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[Humeral lengthening after replantation of the upper limb]
X Pascarel1, J M Peres, G Le Clouerec
1Service d'Orthopédie-Traumatologie, Hôpital Pellegrin Tripode, Bordeaux.
Introduction:
The authors have applied the method of progressive lengthening to correct upper limb discrepancy resulting from arm reimplantation in a young female adult.
Material:
Following a motor vehicle accident, a twenty one years old female had her right arm sectioned. Four hours after the accident, the limb was reimplanted with 10 cm shortening of the humeral shaft, to allow direct nerve suture. Sixteen months later, she had excellent functional recovery, but was annoyed by the aesthetic appearance of her short arm. Humeral lengthening was undertaken.
Method:
The authors used a special external fixation device Orthofix (Verona, Italy) and a proximal corticotomy was performed.
Result:
Progressive callus distraction allowed 10 cm lengthening without any loss of function in 10 months; aesthetic appearance was greatly improved.
Discussion:
Limb reimplantation necessitates substantial bone shortening to protect soft tissue sutures. Functional recovery and aesthetic tolerance are classically good but in this case, aesthetic tolerance was poor. The progressive humeral lengthening was uneventful and allowed excellent outcome, in this young girl, despite distraction of the sutured nerve.
Conclusion:
This technique should be used prudently.