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. 2009 Jun;33(3):807-13.
doi: 10.1007/s00264-007-0491-x. Epub 2007 Dec 19.

Lengthening of short bones by distraction osteogenesis--results and complications

Mehmet Erdem  1 , Cengiz Sen, Levent Eralp, Mehmet Kocaoğlu, Vahit Ozden
Affiliations

Lengthening of short bones by distraction osteogenesis--results and complications

Mehmet Erdem et al. Int Orthop. 2009 Jun.

Abstract
in English, French

We performed bone lengthening surgery on 12 metacarpals and 14 metatarsals of 15 patients. The mean age for metacarpal and metatarsal lengthening was 14.5 (10-21) and 17.5 (10-25) years, respectively. We used a unilateral or a circular external fixator. The mean healing index of the metacarpals and metatarsals was 1.6 (1.1-2.3) and 1.6 (1.0-2.0) months/cm, respectively. The mean increase in metacarpal and metatarsal length was 17.6 (13-26) and 24.3 (20-30) mm, respectively. The functional scores of the metatarso-phalangial (MTP) joint of lengthened metatarsals for the lesser toe were excellent in 12 and good in two cases based on the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system. Complications were seen in six of the metatarsal lengthening cases including four angulations, one subluxation and one non-union. We conclude that the periosteum must be protected with percutaneous osteotomy and lengthening should be performed at a rate of 0.25 mm twice a day and should not exceed 40% of the original bone length (or >20 mm).

Nous avons réalisé une chirurgie d’allongement sur 12 métacarpiens et 14 métatarsiens chez 15 patients. L’âge moyen était respectivement de 14.5 ans pour les métacarpiens (10 à 21) et 17.5 ans pour les métatarsiens (10 à 25). Nous avons utilisé un fixateur unilatéral ou circulaire. L’index moyen de consolidation a été de 1.6 mois/cm d’allongement, de 1.1 à 2.3 pour les métacarpiens et de 1.0 à 2.0 pour les métatarsiens. L’allongement moyen a été de 17.6 mm (13 à 26) pour les métacarpiens et de 23 mm (20 à 30) pour les métatarsiens. Le score fonctionnel de l’articulation métatarso-phalangienne a été excellent chez 12 patients, et bon chez 2 patients (score de l’AOFAS). Les complications ont été constituées par 4 angulations, 1 subluxation et 1 pseudarthrose parmi 6 allongements métatarsiens. Nous pouvons conclure que le périoste doit être protégé lors de l’ostéotomie percutanée mais la vitesse d’allongement doit être de 0.25 mm deux fois par jour. L’allongement ne doit pas excéder 40% de la longueur originale de l’os (plus de 20 mm).

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Figures

Fig. 1
Fig. 1
A 10-year-old female with left fourth short metacarp. a Preoperative X-ray. b X-ray taken during distraction osteogenesis using a unilateral fixator. c X-ray after the removal of the frame
Fig. 2
Fig. 2
A 13-year-old female with bilateral fourth short metatarsal and right metatarsal lengthening. a Preoperative X-ray. b X-ray taken during distraction osteogenesis using a unilateral fixator. c X-ray taken after the removal of the fixator
See this image and copyright information in PMC

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