rhorton
Contributor
DIAGNOSIS: Extra digits bilateral small fingers.
HISTORY OF PRESENT ILLNESS: This is a 2-day-old baby boy who was born with extra digits on the small fingers proximal phalangeal area of both hands. He has a family history in his own father of having extra digits in the same spot. The father's were removed when he was 6 years old. There is also a family history in the paternal grandparents of having extra digits. He was a fullterm, spontaneous, vaginal delivery. He weighed 7 pounds 9 ounces. He is an otherwise healthy baby.
PAST MEDICAL HISTORY: As above.
He had an uneventful delivery and he and his mother are both doing quite well.
PHYSICAL EXAMINATION:
GENERAL: Shows a very healthy-appearing 2-day-old baby boy. His neck is supple. He has no torticollis. He has a normal-appearing spine and there is no hair patch at the base of the spine. Hips abduct equally. Barlow and Ortolani maneuvers are both negative. He has stable hips. Feet are straight with no sign of metatarsus adductus. His startle reflex is intact. Head is rounded and well-formed. Bilaterally on both hands, there is an extra digit with a fingernail and a palpable bone in the extra digit. It is attached by a skin flap to the proximal phalanx of the small finger bilaterally.
ASSESSMENT AND PLAN: I explained to his mother and father that at 2 days old we are able to tie a silk suture very tightly at the base of this extra digit and that over the next week or so, the digit will die and then will fall off. This is the simplest way to take care of this and it will avoid the need for surgery later on. They were amenable to that. I explained the risks, benefits, and possible complications including but not limited to failure of the suture, unsightly scar, and infection. They understood all this and gave their consent. After receiving consent, I took the baby into the nursery and with the assistance of the nursery nurse, I tied a 3-0 silk suture very tightly at the base of both of these extra digit at the small finger. The baby tolerated this procedure quite well and was returned to his mother in excellent condition. He will follow up in my office in about a week.
Thanks in advance,
Stumped
HISTORY OF PRESENT ILLNESS: This is a 2-day-old baby boy who was born with extra digits on the small fingers proximal phalangeal area of both hands. He has a family history in his own father of having extra digits in the same spot. The father's were removed when he was 6 years old. There is also a family history in the paternal grandparents of having extra digits. He was a fullterm, spontaneous, vaginal delivery. He weighed 7 pounds 9 ounces. He is an otherwise healthy baby.
PAST MEDICAL HISTORY: As above.
He had an uneventful delivery and he and his mother are both doing quite well.
PHYSICAL EXAMINATION:
GENERAL: Shows a very healthy-appearing 2-day-old baby boy. His neck is supple. He has no torticollis. He has a normal-appearing spine and there is no hair patch at the base of the spine. Hips abduct equally. Barlow and Ortolani maneuvers are both negative. He has stable hips. Feet are straight with no sign of metatarsus adductus. His startle reflex is intact. Head is rounded and well-formed. Bilaterally on both hands, there is an extra digit with a fingernail and a palpable bone in the extra digit. It is attached by a skin flap to the proximal phalanx of the small finger bilaterally.
ASSESSMENT AND PLAN: I explained to his mother and father that at 2 days old we are able to tie a silk suture very tightly at the base of this extra digit and that over the next week or so, the digit will die and then will fall off. This is the simplest way to take care of this and it will avoid the need for surgery later on. They were amenable to that. I explained the risks, benefits, and possible complications including but not limited to failure of the suture, unsightly scar, and infection. They understood all this and gave their consent. After receiving consent, I took the baby into the nursery and with the assistance of the nursery nurse, I tied a 3-0 silk suture very tightly at the base of both of these extra digit at the small finger. The baby tolerated this procedure quite well and was returned to his mother in excellent condition. He will follow up in my office in about a week.
Thanks in advance,
Stumped