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Results of distraction callus osteogenesis in hand and foot in Iran: A 15-year experience.

Forootan KS, Forootan NS, Lebaschi AH - J Res Med Sci (2015)

Bottom Line: Data concerning distraction, outcome, and complications were recorded.DS is an effective modality for lengthening bones of the hand and feet for both traumatic and congenital conditions.Joint stiffness/contracture is an important complication following DS of the metatarsals.

View Article: PubMed Central - PubMed

Affiliation: Department of Hand and Microscopic Surgery, Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran.

ABSTRACT

Background: Distraction osteogenesis (DS) is currently an important technique for lengthening shortened bones of the hand and foot. Authors report their experience in applying DS for various conditions of the hand and foot using a distractor that the senior author has designed.

Materials and methods: Records of patients who underwent DS for hand and foot conditions in a private clinic were retrieved between January 2001 and January 2015. Data concerning distraction, outcome, and complications were recorded.

Results: There were 17 patients, 7 males, and 10 females with a total 24 distractions. The mean length gained was 21.2 mm (1.69) and the mean total treatment time was 198.58 (15.88) days. Overall, complications occurred in 9 (37.5%) distractions. Major complications occurred in 2 (8.33%) of distractions. Minor complications occurred in 7 (29.2%) distractions.

Conclusion: DS is an effective modality for lengthening bones of the hand and feet for both traumatic and congenital conditions. Joint stiffness/contracture is an important complication following DS of the metatarsals.

No MeSH data available.


Related in: MedlinePlus

A female patient with 4th brachymetatarsia before, during, and after DS. (a) Preoperative photo. (b) Distractor in place with nearly completed distraction. (c) Postoperative photo
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Figure 4: A female patient with 4th brachymetatarsia before, during, and after DS. (a) Preoperative photo. (b) Distractor in place with nearly completed distraction. (c) Postoperative photo

Mentions: There were 17 patients, 7 males, and 10 females. Eleven patients had 1 distractor inserted, 5 patients had 2 distractors inserted, and 1 patient had 3 distractors inserted, with a total number of 24 distractions. The mean age of the patients at the time of distractor insertion was 21.29 ± 1.82 (SD) years (range: 8-38 years). Of all distractions, trauma was the underlying condition in 15 (62.5%) [Figure 2]; the rest belonged to congenital anomalies (9, 37.5%) [Figure 3]. Burn was the most common traumatic cause (66%). Firework explosion and crush injuries equally constituted the rest of the traumatic causes (16% each). Interestingly, all patients with congenital anomalies in this series were females with congenital brachymetatarsia [Figure 4]. There were 14 (58.3%) hand distractions and 10 (41.7%) foot distractions. Table 1 summarizes the bones that were distracted. K-wire insertion was not required in any of our distractions. Only two distractions required iliac bone graft. All patients distracted the distractors twice daily and at a rate of 1 mm/day. Table 2 summarizes distraction times and intervals. The mean consolidation time was 105.81 ± 9.52 (SD) days for hand distractions and 90.40 ± 7.23 (SD) days for foot distraction (P = 0.164). Table 3 summarizes mean length gained by gender, limb, and underlying condition. The mean length gained was not significantly different regarding different categories of these variables. In brachymetatarsia cases, a mean length gained of 24.25 ± 2.18 (SD) mm could be achieved in these patients. The proximal joint function was good in 22 (91.7%) and fair in 1 (4.2%) distractions. Distal joint function was good in 20 (83.3%) and fair in 3 (12.5%) distractions. Overall, complications occurred in 9 (37.5%) distractions. Major complications occurred in 2 (8.33%) of distractions; 1 case of callus fracture and 1 case of device pin loosening. Callus fracture was managed by protracted treatment time. Loosening involved just one of the pins, and, therefore, the patient could complete the treatment. There were no cases of angulation, early or failed consolidation, incomplete corticotomy, and mechanical failure of the distractor. Minor complications occurred in 7 (29.2%) distractions. There were 1 pin tract infection, 4 cases of joint stiffness that required physical therapy, and two cases of joint contracture requiring capsulotomy. Joint contractures occurred only in our brachymetatarsia cases. One of the joints that incurred stiffness belonged to a male with a history of firework explosion. The remaining three joints with stiffness belonged to a female with a history of burn in both hands. This was the only patient who received three distractors. None of the patients complained of a bony prominence.


