THE ROLE OF EXTERNAL FIXATION AND DISTRACTION OSTEOGENESIS AND GRADUAL SOFT TISSUE CORRECTION IN THE HAND AND WRIST IN CHILDREN

Abstract

Introduction and Aims: The hypothesis that ‘utilisation of gradual distraction and soft tissue correction by external fixation improves outcomes in hand and wrist deformity’ was analysed in 29 extremities in 24 patients, to define the indications for gradual soft tissue correction of congenital and acquired deformity and distraction osteogenesis in hypoplastic digits.

Method: This retrospective review of 29 extremities in 24 patients evaluated the role of monolateral external fixators with uniplanar (n=20) and multiplanar (n=9) correction capability (Orthofix, International). Evaluation included an assessment of complications, patient satisfaction, functional outcome, and impact on health-related quality of life.

Results: The devices were successfully used to correct radial longitudinal deficiency of the radius (radial club hand) (n=9); digital hypoplasia (n=15) and wrist flexion contracture secondary to spasticity (n=5). There were no significant complications related to the devices. Pin track irritation and drainage occurred in two of 108 pins. One pin became loose and needed to be replaced, and one fixator required two intraoperative adjustments. Multiplanar fixators used for correction of radial club hands and wrist flexion contracture improved soft tissue position in allowing secondary bony procedures and/or tendon transfers. Distraction osteogenesis of metacarpals and phalanges (included seven previously transferred extraperiostial toe phalanges) was successful with an average lengthening of 2.1 centimetres.

Conclusion: Gradual distraction and soft tissue correction improves outcomes in congential and acquired hand and wrist deformity in children and adolescents. Mono-lateral fixation devices allow correction with hinges or gears, enhance correction of complex deformity, and is well tolerated by patients and caregivers.