Honduras: Day Four

Source: Blog Post

A challenging day at La Providencia.


We screened a 6-year-old girl with Sprengel’s deformity and severe thoracic scoliosis with unbalanced posture and gait.  The child has started to develop shortness of breath which is expected to worsen as her curve progresses.  The team does not have treatment options at its disposable to help this beautiful child.  For many of us, this reality is difficult to accept.


The operative schedule included several challenging cases including open treatment of an old lateral condyle nonunion, tendon transfers and a first webspace deepening in a child with spastic hemiplegia, and a metacarpal osteotomy and first webspace deepening for symbrachydactyly.  Between cases, the team enjoyed a lunch of chicken empanadas and pico de gallo.   



The child with symbrachydactyly was struggling with pinch in the first webspace due to insufficient web depth.  Pre-operative planning was complicated by an index-long metacarpal synostosis with radial deviation of the index metacarpal.  Hand surgeon Ericka Lawler, MD performed a metacarpal osteotomy and first webspace deepening utilizing a dorsal advancement flap designed by Egyptian surgeon HA Ghani.  The challenging case was ultimately rewarding as this combination of procedures dramatically increased space between the thumb and index rays, and is expected to substantially improve hand function by allowing for a more advantageous thumb-index pinch.


The procedure was a learning opportunity for University of Iowa Hand Surgery Fellow, Jonathan Katz, MD who assisted Dr. Lawler and learned the importance of creativity and flexibility in congenital hand surgery.  The Sharing Resources Worldwide mission team always brings a senior orthopaedic surgery resident or a hand surgery fellow to Honduras.  The team is committed to inculcating the philosophy of charity and service to the next generation of hand surgeons. 


Jonathan took some time out of his busy operative day (bouncing between two ORs) to share some thoughts on his experience in Siguatepeque:




“ASSH Touching Hand Project & Sharing Resources World Wide has allowed us a wonderful opportunity to volunteer in Honduras.  Our team includes nurses, scrub techs, CRNA’s, an anesthesiologist, 2 orthopaedic hand surgeons and myself (orthopaedic hand fellow).  This service trip gives all of us the chance to combine our collective knowledge and skills to provide care to an immensely underserved community.  For me personally, as a trainee, the trip allows me to utilize all aspects of my training in a fast paced setting.  It also pushes our team to ‘play jazz’—making do with what you have to get the job done well. 


The variety of pediatric hand patients is remarkable: trauma, malunions, nonunions, cerebral palsy, and congenital upper extremity deformities.  The team has cared for a few patients this week with congenital deformities.  These children are incredible and came to us with goals of improving their daily function.  Learning the technical aspects of treating these complex conditions while in a developing country has been an unbelievable opportunity.  The trip also allowed me the privilege of giving back all of the amazing training I have received to date from the States to a community that would not otherwise receive the same care.”




“The soul is healed by being with children.” –Fyodor Dostoyevsky