Distraction-Lengthening of Digital Rays Using a Small External Fixator

Abstract

We present 19 ray lengthenings in 14 patients done with a small external fixator. In six cases the thumb was lengthened and in the other 13 cases, other digital rays. The most frequent reason for lengthening was an amputation sustained in a work accident. All the lengthenings were done by an osteotomy and subsequent gradual distraction with a small external fixator. The mean lengthening achieved was 20 mm (range, 0-32). An iliac-crest graft was needed in nine cases, corrective osteotomy in five cases and a deepening of the web in the six cases of thumb lengthening. In five cases an additional technique was needed to achieve bony consolidation. We have analysed the functional results and the ability to perform activities of daily living and resume employment. Although most of the patients had multiples injuries, the results have been very favourable, achieving a very high level of patient satisfaction.

First metacarpal lengthening following traumatic amputation of the thumb: long-term follow-up

“…In our cases, the unilateral external fixator was stable enough and a longitudinal Kirschner wire was used during elongation only when the base of the proximal phalanx is preserved, to prevent its flexion [11]. Other external fixators also provide a good stability [12] and others are insufficient [9] in our experience. In metacarpal lengthening, complications involving infection and bone bending are reduced if the gap created is smaller, due to the reduced time of treatment and reduction in metacarpal lever force [13].…”

“…2) with iliac crest or bone from stumps that required revision that was deferred until this time [8,9]. Our technique underwent these modifications to cope with a number of technical difficulties that we encountered, making for a simpler, shorter process with improvement in the final results.…”

Les allongements digitaux par distraction progressive

“…Le segment osseux allongé a été métacarpien dans huit cas (sept pouce et un médius), et phalangien dans quatre cas (trois index et un médius). Ces proportions sont variables dans la littérature : 70 % métacarpien et 30 % phalangien pour Foucher [9], neuf métacarpiens dont six pouces et dix phalanges pour Salom [10].…”

“…Matev n'a pas précisé ce délai. La moyenne de la littérature est de huit jours [9], avec des périodes variant de quatre [10] à dix jours [13].…”

“…Cela explique que la durée moyenne de la phase de distraction est de 123 jours dans notre série (pour les cas de callotasis) et qu'elle n'est que de 44 jours pour Foucher [9] qui associe systématiquement un apport osseux. Pour Salom [10], qui a réalisé un apport osseux dans huit cas sur 19, cette période est de 63 jours.…”