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Toe phalangeal grafts in congenital hand anomalies
R F Radocha1, D Netscher, H E Kleinert
1Christine M. Kleinert Institute for Hand and Micro Surgery, Louisville, KY 40202.
Insights
Younger age and specific surgical techniques improve toe phalangeal graft growth. Early intervention (under 1 year) and careful dissection best preserve physeal openness for optimal bone growth.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Regenerative medicine
Background:
- Toe phalangeal grafts are used to reconstruct digits.
- Assessing factors influencing graft growth is crucial for surgical outcomes.
- Previous studies have not fully elucidated the impact of age and surgical technique on graft growth.
Observation:
- 73 toe phalangeal grafts were analyzed retrospectively.
- Follow-up averaged 42 months, with a minimum of 1 year.
- Physeal openness and growth were evaluated using X-ray imaging.
Findings:
- Physeal openness rates were highest (94%) in patients under 1 year old.
- Growth rates were 1.0 mm/year for patients under 1 year and 1-2 years old.
- Extraperiosteal dissection, ligament reattachment, and age under 12 months positively impacted physeal openness.
Implications:
- Early surgical intervention (under 12 months) is recommended for optimal toe phalangeal graft growth.
- Specific surgical techniques, including extraperiosteal dissection, enhance graft viability.
- These findings can inform surgical planning for pediatric digital reconstruction.
Abstract:
The results of 73 toe phalangeal grafts were reviewed in order to determine the effects of age and operative technique on subsequent growth of the transferred phalanx. Minimum length of follow-up care for inclusion in the study was 1 year (mean, 42 months). Physeal openness and growth of transferred phalanges were determined from standard x-ray films. Physeal openness rates were 94% for those operated on before 1 year of age, 71% for those 1-2 years of age, and 48% for those older than 2 years of age. Mean growth rates were 1.0 +/- .2 mm, 1.0 +/- 0.6 mm, and 0.5 +/- 0.5 mm per year, respectively, for these three age groups. Extraperiosteal dissection of the transferred phalanx, tendon and collateral ligament reattachment, and patient age under 12 months had a statistically beneficial effect on maintaining physeal openness.