Background:
Bone-lengthening in the hand and foot is a relatively new application
for distraction osteogenesis. We present the operative treatment
and postoperative outcome for four patients with M�ller type-D symbrachydactyly
of the hand who underwent metacarpal lengthening with use of a distraction
device to establish pinch function.
Methods:
Four patients who underwent distraction osteogenesis for the treatment
of congenital symbrachydactyly of the hand were evaluated over a
thirteen-year period. The nondominant right hand was treated in
two patients, and the nondominant left hand was treated in the other
two. The patients included three boys and one girl; all patients
had the operation between the ages of five and eleven years. Distraction
osteogenesis was performed on the fifth metacarpal in one patient
and on the fourth and fifth metacarpals in the remaining three,
in whom both bones were lengthened simultaneously with use of a
single device. Postoperative bone elongation was analyzed with radiographs
made at the time of removal of the distractor. The sensory function
of the treated fingers and any growth disturbance of the distracted
bones were evaluated.
Results:
The mean duration of distraction was 37.3 days (range, thirty-two
to forty-nine days), and the distractor was removed at a mean of
eighty-four days after surgery. The bones were lengthened by a mean
of 22.3 mm (81.6% of their original length) at a rate of 0.6 mm/day.
Pinch function was improved in all patients.
Conclusions:
On the basis of our limited experience, we found that distraction
osteogenesis of the metacarpals was an effective technique for the
establishment of pinch function. We also found that an intramedullary
Kirschner wire could maintain the alignment of the osteotomized
bone. Although distraction requires a longer treatment period, it
is apparently more effective than bone-grafting in terms of achieving
adequate bone length. Simultaneous lengthening of two metacarpals
also was found to be an effective technique.