Results of distraction callus osteogenesis in hand and foot in Iran: A 15-year experience.

Forootan KS, Forootan NS, Lebaschi AH - J Res Med Sci (2015)

A female patient with 4th brachymetatarsia before, during, and after DS. (a) Preoperative photo. (b) Distractor in place with nearly completed distraction. (c) Postoperative photo
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4590199&req=5

Figure 4: A female patient with 4th brachymetatarsia before, during, and after DS. (a) Preoperative photo. (b) Distractor in place with nearly completed distraction. (c) Postoperative photo
Mentions: There were 17 patients, 7 males, and 10 females. Eleven patients had 1 distractor inserted, 5 patients had 2 distractors inserted, and 1 patient had 3 distractors inserted, with a total number of 24 distractions. The mean age of the patients at the time of distractor insertion was 21.29 ± 1.82 (SD) years (range: 8-38 years). Of all distractions, trauma was the underlying condition in 15 (62.5%) [Figure 2]; the rest belonged to congenital anomalies (9, 37.5%) [Figure 3]. Burn was the most common traumatic cause (66%). Firework explosion and crush injuries equally constituted the rest of the traumatic causes (16% each). Interestingly, all patients with congenital anomalies in this series were females with congenital brachymetatarsia [Figure 4]. There were 14 (58.3%) hand distractions and 10 (41.7%) foot distractions. Table 1 summarizes the bones that were distracted. K-wire insertion was not required in any of our distractions. Only two distractions required iliac bone graft. All patients distracted the distractors twice daily and at a rate of 1 mm/day. Table 2 summarizes distraction times and intervals. The mean consolidation time was 105.81 ± 9.52 (SD) days for hand distractions and 90.40 ± 7.23 (SD) days for foot distraction (P = 0.164). Table 3 summarizes mean length gained by gender, limb, and underlying condition. The mean length gained was not significantly different regarding different categories of these variables. In brachymetatarsia cases, a mean length gained of 24.25 ± 2.18 (SD) mm could be achieved in these patients. The proximal joint function was good in 22 (91.7%) and fair in 1 (4.2%) distractions. Distal joint function was good in 20 (83.3%) and fair in 3 (12.5%) distractions. Overall, complications occurred in 9 (37.5%) distractions. Major complications occurred in 2 (8.33%) of distractions; 1 case of callus fracture and 1 case of device pin loosening. Callus fracture was managed by protracted treatment time. Loosening involved just one of the pins, and, therefore, the patient could complete the treatment. There were no cases of angulation, early or failed consolidation, incomplete corticotomy, and mechanical failure of the distractor. Minor complications occurred in 7 (29.2%) distractions. There were 1 pin tract infection, 4 cases of joint stiffness that required physical therapy, and two cases of joint contracture requiring capsulotomy. Joint contractures occurred only in our brachymetatarsia cases. One of the joints that incurred stiffness belonged to a male with a history of firework explosion. The remaining three joints with stiffness belonged to a female with a history of burn in both hands. This was the only patient who received three distractors. None of the patients complained of a bony prominence.

Bottom Line: Data concerning distraction, outcome, and complications were recorded.DS is an effective modality for lengthening bones of the hand and feet for both traumatic and congenital conditions.Joint stiffness/contracture is an important complication following DS of the metatarsals.

View Article: PubMed Central - PubMed

Affiliation: Department of Hand and Microscopic Surgery, Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran.

ABSTRACT

Background: Distraction osteogenesis (DS) is currently an important technique for lengthening shortened bones of the hand and foot. Authors report their experience in applying DS for various conditions of the hand and foot using a distractor that the senior author has designed.

Materials and methods: Records of patients who underwent DS for hand and foot conditions in a private clinic were retrieved between January 2001 and January 2015. Data concerning distraction, outcome, and complications were recorded.

Results: There were 17 patients, 7 males, and 10 females with a total 24 distractions. The mean length gained was 21.2 mm (1.69) and the mean total treatment time was 198.58 (15.88) days. Overall, complications occurred in 9 (37.5%) distractions. Major complications occurred in 2 (8.33%) of distractions. Minor complications occurred in 7 (29.2%) distractions.

Conclusion: DS is an effective modality for lengthening bones of the hand and feet for both traumatic and congenital conditions. Joint stiffness/contracture is an important complication following DS of the metatarsals.

No MeSH data available.


Related in: MedlinePlus