Erickson Hernandez
Four-year-old Erickson Hernandez was born with a type of cleft hand that has never been documented, according to Shriners Hospitals for Children® — St. Louis orthopaedic surgeon Charles Goldfarb, M.D.
“This is a one-in-a-lifetime case,” he said. “My partner, Dr. (Paul) Manske, who has been in practice for over 30 years, said he had never seen anything like it. There’s nothing in the medical literature about it.” (Dr. Manske is the senior surgeon for upper extremities at Shriners Hospitals for Children® — St. Louis and is editor of the Journal of Hand Surgery.)
Erickson, from western Guatemala, was born with three arms: one on the right, and two on his left side. The partially-formed arms on his left side performed two completely different and equally vital functions.
Dr. Goldfarb explained that Erickson’s upper arm had a good shoulder joint, and, importantly, a growth plate. The bottom arm was almost like the second half of the top arm, he said, with a normal humerus (the bone that extends from the shoulder to the elbow) and two functioning fingers, but no shoulder or elbow joints to provide movement.
“It’s very uncommon to see extra digits, let alone extra limbs,” Dr. Goldfarb said. “We’ve only seen one other documented case of a boy in China born with three arms, and that was in mainstream media, not in medical journals.”
In that case, surgeons simply amputated the less functional of the two arms on one side. But Erickson’s situation was much different.
Erickson used his two left arms in “beautiful combination,” by grabbing the bottom arm with his top arm, in order to grasp objects, said Kathy Corbett, who arranged for his care at Shriners Hospitals for Children®. Corbett is the executive director for the St. Louis chapter of Healing the Children, a nonprofit, volunteer organization dedicated to securing donated medical and surgical care for children who are in need.
Upon seeing how the two left arms functioned together, Dr. Goldfarb was determined to save this function for Erickson.
“The ideal situation for Erickson was to use the best parts of both arms,” Dr. Goldfarb said. “The fall-back situation would have been to excise the lower arm, because his upper arm has a good shoulder and growth plate. He would have then been able to use a prosthesis to help him use his upper arm. However, we were hoping for a home run,” he said.
“We were excited to help him, but we had to be a little creative in our approach,” Dr. Goldfarb added. Drs. Goldfarb and Manske and their team got that home run. The surgeons were able to join the humerus joints of the top and the bottom arm and fuse them together. They were also able to “re-route” all the nerves and vascular tissue from the bottom arm to the top, in order to provide function and feeling to the fingers of what was his lower arm, newly attached to the top arm.
“I think his arm will allow him to do anything he wants to,” Dr. Goldbarb said. “His arm won’t be a limiting factor in his life.”
And it is his arm. “It’s not my new arm, it’s my left arm. That’s what Miss Valerie told me,” the youngster said.
Erickson’s surgical team, which includes Drs.Goldfarb and Manske, as well as his occupational therapist, Valerie Calhoun, are in now in the process of writing an article for publication in medical journals, in the hopes that this successful outcome will be able to help other children.
In addition to the surgery, Erickson had to transform his arm, surgeons also performed surgery to release a “tethering” in his spine, which could have caused him paralysis in the future, as well as surgery to correct his scoliosis. He will return to the hospital periodically for several years to have the rods placed in his spine extended.