Techniques for Small-Bone Lengthening in Congenital Anomalies of the Hand and Foot

Abstract

The purpose of this study is to analyse three different lengthening techniques used in 31 small bones for congenital malformations of the hand and foot: 15 metacarpals, 12 metatarsals, 1 foot stump and 3 spaces between a previously transplanted phalanx end of the carpus or the metacarpal. Progressive lengthening with an external fixator device was performed in 23 cases: the callus distraction (callotasis) technique was used in 15 cases, whereas in the other 8 cases the speed of lengthening was faster and the defect bridged with a bone graft as a second stage. In another eight cases, a one-stage lengthening was performed. In the callotasis group, the total length gained ranged from 9 mm to 30 mm and the percentage of lengthening obtained (compared with the initial bone length) averaged 53.4%; in the fast lengthening group, the length gained ranged from 8 mm to 15 mm, and the average percentage of lengthening was 53.1%; and in the one-stage group, the length gained ranged from 7 mm to 15 mm, and the average percentage of lengthening was 43%. The overall complication rate was 22.5%.

Complications of Distraction Lengthening in the Hand

“…Infections, which have been reported in other papers (Houshian and Ipsen, 2001; Minguella et al, 2001), were not encountered in this series. It is believed that crushing of soft tissues caused by the drilling of the pins is the main reason for infection.…”

“…However, callotasis cannot lengthen the bone by an unlimited amount, and excessive bone lengthening can cause several complications (Paley, 1990) due to the limitation in the capacity for bone formation as well as the functional and physical limitations of the surrounding soft tissue (Galardi et al, 1990; Lee et al, 1993). Distraction lengthening in the hand is done less commonly than in the lower limbs and the feet (Minguella et al, 2001; Oh et al, 2003). Although Matev (1976) reported the clinical cases in the hand only 5 years after Ilizarov’s report, there have been fewer clinical and experimental reports than for the major limbs.…”

“…However, external fixation is used less frequently in the hand than in the limbs. As a result, there are relatively few reports on associated complications in the hand (Minguella et al, 2001; Oh et al, 2003). There is some concern that common problems observed in major limb lengthening (Paley, 1990) may be even more common in the small and mobile hand, in which the cumbersome hardware should maintain its stability and safety (Houshian and Ipsen, 2001).…”