in order, and the surgery

took place on the 18th. I visited them the following Monday, everyone was very happy.

Priyanshu is well on his way to recovery, evident from his pumped up energy levels while

playing with other babies in the ward, and the way he is keeping his mother on her toes.

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