Dr. Martin Posner, chief of the Division of Hand Surgery in the Department of Orthopaedic Surgery. (Photo by Bud Glick)

In Good Hands

If Nature’s Exquisite Handiwork Needs Repair, HJD Lends a Hand

Dangling from a doorknob in the office of Dr. Martin Posner is an unlikely souvenir for a world-class hand surgeon: an old pair of boxing gloves. Narrower and less cushioned than modern gloves, they have a thumb slot that is bound by stitching to the padded palm.

"The old pros used to stick out their thumbs and jab each other in the eye,"  says Dr. Posner. The gloves  were a gift from a fighter and former patient at NYU Langone Medical Center's Hospital for Joint Diseases, where Dr. Posner is chief of the Division of Hand Surgery in the Department of Orthopaedic Surgery.

It's not the boxer's hand injury, but the boxer himself that fascinates Dr. Posner. He speaks with awe, even reverence, of other famous cases, such as Jim Abbott, the one-handed baseball player who pitched a no-hitter for the  Yankees, and Howard Blackburn, an American seaman who lost all of his fingers to frostbite but managed two solo crossings of the Atlantic.

On this day, three young surgeons are being welcomed into the division's elite fellowship program. Like Dr. Posner, they are drawn to the specialty not only because of the intricacy of the human hand, but also by the remarkable variety of cases.  "I've been doing this for 40 years,"  marvels Dr. Posner,  "and frequently I see problems I've never seen before."  In time, the fellows may join the team of 16 surgeons who comprise the largest academic hand program in the country, performing some 5,000 operative procedures every year.

"We don't teach operations,"  explains Dr. Posner,  "because what happens five years from now when those techniques are no longer applicable? But if you know anatomy really well and understand how the hand functions, then you can think in terms of  'What would I like to accomplish for this patient?' "

Also on this day, a special patient has arrived. He's a two-year-old boy. Eitan, the son of Polish immigrants, was born with golden hair, chocolate eyes, and rare deformities of both hands. Some fingers were fused together in utero and others failed to develop. The ring and pinky fingers in both of his hands are webbed, and in one hand, the thumb shares skin and tendons with the index finger. Where the middle fingers should be, there are wide clefts.

"He's a twin, and his sister has no problem with her hands,"  begins Eitan's father, his voice richly accented but clear.  "They never saw it on a sonogram. Then he's born, and the nurse showed me. It was a shock."

Like son, like father. Dad, too, has similar but less severe hand deformities.  "It's not bothering me,"  he says.  "I'm a carpenter, and I can do everything. But when I was young, other kids were making fun.  You have to be strong inside. Now it's happening to my son. Maybe when he is older, he will ask us,  'Why did you not take me to the doctor to fix my hands?'  Better to do this now, while he is young and can forget everything." 

Eitan has undergone two procedures to separate his fingers and to close the cleft in one hand, and he will likely require additional surgery.  After being told by several surgeons that they could do nothing for Eitan, his mother and father feel they've found the best care available for their child.

Dr. Posner tells the story of a patient who was reluctant to get married because of her own hand deformities until a man convinced her it meant nothing to him.  "They married and had four children,"  he explains,  "and three of them had hand deformities. As the children were growing up, she'd always tell them how special they were. One day the little girl with normal hands was crying because she wished she had hands like her siblings.  'But why?' "  asked the mother.  " 'Because they're special,'  said her daughter."

Eitan's mother takes her twins by the hand and walks them out the door. Eitan's hands will never be
completely normal, Dr. Posner allows. But Eitan will be.