Bone Lengthening by Callotasis in the Hand and Forearm

We have treated or are treating six cases of hand and forearm bone lengthening by callotasis. These cases include two with multiple osteochondromas, two with congenital constriction band syndrome, one with 4th brachymetacarpia and one with bilateral club hands. The ulna was lengthened to reduce the dislocated radial head due to discrepancy in the length of the radius and ulna in the two cases with multiple osteochondromas. The 1st metacarpal was lengthened to correct for congenital amputation of the thumb in two cases with congenital constriction band syndrome. The ulna was lengthened to correct for shortening of the forearm in the case with club hand.The length of elongation was 32mm and 40mm in the ulna respectively, 19mm and 12mm in the 1st or 4th metacarpal bone. The duration of distraction post-operatively was 7 months and 10 months in the first two cases. 3 months and 4 months in the latter two cases. One case with multiple osteochondromas gradually developed re-dislocation of the radial head after surgery.We concluded that the pathological mechanisms undertrying these case were: bone lengthening without correction of the bowing deformity of the ulna; osteochondroma in the proximal radio-ulnar joint; residue of osteochondromas in the distal end of the ulna; reduction without reconstruction of the annular ligament, and discrepancy of bone growth in the radius and ulna after callotasis.The parents of these cases were able to accept the treatment of callotasis despite a variety of disadvantages.