Name of the Procedure:

Osteoplasty, Lengthening, Metacarpal or Phalanx Commonly referred to as: Metacarpal Lengthening Surgery, Phalangeal Lengthening, Bone Lengthening of the Hand

Summary

Osteoplasty for lengthening a metacarpal or phalanx is a surgical procedure designed to correct bone deformities or discrepancies in the length of the bones in the hand. This procedure involves making precise cuts in the bone and gradually lengthening it using specialized medical devices.

Purpose

The main goal of metacarpal or phalanx lengthening is to correct deformities, improve hand function, and attain a more normal appearance of the hand. This can help with grasping, handling objects, and performing daily activities more effectively.

Indications

• Congenital bone deformities in the hand
• Traumatic injuries leading to bone shortening
• Conditions like brachydactyly (abnormally short fingers)
• Functional impairment due to unequal bone length
• Aesthetic concerns resulting from disproportioned hand bones

Preparation

• Fasting for a specific period before the surgery (usually after midnight)
• Adjusting or stopping certain medications as advised by the doctor
• Diagnostic tests including X-rays, MRI, or CT scans to assess bone structure
• Discussion of medical history and surgical expectations with the healthcare team

Procedure Description

1. Anesthesia: General anesthesia or regional anesthesia to numb the area.
2. Incision: A careful incision is made over the affected metacarpal or phalanx.
3. Osteotomy: The surgeon performs an osteotomy, cutting the bone in a controlled manner.
4. Fixation Device Installation: A specialized device, such as an external fixator or internal distraction device, is attached to gradually separate the bone segments.
5. Bone Lengthening: Over weeks, the device is adjusted to slowly pull the bone segments apart, allowing new bone to form in the gap.
6. Closure: The incision is closed using sutures, and a dressing is applied.

Duration

The surgical procedure typically lasts between 1 to 2 hours. However, the lengthening process itself can take several weeks to months.

Setting

The surgery is performed in a hospital or advanced surgical center equipped with specialized tools.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Radiologic technologists (if imaging is performed during the procedure)

Risks and Complications

• Infection at the surgical site
• Nerve or blood vessel damage
• Pain or discomfort
• Nonunion or delayed union of the bone
• Complications related to anesthesia
• Scarring or cosmetic issues

Benefits

• Improved hand functionality and movement
• Correction of bone length discrepancies
• Enhanced ability to perform daily tasks
• Aesthetic improvement of the hand's appearance

Recovery

• Postoperative care includes keeping the hand elevated to reduce swelling.
• Pain management with prescribed medications.
• Follow-up appointments for device adjustments and monitoring bone growth.
• Physical therapy may be needed to aid in recovery.
• Most patients can expect a recovery time of several months, including time for gradual lengthening and bone consolidation.

Alternatives

• Observation and physical therapy, if the functional impact is minimal
• Shortening procedures for the longer bone
• Prosthetic devices for significant functional improvement
• Pros: Non-invasive or less invasive compared to lengthening; may provide immediate results.
• Cons: Might not address all functional or aesthetic concerns effectively.

Patient Experience

• Patients can expect some discomfort during and after the procedure, which is managed with medications.
• Tingling or numbness might be felt due to nerve involvement; these symptoms usually improve over time.
• The experience of the gradual lengthening process involves regular adjustments, which might cause mild to moderate discomfort.
• Follow-up care is essential to monitor progress and make necessary adjustments for optimal outcomes.