- Email: [email protected]
DIGITAL RAY RECONSTRUCTION VIA DISTRACTION OSTEOGENESIS LENGTHENING
ARTICLE IN PRESS 40
MRI. Conclusion : ‘‘Plaster cast and wait’’ is not the treatment for occult carpal bones fractures. 10.1016/j.jhsb.2006.03.076
8.8 DIGITAL RAY RECONSTRUCTION VIA DISTRACTION OSTEOGENESIS LENGTHENING
M. Vekris, J. Gavriilidis, V. Sioros, A. Pakos, G. Mitsionis and A. Beris Ioannina University Medical School, Ioannina, Greece Background: Adequate length is a prerequisite for a functional digit. Over the last 20 years small external fixators have been developed allowing the principles of distraction osteogenesis to be applied to the small bones of the hand and thus permitting digital lengthening and realignment in patients that have suffered a traumatic or congenital amputation of a digit. Aim: Presentation of our series and analysis of the results. Patients and methods: From 1998 to 2005, 32 patients (41 rays) were treated with metacarpal or phalangeal lengthening through distraction osteogenesis using a monolateral frame with two half pins on each site of the osteotomy. The mean age of the patients was 21 years (4–48) and the indications were traumatic amputation in 25 and congenital amputation (transverse deficiency, brachydactyly, constriction band syndrome) in 7. The technique included dorsal approach, pin placement, drilling of the osteotomy site and if necessary realignment of the clinodactyly. The lengthening was started 5 days postop and proceeded with a rate of 1 mm per day in four 0.25 mm increments. The mean distraction period was 3 weeks and the mean consolidation period was 7 weeks. No protective splinting or additional bone grafting was necessary. Results: The distraction callus consolidated in all patients. The mean total length gained was 17.5 mm (68% of the original length). In one patient the holding screw of a miniclamp failed, leading to angulation at the distraction site and the fixator had to be revised. In 2 patients with pseudarthrosis late internal fixation and bone graft was done. No infection fracture or half pin loosening were observed. Conclusions: Callotasis using contemporary monolateral external fixators is a reliable technique for digital ray lengthening. Meticulous surgical technique and close observation of the patient during the distraction period are necessary in order to avoid complications. Over 2 cm of lengthening can be achieved. 10.1016/j.jhsb.2006.03.077
THE JOURNAL OF HAND SURGERY VOL. 31B No. S1 JUNE
2006
8.9 DEFINITION OF A PREDICTIVE MARKER OF CLINICAL ACTIVITY IN DUPUYTREN’S DESEASE: SMOOTH ALFA ACTIN
D. Smarrelli, A. Lazzerini, D. Despirito, M. C. D’ Agostino, E. Tibalt, M. G. DiRocco, B. Fiamengo, B. Franceschini and F. Grizzi I.R.C.C.S Humanitas, Milan, Italy Background: Dupuytren’s disease is a progressive and proliferative fibromatosis characterized by two distinct lesions: nodule and cord. The myofibroblast is mainly responsible for tissue contraction. Surgery is the recommended treatment. To avoid recurrences, the optimum time of surgery is being discussed. Aim: Based on its three progressive phases, we studied a marker of clinical activity that would possibly predict the nature of the disease. We evaluated smooth alfa actin (SMA). Methods: Between October 2003 and September 2005, 60 male patients, within the age of 33 and 88 years, underwent total fasciectomy. In order to avoid false positive results, we exclude recurrences, collagenopaties, neurological and muscular disease, metabolic disorders and trauma. The Tubiana–Michon scale was used to classify our patients. Furthermore, we separated them in two main groups: early (stage 0,1,2) and advanced (stage 3 and 4). The tissue specimens were analysed by histological and immunohistochemical staining. Results: We observed high cell counts in the early stages; in these specimens SMA is expressed. SMA is decreased or absent in the advanced stages, except for few not statistically significant cases. Furthermore, we correlated the rate of SMA with an index of cellular proliferation and we noted, in the early stages, an increased proliferative activity of the cells, except for only two cases. Discussion and conclusions: At the moment there is still some way to go especially about the pathogenesis of Dupuytren’s disease. Many factors are believed to be involved in M.Dupuytren’s evolution. Our results show that SMA increases in the clinical phases of generation of contractile force and it is a good marker of clinical activity. High levels of SMA represent a disease still active and aggressive, therefore with a high potential of recurrence if treated surgically too early. More patients and a long follow-up will improve our ongoing study. 10.1016/j.jhsb.2006.03.078
