Correction of Congenital Ring-Little Finger Metacarpal Synostosis Through Simultaneous Interpositional Allograft Bone After Split Osteotomy of the Synostosis Site and Distraction Lengthening of the Fifth Metacarpal

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume Pub Date : 2025-05-01 DOI:10.1016/j.jhsa.2023.12.009

Ji Sup Hwang MD , Sang Beom Ma MD , Jihyeung Kim MD, PhD , Goo Hyun Baek MD, PhD

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Abstract

Purpose

We attempted a technique for patients with congenital ring-little finger metacarpal synostosis involving simultaneous interpositional allograft bone after split osteotomy of the synostosis site and distraction lengthening of the fifth metacarpal along with correction of the metacarpal joint abduction contracture. The purpose of this study was to describe the surgical technique and its outcomes.

Methods

We reviewed the medical records of children with congenital ring-little finger metacarpal synostosis treated surgically at our institute. Eight hands of six children with an average age of 5.0 (range, 1.7–9.3) years were treated by simultaneous interpositional allograft bone after split osteotomy, distraction lengthening, and tenotomy of abductor digiti minimi. We measured the metacarpal head-to-capitate area ratios from serial radiographs and analyzed them according to age. We also measured the change in the intermetacarpal angle (IMA) and metacarpal length ratio during an average of 8.1 (range, 1.4–16.8) years of follow-up. These changes were compared with changes in seven hands of five children with an average age of 8.1 (range, 1.5–15.6) years treated by the same method, but without a distraction lengthening of the fifth metacarpal and followed up for an of average 12.1 (range, 4.1–19.8) years, as a control group.

Results

Abnormal metacarpal head-to-capitate area ratio before surgery was normalized in all patients within the first 2 years after surgery. The IMA change averaged 39.8°, and the metacarpal length ratio changed by 17%. The control group showed an average IMA change of 36.6° and metacarpal length ratio change of 6%.

Conclusions

Simultaneous interpositional allograft bone after split osteotomy of the synostosis site and distraction lengthening of the fifth metacarpal with correction of metacarpal joint abduction contracture can restore the radiographic parameters in congenital ring-little finger metacarpal synostosis. The normalized ossification of the fifth metacarpal head indicates that the surgical procedure is probably safe.

Type of study/level of evidence

Therapeutic V.

查看原文本刊更多论文

先天性无名指与小指掌骨骨节错位的矫正术：在对骨节错位部位进行分块截骨手术并对第五掌骨进行牵引延长术后，同时进行同种异体骨移植。

目的：我们尝试了一种治疗先天性无名指-小指掌骨突节患者的技术，即在对突节部位进行劈裂截骨后，同时植入同种异体骨，并对第五掌骨进行牵引延长，同时矫正掌指关节内收挛缩。本研究旨在描述手术技术及其结果：我们回顾了在我院接受手术治疗的先天性无名指-小指掌骨突节症患儿的病历。6名平均年龄为5.0岁（1.7-9.3岁）的患儿的8只手在进行劈裂截骨、牵引延长和小臂内收肌腱鞘切除术后，同时进行了同种异体骨移植。我们通过序列X光片测量了掌骨头与掌骨的面积比，并根据年龄对其进行了分析。我们还测量了平均 8.1 年（1.4-16.8 年）随访期间掌骨间角 (IMA) 和掌骨长度比的变化。这些变化与作为对照组的五名平均年龄为 8.1 岁（1.5-15.6 岁）的儿童的七只手的变化进行了比较：所有患者手术前的掌骨头与掌骨头面积比值异常，均在术后两年内恢复正常。IMA 平均变化了 39.8°，掌骨长度比变化了 17%。对照组的 IMA 平均变化为 36.6°，掌骨长度比变化为 6%：结论：对先天性无名指-小指掌骨突节进行劈裂截骨和第五掌骨牵引延长术并矫正掌指关节内收挛缩后，同时进行同种异体骨移植，可恢复先天性无名指-小指掌骨突节的影像学参数。第五掌骨头骨化正常表明手术过程可能是安全的：治疗V.

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来源期刊

Journal of Hand Surgery-American Volume 医学-外科

CiteScore

3.20

自引率

10.50%

发文量

402

审稿时长

12 weeks

期刊介绍： The Journal of Hand Surgery publishes original, peer-reviewed articles related to the pathophysiology, diagnosis, and treatment of diseases and conditions of the upper extremity; these include both clinical and basic science studies, along with case reports. Special features include Review Articles (including Current Concepts and The Hand Surgery Landscape), Reviews of Books and Media, and Letters to the Editor.