C Romana1, G Ciais2, F Fitoussi3. 1. Service de chirurgie orthopédique et réparatrice de l'enfant, UPMC université Paris 06, hôpital Trousseau, Paris, France; Centre de référence des malformations des membres, hôpital national de Saint-Maurice, Saint-Maurice, France. 2. Service de chirurgie orthopédique et réparatrice de l'enfant, UPMC université Paris 06, hôpital Trousseau, Paris, France. 3. Service de chirurgie orthopédique et réparatrice de l'enfant, UPMC université Paris 06, hôpital Trousseau, Paris, France; Centre de référence des malformations des membres, hôpital national de Saint-Maurice, Saint-Maurice, France. Electronic address: franck.fitoussi@trs.aphp.fr.
Abstract
INTRODUCTION: Treatment of severe radial club hand is difficult. Several authors have emphasized the importance of preliminary soft-tissue distraction before centralization. HYPOTHESIS: Treatment of severe radial club hand by articulated mini-rail allowing prior soft-tissue distraction improves results. MATERIAL AND METHODS: Thirteen patients were treated sequentially, with an initial step of distraction and a second step of centralization. The first step consisted in fitting 2 mini-fixators, one in the concavity and the other in the convexity of the deformity. Four transfixing wires through the ulna and metacarpal bone connected the 2 fixators. After this preliminary distraction, the fixator was removed and a centralization wire was introduced percutaneously, with ulnar osteotomy if necessary. Sagittal and coronal correction was measured on the angle between forearm and hand. RESULTS: Mean age at treatment was 37.5 months (range, 9-120 months). Mean distraction time was 53.2 days (26-90 days). Ulnar osteotomy was required in 8 cases (61%). There were no major complications requiring interruption of distraction. Sagittal and coronal correction after centralization reduced mean residual forearm/hand angulation to<12°. DISCUSSION: Soft-tissue distraction in the concavity ahead of centralization is essential to good correction, avoiding extensive soft-tissue release and hyperpressure on the distal ulnar growth plate. There have been several studies of distraction; the present technique, associating 2 mini-fixators connected by threaded K-wires, provided sufficient distraction in the concavity of the deformity to allow satisfactory correction in all cases. Subsequent complications (breakage or displacement of the centralization wires) testify to the complexity of long-term management. CONCLUSION: The present study confirms the interest of a preliminary soft-tissue distraction step in treating severe radial club hand.
INTRODUCTION: Treatment of severe radial club hand is difficult. Several authors have emphasized the importance of preliminary soft-tissue distraction before centralization. HYPOTHESIS: Treatment of severe radial club hand by articulated mini-rail allowing prior soft-tissue distraction improves results. MATERIAL AND METHODS: Thirteen patients were treated sequentially, with an initial step of distraction and a second step of centralization. The first step consisted in fitting 2 mini-fixators, one in the concavity and the other in the convexity of the deformity. Four transfixing wires through the ulna and metacarpal bone connected the 2 fixators. After this preliminary distraction, the fixator was removed and a centralization wire was introduced percutaneously, with ulnar osteotomy if necessary. Sagittal and coronal correction was measured on the angle between forearm and hand. RESULTS: Mean age at treatment was 37.5 months (range, 9-120 months). Mean distraction time was 53.2 days (26-90 days). Ulnar osteotomy was required in 8 cases (61%). There were no major complications requiring interruption of distraction. Sagittal and coronal correction after centralization reduced mean residual forearm/hand angulation to<12°. DISCUSSION: Soft-tissue distraction in the concavity ahead of centralization is essential to good correction, avoiding extensive soft-tissue release and hyperpressure on the distal ulnar growth plate. There have been several studies of distraction; the present technique, associating 2 mini-fixators connected by threaded K-wires, provided sufficient distraction in the concavity of the deformity to allow satisfactory correction in all cases. Subsequent complications (breakage or displacement of the centralization wires) testify to the complexity of long-term management. CONCLUSION: The present study confirms the interest of a preliminary soft-tissue distraction step in treating severe radial club hand.