Bone-periosteal-muscle flap for ulnar lengthening in children with congenital radial club hand

Abstract

Introduction. Congenital radial club hand is characterized by underdevelopment of all structures of the forearm. The main symptoms include: 1) radial wrist deviation; 2) first finger hypoplasia; 3) shortening and deformation of the ulna. Ulnar bone shortening averages 24.7-50% compared to the intact limb. Lengthening results of 4-7 cm are presented, however, delayed consolidation of fragments most commonly occurs. Therefore, the creation of an active regeneration source in the lengthening zone is required. Aim. To evaluate the results of ulnar bone lengthening using distraction osteogenesis in patients with congenital radial club hand type IV (according to Bayne and Klug classification), who underwent osteotomy with formation of a bone-periosteal-muscle flap. Materials and methods. The main group consisted of 20 patients (treatment period from 2019 to 2022) who underwent osteotomy with formation of a bone-periosteal-muscle flap during ulnar bone lengthening. The control group included 22 patients who received treatment from 1998 to 2018. Oblique osteotomy of the ulnar bone was performed in this cohort. Evaluation parameters included: 1) length of the regenerated bone; 2) distraction time; 3) correction period; 4) fixation index; 5) osteosynthesis index; 6) complications. Results. Lengthening of 4.1 cm was achieved (30.7% of the original ulnar bone length). Correction of angular deformity was -71.4%, with greater correction achieved with osteotomy in the proximal segment. The distraction and osteosynthesis indices in the subgroup of proximal segment osteotomy were 25.6 and 25.7 days/cm respectively, while in the mid-third osteotomy group, they were 42.3 and 42.6 days/cm. In complications, only inflammatory phenomena were recorded in 30% of cases. Discussion. "Maturation of the regenerate" was achieved in 100% of cases in the main group of patients. Thus, the bone tissue fragment with a periosteal-muscle pedicle serves as a source of additional bone formation during distraction. Conclusion. The conducted study proved the expediency of using osteotomy with formation of a bone-periosteal-muscle flap in children with congenital radial club hand. By applying this technique, greater deformation correction can be achieved, the formation period of the regenerate is shortened, and the number of complications is reduced.