Osteotomy of Malunited Metacarpals and Phalanges in Pediatric Patients

Objectives: Malunion of the phalanges and metacarpals in the hand cause malposition, pain, and functional impairment that can be treated by osteotomy of malunited bone. Posttraumatic malunion in pediatric hand is a rare condition. Growing bone and its small size need “special” approach to the problem. Procedure must preserve growing ability, osteosynthetic material must be fine, and postoperative care has to be aimed not only on deformity correction but also on preserving range of motion. Authors present group of 12 pediatric patients treated by osteotomy of the phalanx or metacarpal. They describe specifics of the technique used, present results, and discuss complications. Patient and Methods: Thirteen osteotomies in 12 patients with “virgin“—nonoperated posttraumatic malunion of phalanges and metacarpals were performed by senior author between 2001 and 2014. Four intraarticular corrections and 7 extraarticular corrections were used for various malunions. Authors used different approaches to reflect bone from dorsal, dorsolateral or lateral side, according to type of deformity and type of osteotomy. Eight cases were corrections of proximal phalanx in proximal interphalangeal joint region, 2 at the base of proximal falanx, 1 at the base of middle phalanx, 1 at the head of middle phalanx and 1 at the base of first metacarpal. One patient was treated by sequential osteotomy repeated after 3 years due to growth disturbance at the base of middle phalanx. In 3 patients bone graft from distal radius was used to fill the gap in open wedge osteotomy. Removal of osteosynthetic material was performed in 4 cases. In 3 patients and 4 osteotomies no osteosynthetic material was used. All patients had a cast for 1 to 2 weeks after surgery followed by protected mobilization until x-ray healing of the bone. Results: All patients healed uneventfully. Deformity was fully reconstructed in 9 patients and 3 had some residual deformity with functionally and aesthetically much better result. Range of motion was preserved or reconstructed in all. Functional impairments like triggering or scissoring of the fingers were relieved. Pain subsided to zero in all. Discussion: Symptomatic malunion in fingers and metacarpals causing functional impairment is indicated to surgical treatment and osteotomy of malunited bone. Soft tissue coverage and small size of the bone put great requirements to the operating surgeon due to risk of breakage of the bone, necrosis of small bony fragments, loos