Tibial lenghtening through callus distraction in a patient with Schmid-type metaphyseal chondrodysplasia with a novel COL10A1-mutation

We report on a patient with Schmid-type metaphyseal chondrodysplasia (MCDS) carrying a novel COL10A1 mutation who underwent bilateral tibial lengthening at the age of 16.5 years using the technique described by Ilizarov. The disease-causing mutation Phe554Leu (g. 1660 T>C) represents the most amino terminal mutation within the NC1-domain of collagen type X described in MCDS so far. Failure of consolidation of the anterior distraction callus required secondary conversion to intramedullary nailing 344 days after primary surgery. Length gained was 5 cm (17.2% of tibial length), and healing index was 160 days/cm (46.5 days/percentage). This is the first case of callus distraction reported in a patient carrying a defined collagen X missense mutation. The associated defect in endochondral ossification may represent a central factor leading to the failure of callus consolidation.

Metacarpal Enlargement of the Amputated Thumb using Callotaxis: An Observational Study

Purpose To confirm the effectiveness of bone elongation through callus distraction of the first metacarpal as a functional alternative in active patients with a thumb amputation. Methods The study population consisted of patients who suffered a nonreplantable amputation of the thumb and failed to meet the criteria for a microsurgical transfer at our hospitals between 1995 and 2014. We performed an observational cohort study for the incidence analysis and a cross-sectional design for the analysis of the correlations among the variables. Results We presented 23 callus distractions of the first metacarpal, with an elongation time between surgeries of approximately 104.7 days (standard deviation [SD]: 3.2), with a miniRail external mini-fixator, and an average elongation of 25.5 mm (SD: 0.54). All patients achieved a functional grip, but five of them had to find new jobs. The degree of satisfaction was high, except in two patients, and was significantly related to the time of the elongation. Conclusions Callus distraction allows for a reconstruction of the thumb with few complications. We recommend associating it with a commissuroplasty and an adductor transposition. Patients give more importance to the comfort of the procedure than to the elongated length, provided that adequate function is achieved.