MRI. Conclusion : ‘‘Plaster cast and wait’’ is not the treatment for occult carpal bones fractures. 10.1016/j.jhsb.2006.03.076
8.8 DIGITAL RAY RECONSTRUCTION VIA DISTRACTION OSTEOGENESIS LENGTHENING
M. Vekris, J. Gavriilidis, V. Sioros, A. Pakos, G. Mitsionis and A. Beris Ioannina University Medical School, Ioannina, Greece Background: Adequate length is a prerequisite for a functional digit. Over the last 20 years small external fixators have been developed allowing the principles of distraction osteogenesis to be applied to the small bones of the hand and thus permitting digital lengthening and realignment in patients that have suffered a traumatic or congenital amputation of a digit. Aim: Presentation of our series and analysis of the results. Patients and methods: From 1998 to 2005, 32 patients (41 rays) were treated with metacarpal or phalangeal lengthening through distraction osteogenesis using a monolateral frame with two half pins on each site of the osteotomy. The mean age of the patients was 21 years (4–48) and the indications were traumatic amputation in 25 and congenital amputation (transverse deficiency, brachydactyly, constriction band syndrome) in 7. The technique included dorsal approach, pin placement, drilling of the osteotomy site and if necessary realignment of the clinodactyly. The lengthening was started 5 days postop and proceeded with a rate of 1 mm per day in four 0.25 mm increments. The mean distraction period was 3 weeks and the mean consolidation period was 7 weeks. No protective splinting or additional bone grafting was necessary. Results: The distraction callus consolidated in all patients. The mean total length gained was 17.5 mm (68% of the original length). In one patient the holding screw of a miniclamp failed, leading to angulation at the distraction site and the fixator had to be revised. In 2 patients with pseudarthrosis late internal fixation and bone graft was done. No infection fracture or half pin loosening were observed. Conclusions: Callotasis using contemporary monolateral external fixators is a reliable technique for digital ray lengthening. Meticulous surgical technique and close observation of the patient during the distraction period are necessary in order to avoid complications. Over 2 cm of lengthening can be achieved. 10.1016/j.jhsb.2006.03.077
THE JOURNAL OF HAND SURGERY VOL. 31B No. S1 JUNE
2006
8.9 DEFINITION OF A PREDICTIVE MARKER OF CLINICAL ACTIVITY IN DUPUYTREN’S DESEASE: SMOOTH ALFA ACTIN
D. Smarrelli, A. Lazzerini, D. Despirito, M. C. D’ Agostino, E. Tibalt, M. G. DiRocco, B. Fiamengo, B. Franceschini and F. Grizzi I.R.C.C.S Humanitas, Milan, Italy Background: Dupuytren’s disease is a progressive and proliferative fibromatosis characterized by two distinct lesions: nodule and cord. The myofibroblast is mainly responsible for tissue contraction. Surgery is the recommended treatment. To avoid recurrences, the optimum time of surgery is being discussed. Aim: Based on its three progressive phases, we studied a marker of clinical activity that would possibly predict the nature of the disease. We evaluated smooth alfa actin (SMA). Methods: Between October 2003 and September 2005, 60 male patients, within the age of 33 and 88 years, underwent total fasciectomy. In order to avoid false positive results, we exclude recurrences, collagenopaties, neurological and muscular disease, metabolic disorders and trauma. The Tubiana–Michon scale was used to classify our patients. Furthermore, we separated them in two main groups: early (stage 0,1,2) and advanced (stage 3 and 4). The tissue specimens were analysed by histological and immunohistochemical staining. Results: We observed high cell counts in the early stages; in these specimens SMA is expressed. SMA is decreased or absent in the advanced stages, except for few not statistically significant cases. Furthermore, we correlated the rate of SMA with an index of cellular proliferation and we noted, in the early stages, an increased proliferative activity of the cells, except for only two cases. Discussion and conclusions: At the moment there is still some way to go especially about the pathogenesis of Dupuytren’s disease. Many factors are believed to be involved in M.Dupuytren’s evolution. Our results show that SMA increases in the clinical phases of generation of contractile force and it is a good marker of clinical activity. High levels of SMA represent a disease still active and aggressive, therefore with a high potential of recurrence if treated surgically too early. More patients and a long follow-up will improve our ongoing study. 10.1016/j.jhsb.2006.03.078