Distraction lengthening following growth cessation due to thumb replantation in a child.
Growth disturbance due to premature physeal closure as a sequela of digit replantation, on occasion, can cause shortening, resulting in suboptimal function. A simple method for correction using only local tissues is possible via gradual bony distraction. This was attempted in a toddler, whose dominant thumb was amputated by a riding lawn mower when he was an infant, because replantation caused significant growth cessation. The first metacarpal distraction over 64 days netted 22 mm of lengthening. Because a further immobilization period to allow spontaneous consolidation by neo-osteogenesis was aborted at the family's insistence, a fibular autograft of that dimension was inserted into the created bony gap. Ultimately, after 24 months of follow-up, the distracted thumb had been increased 26% in length and was 88% of the length of the contralateral thumb at that time, compared to only 74% prior to initiating the distraction.
Hallock
G G
GG
Division of Plastic Surgery, Lehigh Valley Hospital, Allentown, PA, USA.
D000673:Amputation, Traumatic / Q000000981:diagnostic imaging / Q000601:surgery*; D001852:Bone Lengthening / Q000295:instrumentation*; D001861:Bone Regeneration / Q000502:physiology; D016025:Bone Transplantation / Q000295:instrumentation; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008297:Male; D010027:Osteotomy / Q000295:instrumentation; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012086:Reoperation; D012092:Replantation / Q000295:instrumentation*; D013933:Thumb / Q000293:injuries*; D016896:Treatment Outcome