Distraction lengthening following growth cessation due to thumb replantation in a child.

Abstract

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.