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, 20 patients (26 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 (6–48) and indications included traumatic amputation in 13 and congenital amputation (transverse deficiency, brachydactyly, constriction band syndrome) in 7. 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 and the fixator had to be revised. No infection, fracture or half pin loosening were observed. Conclusions: Callotasis is a reliable technique for digital ray lengthening. Meticulous 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

Aim: To investigate the natural history and the impact of reconstruction in shoulder deformities due to obstetrical brachial plexus palsy. Methods: Pre and postoperative CT scans of bilateral upper extremities of 28 patients with obstetrical palsy were studied. The age during the preoperative CT scan ranged from 1.5 months to 10 years (average: 4 ± 3 years). 17 patients had Erbñs palsy and 11 global plexus involvement. Eighteen had primary shoulder reanimation mainly via intraplexus neurotization. Palliative surgery in 25 patients included trapezius transfer for shoulder abduction, adductors release and rerouting of the latissimus dorsi and terres major for external rotation, scapula stabilization and rotational osteotomy of the humerus. The CT measurements included: humeral head retroversion, spinoscapular angle, glenoid fossa inclination, congruence of the humeral head to the glenoid and distance of the lower angle of the scapula from the midline. Results: Preoperatively the humeral head was subluxated or dislocated posteriorly and had decreased retroversion. The hypoplastic scapula had winging and increased distance from the midline, while the glenoid fossa was more retroverted. Postoperatively all the above measurements were improved. Conclusions: Novel measurements on CT scans of bilateral shoulders provide valuable information. Surgical intervention signiþcantly improves the functional anatomy and the dynamics of the shoulder joint.

Aim: To study the functional outcome ofmusculocutaneous nerve neurotization in brachial plexus palsy patients. Methods: From 1998 to 2001, 51 adult patients (mean age 24,6 years) with posttraumatic brachial plexus palsy were operated. Exploration of the brachial plexus was performed in 39 patients with a mean denervation time of 6 months (1 to 14 months). Seven patients had an extended infraclavicular lesion, while from the 32 supraclavicular lesions, 21 had the element of avulsion (4 global, 10 four-root and 7 three-roots avulsions). Neurotization of the musculocutaneous was performed in 25 via nerve grafts from intraplexus donors (C5, C6, C7)and from extraplexus donors in 14. In 7 patients, the phrenic was used alone or with intraplexus donor (5), in 3 cases the accessory nerve, in one patient the accessory and cervical plexus motor branches and þnally in 3 patients 3 intercostal nerves were used. Results: All intraplexus neurotizations of the musculocutaneous nerve, but two, regained useful biceps function (M3+ to M4+). From the extraplexus neurotizations the phrenic n. as a conjunctant donor gave functional result, when used alone gave M3 and M3−; the accessory n. gave M3+ in combination with cervical motors and M3− when used alone. The intercostal neurotizations gave M2+ and M3−. Conclusions: In brachial plexus paralysis, when avulsion is present the reconstruction often is based in extraplexus donors. The return of biceps function is greater and faster when intraplexus donors are used. Extraplexus neurotizations yield satisfactory results used in combinations Vertebral osteoporosis and fracture

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.