First Experience with a Distraction Apparatus Prototype (SM-Fix-Phalanx Distractor) for Phalanges Lengthening

Abstract

Since 1991 seven children aged between 5-17 years have been treated at the University Children's Hospital in Basel for 10 traumatically partially amputated phalanges with a newly developed external fixator and distractor. Through continual distraction of the osteotomy a phalanx lengthening of 3-10 mm has been achieved (on average 55% of the rest phalanx). The results of this method in distal phalanx amputation with resulting nail dystrophy (claw nail) has shown functional and cosmetic improvements. The average distraction and consolidation phases lasted 5 weeks. The after care lasted 2-12 months. As children have good distraction-histogenesis bone grafting is not necessary. A prerequisite would be, however, an intact or appropriately prepared integument. The advantage of this external fixator and distractor system is that it is suitable for the delicate anatomical structures of a child's hand. The distractor component is only necessary for a distraction step to be carried out. A further advantage of this system is the relatively light but stable construction.

Is progressive lengthening of the distal phalanx of a child’s index finger possible and safe?

“…In contrast, a poor skin condition may contraindicate or enforce a premature termination of the procedure [4,8,12]. We did not encounter any complication in our case despite the pre-existing bad scar tissue.…”

“…One thumb was elongated by 7 mm and two index fingers by 3 and 12 mm [8]. One thumb was elongated by 7 mm and two index fingers by 3 and 12 mm [8].…”

“…The success of the procedure depends on the age and the amount of lengthening, with a better chance of consolidation in children [4,5,[8][9][10][11]. The limitation of the surgical indication for an objective functional deficit, specifically the hand grip or interdigital pinch, is reported by several authors, who do not recommend phalanx lengthening for pure cosmetic purposes [1,6].…”

A Simple and Light Weight External Fixator for Distraction Advancement Manoplasty

“…Matev recommended that a gap of 3 cm or more in patients over 20 years of age should be filled with bone graft without delay because spontaneous consolidation is doubtful(4, 9, 10). Most authors have followed this procedure, which entails gradual lengthening and bone grafting(2, 11-14). In our study, the mean HI was 101 days/cm (58 to 216) in the proximal phalanx.…”