Rui Zhang1, Mengwei Wang2*, Xiaoyu Wang1, Li Shi3, Shenghe Liu1, Jia Xu1, Qinglin Kang1

1Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
2Department of Trauma and Microscopic Orthopedics, Renmin Hospital of Wuhan University, Wuhan, China
3Department of Traumatic Surgery, Chongqing Municipal Fourth Hospital, Chongqing, China

Keywords: Complication, deficiency, distraction osteogenesis, external fixation, metacarpal, phalange, plating after lengthening.


Objectives: This study aims to investigate whether plating after lengthening in patients with phalanges and metacarpals deficiency could significantly shorten the duration of external fixation and decrease bone healing index.

Patients and methods: Between February 2010 and December 2018, 11 phalanges in nine patients (6 males, 3 females; mean age: 28.4±4.4 years; range, 22 to 35 years) and nine metacarpals in six patients (2 males, 4 females; mean age: 21.0±2.9 years; range, 16 to 25 years) were lengthened at a rate of 0.25 mm in two increments. A unilateral external fixator was applied in all cases. A locking compression plate was applied at the end of the distraction period before the external fixator was removed. Removal of the plate was considered two years after the internal fixation.

Results: The desired length and bone consolidation were achieved in all cases. The additional lengths achieved in the phalanges and metacarpals group were 18.3 mm and 27.7 mm on average, respectively. The bone healing indexes in the phalanges and metacarpals were 1.33 and 1.44 mo/cm, respectively. No significant difference was observed in the pre- and postoperative range of motion of involved metacarpophalangeal joint of both phalangeal (95% CI: -0.469~1.014, t=0.820, p=0.432) and metacarpal (95% CI: -0.689~0.975, t=0.420, p=0.689) lengthening cases. Only one case of minor complication (track infection) occurred.

Conclusion: Plating after lengthening is an ideal method for phalanges and metacarpals deficiency. Its advantages include shorter duration of external fixation, lower complication rate, and early functional recovery.

Citation: Zhang R, Wang M, Wang X, Shi L, Liu S, Xu J, et al. Plating after lengthening in treating phalangeal and metacarpal deficiency: An alternative method. Jt Dis Relat Surg 2022;33(2):265-272.

* Co-First Author

Ethics Committee Approval

The study protocol was approved by the Institutional Ethics Committee of Shanghai Sixth People's Hospital (2021-KY-113[K]). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Manuscript drafting: R.Z., M.W.; Data collection: X.W.; Data analysis: L.S.; Administrative support: S.L.; Study design: J.X., Q.K.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

Received financial support from National Natural Science Foundation of China (No. 82072421) and Natural Science Foundation of Shanghai (No.20ZR1442200).