May 30, 2006 — During his medical career, Dr. Larry Hollier has seen only two babies born with three arms.
In both cases, there was no question about which arm had to be removed.
"The third arm was not as developed, so it was a fairly easy decision to amputate," said Hollier, co-director of the cranial facial surgery program at Texas Children's Hospital in Houston.
However, a baby boy born in China poses a more difficult challenge for doctors. Known as Jie-jie, the 2-month-old was born with one right arm and two left arms — which do not seem fully functional.
His Shanghai surgeons now must decide which arm to remove, and at this point, they aren't sure which arm will be the one to go.
Although rare, doctors have reported children born with extra extremities, such as arms, legs, fingers, toes. They usually determine which to remove depending on how well it works. Hollier said there are no reliable statistics to say how common extra limbs or extremeties are, especially since malformed fetuses are often aborted either spontaneously or surgically and therefore are not reported accurately.
When deciding which extremity to keep, doctors must carefully analyze the anatomy and physiology through imagery like X-rays and MRIs, which show bone structure and blood flow, as well as electro-diagnostic studies, which monitor nerve impulses from the brain to the muscle, doctors said. While an extra limb is rare, children with multiple digits and even hands are more common, said Dr. Ann Van Heest, an upper extremity surgeon at Gillete Childrens Speciality Healthcare in Minnessota. She has never seen a case like the baby in China.
How It Happens
Van Heest estimated that one out of 200,000 babies are born with two thumbs on one hand and one out of 2 million have doubling at the wrist, resulting in two hands.
To decide which extremity to remove, doctors usually wait until the child is six to 12 months old to perform any surgery, as they want to observe which extremity the child favors and uses more, Van Heest said.
"For a 2-month-old, I am not sure one would be ready to make that final assessment," she said.
Most cases of multiple limbs result from conjoined twins forming in development. One child does not survive and becomes essentially absorbed into the other, said Dr. Russell Jennings at the Children's Hospital in Boston.
In those cases, the extra limb is not connected to the baby's brain and the decision to amputate is straightforward. The cause of Jie-jie's extra arm seems unclear.
According to the evidence so far, Dr. Steven Stylianos of Miami Children's Hospital said he suspects that the extra limb most likely came about in the conjoined twin process. Whatever the explanation, Dr. Jorge Lazzareff said he has confidence in the Shanghai doctors' skills. In the last four years, he has traveled to China several times to perform surgery on orphans with birth defects.
"The baby is in good hands, in my experience. They are up to the task," said Lazzareff, director of pediatric neurosurgery at the University of California Los Angeles.
Hollier, at Texas Children's, said that infants tend to adapt to these disabilities. Their minds are at the early stage, so they can adapt to changes in motor development.
It would be interesting to know how that extra arm developed.
The article said
According to the evidence so far, Dr. Steven Stylianos of Miami Children's Hospital said he suspects that the extra limb most likely came about in the conjoined twin process. Whatever the explanation, Dr. Jorge Lazzareff said he has confidence in the Shanghai doctors' skills. In the last four years, he has traveled to China several times to perform surgery on orphans with birth defects.
A co-joined twin occurs when two eggs are fertilized, but one of them fails to develop properly and survives by "merging" with the other egg. It can survive by taking nutrients and the like from the normal foetus even though it is not viable on its own. Because the DNA is similar and because they join at a time when the Baby's immune system is not working, and presumably through a process of "acculturisation", they can survive for some time. A surprising number of people are thought to have undetected reminants of twins within their body. In extreme cases this can involve a twin of the opposite gender and hence the very rare phenomenon of genuine hermaphrodites. So it is likely that only one arm is "really" his and the other is not.
I guess having two thumbs isn't as bad as having an extra arm.
It is likely to be more common as that sort of thing can be produced by DNA damage as opposed to an entire extra twin.
Le coeur a ses raisons, que la raison ne connait pas. - Blaise Pascal
Incidences like this is not that infrequent. Actually when you look at the development of a fetus, it is more of a miracle that it does not happen more often. As stated above the common cause is in the case of conjoined twins and one does not develope fully. However there are other causes, some can be the result of trauma at a very early stage of developement.
I do not believe they are to be viewed as Wrath from Allah(swt) or any type of punishment. Just verification of the simple fact we are in a physical world and have physical bodies. We are subject to every natural event that can occur. We pay a high price for free will. Because of free will, we have to live in a surrounding that allows all things to occur, including the nuances of cellular division during pre-natal development. Yes, it is harsh and seems cruel, but if Allah(swt) were to intervine very much with protecting us from the forces of this physical life, we would loose free will.
Yeah I read this article this morning, Subhanallah it's really amazing, but it's painful for the poor baby :'(. This kind of stuff always amazes and interests me though.......My Aunt has 2 thumbs on her left hand and it comes in quite handy for her sometimes she claims
All in All Allah is most great......Allah shows us these signs so that we normal ones may be grateful.
O Allah Wash away my sins with the water of snow and hail, and cleanse my heart from sin as a white garment is cleansed from filth, and put a great distance between me and my sins, as great as the distance You have made between the East and the West.”
A two-month-old boy born with two left arms has successfully undergone surgery to remove one of them, doctors in Shanghai say.
Neither arm was fully functional and doctors decided to remove the one closest to his chest after tests revealed it was less developed.
Doctors say the boy, Jie-jie, will require long-term physical therapy to build strength in his remaining arm.
The operation took place on Tuesday at the Shanghai Children's Medical Centre.
Jie-jie was born on 1 April at a small hospital in Anhui Province.
He is reported to have just one kidney, and may have problems that could lead to curvature of the spine.
When either of his left arms was touched, Jie-jie would cry, but he smiles and responds normally to other stimuli.
Before the surgery, doctors were unsure as to how to approach the operation.
Dr Chen Bochang, head of the orthopaedics department at Shanghai Children's Medical Centre, said his case was "quite peculiar".
"We have no record of any child with such a complete third arm."
Dr Chen's hospital is one of China's most experienced in dealing with unusual birth defects, including separating conjoined twins.
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