Engineering a little hand

Surgeon found unique answer

When orthopaedic surgeon Dr. Bryan Theunissen took a walk down to the hospital’s engineering department in February 2017 he was planning surgery that had never been done before.
A few days earlier a little girl, Jamie Prins, just over two years old, had been brought to the casualty unit, her middle and ring fingers ripped apart by an escalator at a shopping centre.
Jamie’s mother Melanie this week said: “We used to live in Timothy Valley [and] on February 4 2017 I took Jamie and my other children with me to do some shopping.
“Jamie wanted to go to the bathroom. I had a whole lot of bags to carry [so] I asked her brother to hold her hand while we went up the escalator.
“When I turned around I saw that she had pulled her hand out of her brother’s. She fell and her hand was being swallowed by the escalator.
“I was screaming and screaming. The security guards came running. Jamie was quiet.
“It was only after they had rolled the stairs of the escalator back to free her hand that she started screaming.
“Her little hand was absolutely destroyed. There was almost nothing left of her middle and ring fingers.”
The little girl was transported to the casualty unit at Livingstone Hospital.
“First we had another doctor who said we might have to amputate the fingers. I asked for another opinion. “Then I met Dr Theunissen.” Theunissen explained that the escalator had ripped open the entire front section of one of Jamie’s fingers.
He said the middle bone of her middle finger and almost all of the middle bone of the ring finger and the entire joint of her ring finger as well as the tendons had been ripped out by the escalator.
They took her to theatre and did some initial work, waiting 48 hours to take another look.
“The decision was mine whether to amputate [her fingers] or try to salvage them,” Theunissen said. “What I did was to clean it up again and take some residual tissue out. Then I did some thinking.
“There wasn’t an operation prescribed for such significant bone loss that doesn’t also compromise the joint. So I pretty much invented one.
“I went to the engineering department and got a block of brass from them to create a jig.
“It had a circular hole and an offset circular hole drilled through it as it created a crescent shape and at a right angle there was another hole drilled through the thing.
“I went back to theatre [and] opened up her hand again. I took two hollow metal tubes 8mm and 4mm in diameter. I took a bone graft from the femoral head [highest part of the thigh bone]. I then cut a halfmoon-shaped surface into the bone.
“She was so small. She was just a baby and a sizable portion of her finger bones and tendon was missing so I made a construct using the bone grafts.
“To prevent the bones from growing together like a fracture, I took some tissue from her thigh and fitted that between the bone grafts.”
Theunissen said he had then followed up for a year-and-ahalf on the little girl’s progress.
“She can now open and close her hand. She recovered almost all of the function of the hand. I am pretty proud of the effort and happy with the outcome.”
He said there was a similar procedure which had been undertaken in adults with rheumatoid arthritis, but the synthetic spacers to fit between the bones would have been too big for Jamie’s little hand.
“This surgery has, as far as I know, never been described for children before,” he said.
“I will be following up on her recovery. There are some tricks we can employ once the hand has grown to make the fingers longer.”
Theunissen is an orthopedic surgeon with a special interest in hands.
“I guess the simple thing would have been to just amputate or to do a simple bone graft, but that would have resulted in a stiff finger,” he said. “It helped that she was young.”
Theunissen said the surgery he devised had a potential application for other situations, including correcting hand deformities in children.
Theunissen obtained his MBCHB from the University of the Witwatersrand and specialised in orthopaedic surgery at the University of Cape Town.
He has been working as an orthopaedic surgeon at Livingstone Hospital for the past four years.
Melanie said she was very grateful to Theunissen for saving Jamie’s hand.
“She can use her hand like any other child. Sometimes it is a bit sore, but she never complains. She just says: ‘Mommy my doctor will fix it’.”

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