Anatomical And Distraction Osteogenesis Study In Distal Phalanx

Objectivesthrough anatomy, measurement,analysis of distal phalanx, such as the distance of insertion of flexor and extension tendon bone, nourishing blood vessels to distal interphalangeal joint, length of nail plant,nail lunula,matrix and its relative position to distal interphalangeal, discuss the best level of osteotomy in distal phalanx and appearance reconstruction method of distal phalanx amputation stump. By now, distal phalanx external lengthening fixtor was simple, and can't provide effective extension effect, due to distal phalanx has special anatomical configurations, all ring type external fixator was not suitble,according to the clinical experience and palm finger configuration, we designed a new external fixator.MethodsFrom October 2013 to January 2015, 30 fresh amputated adult forearmwere collected to make anatomy. Pour into red latex via radial or ulnar artery.Make dissection via nail plant, nail bed, pulp and and expose the bone and its nourishing blood vessels. Measure the 150 hands' distal phalanx via vernier caliper of 0.01 mm precision. Observe and measure the affiliated structure, distance of distal interphalangeal to insertion of extension tendon,distance of matrix to insertion of flexor tendon,length of matrix, distal of matrix to distal of phalanx, length of nail plant, length of nail plant under eponychium, distance of distal interphalangeal to insertion of flexor tendon, distance of distal interphalangeal to nourishing blood vessel. We adopt SPSS19.0 software package to make statistical analysis to the measured data. The exteral fixtor we disigned must be steady, have five functions of compression, lengthening, counter angulation, counter axial rotation, counter lateral transposition, make the stress distributed on the end of the bone balanced, give full play to strain-stress stimulation, and have periodic axial direction, promoting bone union, reducing stress shielding.ResultsIn the thumbs, the total length was 26.58±1.13 mm, distance of distal interphalangeal to insertion of extension tendon was 6.34±1.15 mm, distance of matrix to insertion of flexor tendon3.25 ±0.24 mm,length of matrix was 5.93±1.41 mm, distal of matrix to distal of phalanx was 11.12±0.56 mm, length of nail plant 16.98±0.50 mm, length of nail plant under eponychium was 4.83±0.14 mm, distance of distal interphalangeal to insertion of flexor tendon was 12.68±0.61 mm, distance of distal interphalangeal to nourishing blood vessel was 16.51±2.64 mm.In the fingers, the total length was 18.63±1.32 mm, distance of distal interphalangeal to insertion of extension tendon was 1.94±0.25 mm, distance of matrix to insertion of flexor tendon 1.77±0.49 mm,length of matrix was 5.34±1.19 mm, distal of matrix to distal ofphalanx was 9.38±0.93 mm, length of nail plant 14.91±0.95 mm, length of nail plant under eponychium was 4.67 ± 0.20 mm, distance of distal interphalangeal to insertion of flexor tendon was 7.65±0.81 mm, distance of distal interphalangeal to nourishing blood vessel was 11.24±1.56 mm.the new external fixtor we designed was steady and high effective in distal phalanx lengthening, and have advances of little soft issues injury, steady fixation,easy in lengthening. Compared with original instrument, the new external fixtor was easy to product, rational construction,cost low,small in size, Easy to carry, convenient operation, applicable to all levels ofhospitals touse.ConclusionDistal phalanx bone lengthening by osteogenesis can providea new concept for clinical treatment of patients with short stump, especially for adolescent patients withhigher cosmetic requirements. The best location of distal phalanx osteotomy is near base of the phalanx, extension of bone can make the nail bed longer meanwhile, in the treatment of bad result for shorter stumps of distal phalanx witheponychium flap cases, can restore function and appearance of the patient's finger.But in distal phalanx of the finger, the operating range is small, need to be careful in operation.This study only from the concept of anatomy to discussthe best level in distal phalanx bone osteotomy lengthening, and it's also affected by surgical operation and lengthening equipment, its effection remains to be verified by clinical application. The external fixator was simple and convenient, can extend distal phalanx steadily.