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The Journal of Bone and Joint Surgery (American) 84:986-991 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Bone-Lengthening for Symbrachydactyly of the Hand with the Technique of Callus Distraction

Takeshi Miyawaki, MD, PhD, Genzo Masuzawa, MD, PhD, Masahiko Hirakawa, MD, PhD and Kunihiro Kurihara, MD, PhD

Investigation performed at the Department of Plastic and Reconstructive Surgery, Jikei University School of Medicine, Tokyo, Japan

Takeshi Miyawaki, MD, PhD
Genzo Masuzawa, MD, PhD
Masahiko Hirakawa, MD, PhD
Kunihiro Kurihara, MD, PhD
Department of Plastic and Reconstructive Surgery, Jikei University School of Medicine, 3-25-8 Nishishimbashi Minato-ku, Tokyo 105-0008, Japan. E-mail address for T. Miyawaki: caritakm{at}aol.com

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Bone-lengthening in the hand and foot is a relatively new application for distraction osteogenesis. We present the operative treatment and postoperative outcome for four patients with Müller type-D symbrachydactyly of the hand who underwent metacarpal lengthening with use of a distraction device to establish pinch function.

Methods: Four patients who underwent distraction osteogenesis for the treatment of congenital symbrachydactyly of the hand were evaluated over a thirteen-year period. The nondominant right hand was treated in two patients, and the nondominant left hand was treated in the other two. The patients included three boys and one girl; all patients had the operation between the ages of five and eleven years. Distraction osteogenesis was performed on the fifth metacarpal in one patient and on the fourth and fifth metacarpals in the remaining three, in whom both bones were lengthened simultaneously with use of a single device. Postoperative bone elongation was analyzed with radiographs made at the time of removal of the distractor. The sensory function of the treated fingers and any growth disturbance of the distracted bones were evaluated.

Results: The mean duration of distraction was 37.3 days (range, thirty-two to forty-nine days), and the distractor was removed at a mean of eighty-four days after surgery. The bones were lengthened by a mean of 22.3 mm (81.6% of their original length) at a rate of 0.6 mm/day. Pinch function was improved in all patients.

Conclusions: On the basis of our limited experience, we found that distraction osteogenesis of the metacarpals was an effective technique for the establishment of pinch function. We also found that an intramedullary Kirschner wire could maintain the alignment of the osteotomized bone. Although distraction requires a longer treatment period, it is apparently more effective than bone-grafting in terms of achieving adequate bone length. Simultaneous lengthening of two metacarpals also was found to be an effective technique.


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