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. 2019 May;14(3):339-345.
doi: 10.1177/1558944717736859. Epub 2017 Oct 31.

Metacarpal Lengthening in Adults With Brachymetacarpia

Aaron Lam  1 , Austin T Fragomen  2 , S Robert Rozbruch  2
Affiliations

Metacarpal Lengthening in Adults With Brachymetacarpia

Aaron Lam et al. Hand (N Y). 2019 May.

Abstract

Background: Metacarpal lengthening by distraction osteogenesis has been well documented in pediatric patients but limited in older patients. Fewer studies have assessed the success of the procedure through outcome measure scores. The purpose of this study is to assess the outcomes of distraction osteogenesis in skeletally mature adults with brachymetacarpia and patients' perspectives on their satisfaction through outcome measure scores.

Methods: Retrospective chart review of a consecutive series of metacarpal lengthenings for the treatment of brachymetacarpia was performed. Key parameters collected include starting metacarpal length, amount lengthened, range of motion of metacarpophalangeal joint, type of fixator used, distraction time, and total time in fixator. Relevant comorbidities and complications encountered were recorded as well. The Body Image Quality of Life Inventory (BIQLI) and Limb Deformity Modified Scoliosis Research Society (LD-SRS) score were given to evaluate patients' perspectives on their satisfaction of surgery.

Results: Seven metacarpal lengthenings were performed in 4 adult females (average age: 22.8 years) between 2005 and 2016. The average amount lengthened was 1.5 cm (range, 1.2-2.1 cm), corresponding to a mean percent lengthening of 44.4% (range, 33.3%-57.1%). The mean distraction rate was 0.432 mm/day (range, 0.286-0.724 mm/day). The mean distraction time was 38 days (range, 28-55 days). External fixation index was 71.8 days/cm (range, 53.5-99.2 days/cm). No functional loss was observed.

Conclusions: Progressive distraction osteogenesis can obtain functionally successful results and improvement in aesthetics and body image without severe complications in skeletally mature adults with brachymetacarpia.

Keywords: adults; brachymetacarpia; distraction osteogenesis; metacarpal lengthening; outcome measure scores.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: AL declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ATF reports personal fees from Smith & Nephew, personal fees from NuVasive, personal fees from Synthes, outside the submitted work. SRR reports personal fees from Smith & Nephew, personal fees from NuVasive, personal fees from Stryker, outside the submitted work.

Figures

Figure 1.
Figure 1.
(a) Front view of the left hand showing shortening of the fourth finger. (b) When in a fist position, the absence of the knuckle (arrow) and the metacarpal shortening is apparent. (c) AP x-ray of left hand showing fourth metacarpal shortening of about 13 mm (magnification marker is 25.4 mm or 1 inch).
Figure 2.
Figure 2.
(a) Two months after removal of the second hand frame. (b) Patient demonstrates excellent function and range of motion of hand. (c) Anteroposterior radiograph of left hand showing bone union, restoration of the fourth metacarpal lengths, and satisfactory alignment.
See this image and copyright information in PMC

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