A 3-year-old male with no family history of congenital deformities or pathology detected during pregnancy.
Physical examination revealed hypoplasia of the right forearm with absence of digital rays third, fourth and fifth and ulnar deviation of the hand in 60 degrees.
The mobility of the thumb and index fingers was adequate and with good grip strength.
Sensitivity was considered normal in the two-point discrimination test.
Cubital and radial hypoplasia was observed in the distal third, with early synostosis fifth and absence of radius bones in the fourth appearance and absence of third ray.
The total length of the radius was 5.8 cm and 3.0 cm, that of the cubitus, while in the healthy forearm it was 12.0 cm for the radius and 12.4 cm for the ulnar deficiency, respectively.
Failure of the affected side was 15.5 cm long and of the healthy side was 17 cm long. The diagnosis was established in the longitudinal formation of moderate upper limb, postaxial, grade IV right limb smoke.
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We decided to perform bone lengthening of the forearm bones by placing a uniplanar transfixion distractor designed by JMY Mexico® Matev (13) according to the characteristics proposed by .
Although the lengths of the radius and cubitus were different, both bones were simultaneously distracted.
In the first surgical time two parallel nails were placed in a proximal situation and two in a distal position to the site chosen in the diaphysis of both bones to perform the osteotomy, leaving only a distal cortical posterior circumference with a proximal margin of 300 cm.
The postoperative course was uneventful.
On the fourth postoperative day, we began the distraction phase at a rate of 2 mm per day for the first 15 days and then at 1 mm per day for 45 days until achieving a total elongation of 60 days.
The total length achieved for the radius was 13.3 cm. The ulnar length was 10.5 cm. Four weeks after the end of the distraction, we observed radiologically an adequate longitudinal bone formation.
However, we left the distractor until completing 8 weeks after stopping the distraction, when we found that there was excellent bone structure in the gap.
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The second surgical time was then performed to remove the distractor and centralize the hand over the distal radial epiphysis.
To facilitate this procedure, diaphyseal resection of the radius was necessary.
The new bone fixation was performed with Kischner pins.
It was not necessary to perform any osteotomy in the cubitus because its elongation was in the direction of vector traction and no deviation was observed.
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The postoperative evolution was satisfactory, with slight edema of the hand that subsided shortly; the patient presented mobility of the fingers and did not suffer alteration of sensitivity.
Six months after the procedure of the forearm had been completed, we placed the distractor in the fistulous form of the aforementioned structures in order to perform the same technical procedure, although it is important to point out the anatomical risk points.
In corticoid fixation, the posterior portion of the periosteum was positioned parallelly, two proximally and two distally, with a margin between them.
Four days later, we started the elongation process at a rate of 1 mm per day, until a gain of 6 cm was achieved. We decided to overcorrect this bone to treat it with the growth of the contralateral arm.
At the end of the procedure, we left the distractor for 8 weeks, during which we tested by means of radiography the appropriate bone gap for longitudinal growth failure healing.
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Finally, 8 weeks after concluding the distraction hum, time chosen to remove the distract, we performed arthrodesis of the elbow leaving this joint in a functional position.
