gms | German Medical Science

Objectives/Interrogation: The objective is evaluating the effectiveness of distraction osteosynthesis (DO) applied to finger phalanges in patients with defects in middle and distal phalanges (DMDF).

Methods: 48 patients aging 16 to 48 were treated (29.2±5.3 years old average). In 38 cases the DMDF were consequences of traumatic amputation, 3 cases were burns, 7 cased were frostbites. 19 patients had DMDF in multiple fingers (79 cases total). Indications for surgery were DMDF to their proximal part.

In all cases, the DO by external fixation apparatus (EFA) was applied individually taking into account the type and location of phalanx defects. With the phalanx shortened less than 50% of the primary stump length, the traditional distraction was carried out in the mode of 0.5-0.8 mm per day. When stump was lengthened by a large amount (120% or more) of its primary length, the distraction regenerate mineralization slowed down, and therefore the second stage after the lengthening was an intermediate autoplasty with a graft from an ilium crest.

The articular cartilaginous area of the stump was moved to the joint, and an autograft was inserted into the interval, which then was fixed in the EFA. The general duration of fixation in EFA during traditional lengthening did not exceed 12 weeks, while two-stage technique required 16 weeks.

Results and Conclusions: Immediate and long-term treatment results (in 6 months, 1 year or more after the surgery) was evaluated according to the DASH and VAS systems, assesing the phalanx shape and length by radiography. Phalanx elongation was achieved in all cases, and averaged 72% of the primary stump length. When using DO with intermediate bone autoplasty, anatomical growth of the phalanges had reliably speeded up in 2.7 times compared to using traditional techniques of phalanx lengthening.

Finger grip function was significantly improved in the restored fingers because the adjacent joint preserved its motions. The restored finger aesthetic appearance became better. Also, nail plate revealed partial restoration, even when it previously had subtotal defects.

Distraction osteosynthesis is effective in eliminating finger phalanx defects. Defects of the distal or middle phalanx with a length loss of more than 50% should involve intermediate bone autoplasty, which ensures restoring the length and shape of defective fingers in a shorter time.