Abstract
Aim: Adequate length is an important prerequisite for a functional digit. Over the last 20 years small external fixators have been developed allowing the principles of distraction osteogenesis to be applied to the small bones of the hand. We present our experience in digital lengthening with the contemporary designs of external fixators.
Methods: From 1998 to 2001, 14 patients (15 rays) were treated with metacarpal or phalangeal lengthening through distraction osteogenesis using a monolateral frame with two half-pins on each site of the osteotomy. The mean age of the patients was 21 years (7–48) and the indications were traumatic amputation in 8 and congenital amputation (transverse deficiency, brachydactyly, constriction band syndrome) in 6. The mean distraction period was 3 weeks and the mean consolidation period 7 weeks. No protective splinting or additional bone grafting was necessary.
Results: The distraction callus consolidated in all patients. The mean total length gained was 17, 5 mm (68% of the original length). The mean treatment time was 2, 8 days for every mm of length gained. One patient suffered angulation at the distraction site due to hardware failure and the fixator had to be revised and in another bony prominence was noted necessitating trimming. No infection, fracture or half pin loosening were observed.
Conclusions: Callotasis using contemporary monolateral external fixators is a reliable technique for digital ray lengthening. Meticulous preoperative planning and surgical technique and close observation of the patient during the distraction phase are necessary in order to avoid complications. Over 2 cm of lengthening can be achieved without bone grafting.
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