The 2008 Shriners Hospitals for Children (SHC) Symposium, "The Science and the Surgery of Congenital Upper-Limb Malformations," was the sixth triennial symposium in this series. The concept of a series of symposia on pediatric orthopaedic topics originated with Newton C. McCollough III, MD. As president of the American Academy of Orthopaedic Surgeons (AAOS) in 1989, Dr. McCollough worked together with Mr. Gene Bracewell, Chairman of the Board of Trustees of SHC, to arrange for the SHC board to grant $50,000 every three years to fund a workshop that would result in a publication on prevention, treatment, and future directions for an important pediatric orthopaedic condition.
The first four symposia were jointly sponsored by SHC and the AAOS. The fifth symposium, the topic of which was the immature spine, was a joint venture of SHC, the Scoliosis Research Society (SRS), and the Pediatric Orthopaedic Society of North America (POSNA); this symposium departed from the previous format (i.e., instead of a workshop, a one-day course was held at the annual meeting of the SRS, resulting in a JBJS supplement instead of a book). The topics of the previous symposia are presented in Table I.
For the sixth SHC Triennial Symposium, Dr. Peter F. Armstrong, Vice President of Medical Affairs of SHC, selected congenital upper-limb malformations as the topic and chose Michelle A. James, MD, as chairperson in 2005. Due to the foresight and collaborative spirit of JBJS Editor James D. Heckman, MD, the SHC funding was designated for a JBJS supplement once again. The original workshop concept that had been used for the first four symposia was well-suited to this topic, but no professional association cosponsor was forthcoming, as the topic falls "between the cracks" of the pediatric orthopaedic and hand-surgery professional associations. An SHC conference grant was submitted, and, owing to the support of SHC Vice President of Research Zakir Bengali, PhD, funding was received to hold a workshop in 2008.
The concept of intermingling pediatric hand surgeons and basic scientists at the workshop originated with the four symposium organizers, Marybeth Ezaki, MD, Charles A. Goldfarb, MD, Michelle A. James, MD, and Ann E. Van Heest, MD. Nine subjects related to congenital malformations of the upper limb were selected by the organizers, either on the basis of recent developments in molecular biology and genetics that might advance the understanding of the subject for orthopaedic surgeons or because a review of these recent developments by clinicians and scientists together might eventually lead to breakthroughs in diagnosis, treatment, or prevention of particular upper-limb malformations. The following subjects were selected: classification, prenatal diagnosis and treatment, anthropology, unregulated growth, arthrogryposis, radial longitudinal deficiency, transverse deficiency, amniotic constriction bands, and multiple hereditary exostoses. Clinicians and scientists with special interest and expertise in these subjects were invited to coauthor articles related to their subject and to attend the symposium in order to present their topic and participate in the discussion of all topics. The symposium was held at the Twin Cities Shriners Hospital on November 7 and 8, 2008 (Fig. 1). All participants presented at the symposium, and ample time was allowed to discuss the presentations, argue about the interpretation of research findings, and develop friendships and potential future collaborations.
The symposium organizers owe a debt of gratitude to Dr. McCollough and Mr. Bracewell for their vision of triennial symposia, with an ultimate goal of improving the care of children with orthopaedic conditions; to the SHC Board of Trustees for their ongoing sponsorship of this vision; to Dr. Armstrong and Dr. Bengali for supporting the proposals for both the symposium topic and the conference grant; to Dr. Heckman and the JBJS editorial staff for their assistance and encouragement; to the staff of the Twin Cities Shriners Hospital for hosting the workshop; and to our colleagues and friends, the workshop participants, with whom we hope to enjoy fruitful future collaborations. 