L'allongement par distraction progressive du squelette de la main dans les malformations congénitales

A propos de 41 observations

Translated title of the contribution: Progressive bone lengthening of the hand in congenital malformations

G. Foucher, G. Pajardi, C. Lamas, J. Medina, R. Navarro

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Purpose of the study: We retrospectively reviewed the experience of two Hand Units with progressive bone distraction lengthening, collecting 41 cases of hand skeleton lengthening for congenital malformations. Material and methods: The Ilizarov callostasis method was used in 31 cases and in 10 cases bone union was reestablished at a second stage with an iliac graft (2 cases), vascularized metacarpal bone graft (one case), and vascularized (one case) or nonvascularized (3 cases) toe epiphysis. In the last three cases of index lengthening, the distal part was translocated to the tip of the third, deepening at the same stage the first web. The most frequently treated malformation was symbrachydactyly (22 cases). Results: Mean lengthening was 2.3 cm (0.9 to 3.5) with a mean treatment duration of 3.8 months (1.5 - 8.2). The "lengthening index" was 0.59. There was a significant difference between phalanx and metacarpal lengthening, but the amount of lengthening or treatment duration were not affected by technique (llizarov vs bone grafting) or age. The complication rate was 32 %. There were two complete failures, one extensor tendon tear, 3 pin tract infections (one requiring interruption of the lengthening), 2 cases of relevant pain, 2 delayed unions, 2 angulations and 1 callus fracture, 1 metacarpophalangeal dislocation and 1 joint stiffness. Discussion: Despite advances in micorsurgical toe transfer, there are still indications for bone lengthening in congenital malformations. The apparent simplicity of the technique can mask a certain number of complications, emphasizing the need for surgical experience. Progressive bone lengthening in congenital deformity has the advantage of preserving sensitivity and avoiding bone resorption. Callostasis does not increase the duration of treatment compared to bone graft.

Original languageFrench
Pages (from-to)451-458
Number of pages8
JournalRevue de Chirurgie Orthopedique et Reparatrice de l'Appareil Moteur
Volume87
Issue number5
Publication statusPublished - 2001

Fingerprint

Bone Lengthening
Hand Bones
Metacarpal Bones
Toes
Transplants
Hand
Ilizarov Technique
Bone and Bones
Epiphyses
Bone Transplantation
Bony Callus
Bone Resorption
Masks
Joint Dislocations
Skeleton
Tendons
Therapeutics
Pain
Infection

Keywords

  • Bone lengthening
  • Callotasis
  • Congenital hand malformations
  • Distraction
  • Matev

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

L'allongement par distraction progressive du squelette de la main dans les malformations congénitales : A propos de 41 observations. / Foucher, G.; Pajardi, G.; Lamas, C.; Medina, J.; Navarro, R.

In: Revue de Chirurgie Orthopedique et Reparatrice de l'Appareil Moteur, Vol. 87, No. 5, 2001, p. 451-458.

Research output: Contribution to journalArticle

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abstract = "Purpose of the study: We retrospectively reviewed the experience of two Hand Units with progressive bone distraction lengthening, collecting 41 cases of hand skeleton lengthening for congenital malformations. Material and methods: The Ilizarov callostasis method was used in 31 cases and in 10 cases bone union was reestablished at a second stage with an iliac graft (2 cases), vascularized metacarpal bone graft (one case), and vascularized (one case) or nonvascularized (3 cases) toe epiphysis. In the last three cases of index lengthening, the distal part was translocated to the tip of the third, deepening at the same stage the first web. The most frequently treated malformation was symbrachydactyly (22 cases). Results: Mean lengthening was 2.3 cm (0.9 to 3.5) with a mean treatment duration of 3.8 months (1.5 - 8.2). The {"}lengthening index{"} was 0.59. There was a significant difference between phalanx and metacarpal lengthening, but the amount of lengthening or treatment duration were not affected by technique (llizarov vs bone grafting) or age. The complication rate was 32 {\%}. There were two complete failures, one extensor tendon tear, 3 pin tract infections (one requiring interruption of the lengthening), 2 cases of relevant pain, 2 delayed unions, 2 angulations and 1 callus fracture, 1 metacarpophalangeal dislocation and 1 joint stiffness. Discussion: Despite advances in micorsurgical toe transfer, there are still indications for bone lengthening in congenital malformations. The apparent simplicity of the technique can mask a certain number of complications, emphasizing the need for surgical experience. Progressive bone lengthening in congenital deformity has the advantage of preserving sensitivity and avoiding bone resorption. Callostasis does not increase the duration of treatment compared to bone graft.",
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