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Bone Lengthening in the Pediatric Upper Extremity.

Sebastian Farr1, Gabriel Mindler2, Rudolf Ganger2

  • 1Department of Pediatric Orthopaedics and Adult Foot and Ankle Surgery, Orthopaedic Hospital Speising, Vienna, Austria Sebastian.farr@oss.at.

The Journal of Bone and Joint Surgery. American Volume
|September 9, 2016
PubMed
Summary

Pediatric bone lengthening effectively treats various upper extremity conditions. However, success is often measured radiographically, and complications are common, necessitating careful patient selection and management.

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Area of Science:

  • Orthopedics and Pediatric Surgery
  • Skeletal Dysplasias and Limb Deformities

Background:

  • Bone lengthening is a reconstructive surgical technique utilized for congenital and acquired pediatric limb abnormalities.
  • Indications span a range of conditions including achondroplasia, radial longitudinal deficiency, and post-traumatic growth arrest.

Purpose of the Study:

  • To review the current practices and outcomes of pediatric upper extremity bone lengthening.
  • To highlight common indications, preferred distraction rates, outcome measures, and associated complications.

Main Methods:

  • Review of literature and common clinical practices regarding pediatric upper extremity bone lengthening.
  • Analysis of preferred distraction rates for different long bones in the upper extremity.
  • Evaluation of current metrics for defining successful bone lengthening outcomes.

Main Results:

  • Distraction rates typically range below 1 mm/day, with the humerus being an exception at 1 mm/day.
  • Success is predominantly defined by radiographic bone lengthening and joint mobility, with less emphasis on validated patient-reported outcomes.
  • High complication rates are reported, including pin-track infections, device failure, nerve injuries, and nonunion.

Conclusions:

  • Pediatric upper extremity bone lengthening is a viable treatment for various conditions.
  • Current outcome assessments may not fully capture patient-centered results.
  • The procedure carries a significant risk of complications, requiring vigilant monitoring and management.