Previously published in Rite Up, 2025 – Issue 1

Just two days after Christmas, 4-year-old Brigham, who goes by Briggs, underwent what he calls his “Transformer” surgery at Scottish Rite for Children. Briggs, of Longview, Texas, loves playing with cars, trucks and Transformers — the Hasbro action figures that start as robots, transform into various vehicles and also star in comic books, animated series and blockbuster films. On surgery day, Briggs arrived dressed as his favorite character, Optimus Prime, a robot-to-18-wheeler Transformer who is the central hero and courageous leader of the Autobots — the good guys.

Briggs’ parents, Rachel and Robert, had an inkling that something might be different when Briggs was born. During an ultrasound, Rachel recalls a doctor saying that something was going on with Briggs’ hand, but he could not see for sure because of the way he was positioned. “It scared me, and I remember leaving there thinking, ‘Is there something wrong with my baby?’” Rachel says.

thumb. The fingers on one side of his hand mirrored the fingers on the other side. In addition to the hand, ulnar dimelia affects the functionality of the arm. Typically, a baby is born with two bones in their forearm, including the radius on the thumb side and the ulna on the pinky finger side. A child with ulnar dimelia has no radius. Instead, the ulna is duplicated, which affects the ability to bend and rotate the elbow and wrist.

“Ulnar dimelia is one of the rarest congenital disorders of the arm,” Dr. Oishi says. “Many surgeons that do pediatric hand surgery have never seen it in their life.” An article published in the Journal of Musculoskeletal Surgery and Research describes ulnar dimelia as a rare developmental anomaly with only about 70 cases reported worldwide. “At Scottish Rite for Children, we have a vast amount of experience treating conditions that are very rarely seen,” Dr. Oishi says. “And, we have an entire multidisciplinary team of not just surgeons but also child life specialists and occupational therapists, as well as hand camp programs for children with congenital anomalies.”

Dr. Oishi and his clinical team designed an individualized treatment plan for Briggs that they continue to manage as he grows. To date, Briggs has undergone three different surgeries to improve the functionality of his arm and hand. The first one occurred right before his first birthday. Prior to the procedure, his arm was stuck in extension, meaning Briggs could

not bend his elbow. After a complex surgery, Dr. Oishi created a functioning elbow that Briggs could begin to move. “He went from his arm being kind of twisted behind him to having an arm that hangs normally with a slight bend,” Robert says. “It was amazing! I mean, how in the world do you create an elbow for somebody?”

When Briggs was 3, Dr. Oishi performed a second surgery to release soft tissue that took Briggs’ wrist from a locked position into a more flexible one. “When your wrist is curled in, it makes your arm look very short,” Robert says. “That surgery released his wrist, and he was able to have it stretched out more.”

A close-up of 4-year-old Briggs’ left hand with seven fingers.

Briggs’ latest operation — his “Transformer” surgery — is technically called pollicization. He went into surgery with seven fingers and no thumb, and Dr. Oishi transformed his hand into one that now has three fingers and a functioning thumb. The pollicization procedure creates a thumb to give a child the ability to grab objects. This is accomplished by converting one of the fingers into a thumb by moving it down the hand and rotating it into opposition to the other fingers.

Your thumb plays a pivotal role because it comes toward your other fingers to give you true functional grabbing ability,” Robert says. “Briggs never had that. He could grab things by pinching two fingers together, but they were side by side.”

Dr. Oishi explains that a child will usually indicate which finger they want to be their thumb. “The finger has to be what we call supple, so when you push on it, it bends easily,” he says. “Some kids have stiff fingers, and they don’t work well as a thumb.” Over the years during

Briggs’ appointments, Dr. Oishi examined his fingers and also determined his grip pattern. “I have a lot of toys in my pockets,” he says. “People think I’m just playing with the kids, which I am, but I’m actually playing with them with purpose to see which finger they want to use as their thumb, and that’s how we determine which one to move.”

Briggs’ most functional fingers include the four that were originally located on the left side of his hand — the side on which they are supposed to grow. These are his pinky, ring and middle finger. The one located immediately after the middle finger was his best finger, the one that Dr. Oishi made into a thumb. “You’d like to leave him with four fingers and a thumb, but the other three fingers were stiff, and he didn’t use them,” Dr. Oishi says. “My goal is to give him the most aesthetically pleasing and most functional hand.”

Having a functioning thumb is critical to overall hand function. It is better for a child to have three fingers and a thumb than four fingers and no thumb. It is also important for a child to undergo pollicization surgery when they are young so their brain can adapt and functionally integrate the new thumb. “Researchers debate about when the use pattern of plasticity sets in,” Dr. Oishi says, “but usually, you conduct a pollicization before a child turns 4, 5 or 6 so they can incorporate the idea of the thumb into their brain.” When these children get older, they simply think of that finger as their thumb, whereas a child who undergoes pollicization later still thinks of their thumb as the finger that was moved.

When Briggs came out of surgery, he wore a blue cast to match his Optimus Prime outfit. He also got Transformers stickers, which of course, he stuck on his cast. “Briggs has lived a large portion of his life in a cast or with a splint on his arm,” Robert says. “I would be a hot mess of complaining, but it doesn’t faze him. He just doesn’t get down, which is really cool to watch.”

“Briggs is an overcomer,” Rachel says. “He has a spirit of true joy.” She shares that recently, Briggs was pretending to be a doctor. “I was like, ‘Are you being Dr. Oishi?’” Rachel says, “and Briggs was like, ‘Yeah!’”

Dr. Oishi’s hope for Briggs is that he has no pain and can do everything he wants to do without any help. “Briggs is still young, but he’s pretty close to achieving this,” Dr. Oishi says. “He’s got a great support system, and he doesn’t let anything stop him.”

“We have a high level of trust in Dr. Oishi and feel that he’s got Briggs’ best interest in mind,” Robert says. Rachel appreciates his bedside manner. “The trust we have in him is because of how much he genuinely cares,” she says. “You can see how passionate he is about his patients — every single one.”