Progressive bone lengthening of the hand in congenital malformations

Purpose of the study We retrospectively reviewed the experience of two Hand Units with progressi ve bone distraction lengthening, collecting 41 cases of hand skeleton lengt hening for congenital malformations. Material and methods The Ilizarov callostasis method was used in 31 cases and in 10 cases bone u nion was reestablished at a second stage with an iliac graft (2 cases), vas cularized metacarpal bone graft (one case), and vascularized (one case) or nonvascularized (3 cases) toe epiphysis. In the last three cases of index l engthening, the distal part was translocated to the tip of the third, deepe ning at the same stage the first web. The most frequently treated malformat ion 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 signi ficant difference between phalanx and metacarpal lengthening, but the amoun t of lengthening or treatment duration were not affected by technique (Iliz arov vs bone grafting) or age. The complication rate was 32 %. There were t wo complete failures, one extensor tendon tear, 3 pin tract infections (one requiring interruption of the lengthening), 2 cases of relevant pain, 2 de layed unions, 2 angulations and 1 callus fracture, 1 metacarpophalangeal di slocation 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 th e need for surgical experience. Progressive bone lengthening in congenital deformity has the advantage of preserving sensitivity and avoiding bone res orption. Callostasis does not increase the duration of treatment compared t o bone graft.