Bone extension after BAD BREAK! Need Help!

[Ralph]

Here it is,

I broke the thrid metacarpal in my hand after hitting the back of a car with it. Not know it was broken but could easily see the extreme swelling, I put it on ice and went to see a doctor a few weeks later. Before my initial appointment, I began to notice a depressed middle knuckle the more the swelling went down. I went to an orthopedic doctor who gave me x-rays that confirmed a angulated break in my third metacarpal. The doctor said he could return the hand back to its original state, but he would have to place a plate and screws on top of the bone to keep it in place. He insisted that the plate would be so discreate that I wouldn't be able to see it or feel it. As for the knuckle, he explained the shortage was due to the anglated metacarpus, and would also be corrected with the angulation.

After the swelling went down from the surgury, it revealed that the knuckle depression had not changed, and the plate is so bulky, I have trouble even reaching into my pants pocket. As the mobilty in my hand returned, it became s decent, except for my post-op visit back to the doctor was unpleasing visit. He exlpained that the bone was shortened due to the injury and was not for extending it because of how well the bone healed. A second opinion revealed that the bone was shortened 6mm, in ideal range to perform a bone graph. Although the procedure was briefly explained, the downfalls to this were not.

My concerns are:
1: The worst case possibilities to getting the surgery
2: Finding the right dotor to removed plate and perform bone graph (Michigan)
3: Is it worth it?:confused:

[Zaynah]

hi there

i'm sorry to hear about the injury and post operative complications.

shortening of bones are a big problems, expecially if its in a place with lots of muscle attachements and tendons running over it like in the hand. internal fixation (plate and screws) for the bones in the hand and fingers can look bulky underneath the skin, as the bones are very superficial underneath the skin, with only tendons running over them. Bone grafts are done quite often for malunion of fractures. they will take bone from an area like you pelvis just above your hipjoint, or from the surrounding bones in the hand and then they'll break up the bone into tiny chips that they will 'pack' into the 3rd metacarpal bone to elongate it. They can either fixate this with screws and pins or with a plate. you'll probably be in a plaster cast for a few weeks or have an external fixation device on. Upperlimb fractures (the shoulder down to the hand) usually starts healing in 3weeks and should be 80% done in 6weeks time. you're having a graft surgery done, so the healing could be longer, up to 3months. the body will break down and form new bone tissue in that area for the next year. They'll remove the fixation devices and cast when you've started healing well and don't need so much immobilization. sometimes the lengthening is done in 2phases instead of one, but this is usually only the case if there is more than 10mm length discrepency.

here are some links to websites and articles that will give you more information:

[Zaynah]

THE FIRST REPLY WASN'T COMPLETE, HAD A POWER OUTAGE!

hi there

i'm sorry to hear about the injury and post operative complications.

shortening of bones are a big problem, expecially if it's in a place with lots of muscle attachements and tendons running over it like in the hand. internal fixation (plate and screws) for the bones in the hand and fingers can look bulky underneath the skin, as the bones are very superficial underneath the skin, with only tendons running over them. Bone grafts are done quite often for malunion of fractures, lengthening the bone or achieving better bone healing (union). they will take bone from an area like you pelvis just above your hipjoint (this bone has amazing bloodsupply for maximum healing), or from the surrounding bones in the hand and then they'll break up the bone into tiny chips that they will 'pack' into the 3rd metacarpal bone to elongate it. They can either fixate this with screws and pins or with a plate (internal fixation) or with only an external fixation (a device outside the skin with pins running into the bone). you'll probably be in a plaster cast for a few weeks if internal fixation was used. Upperlimb fractures (the shoulder down to the hand) usually starts healing in 3weeks and should be 80% done in 6weeks time. you're having a graft surgery done, so the healing could be longer, up to 3months. the body will break down and form new bone tissue in that area for the next year. They'll remove the fixation devices and cast when you've started healing well and don't need so much immobilization. sometimes the lengthening is done in 2phases instead of one, but this is usually only the case if there is more than 10mm length discrepency. They can also use a technique called distraction osteogenesis (callotasis) where they don't use the bone graft but rather distract the bone so that the body fills in the gap with bone tissue like with a new fracture. The treatment can take longer than a straight forward bone graft, and sometimes the bone is of weak quality and re-fracture occurs, but it is less invasive than a graft and exercises can be continued while distraction over the time period continues. Graft surgery can fail to achieve bone union (fail incorporate the bone chips into to bone, to heal as a strong bone as a whole). The usual cons of surgery are infection, nerve and tendon damage and excessive post operative swelling and stiffness. Don't be afraid to ask questions and talk about your concerns before you have the operation. You need to make and informed decision, and you need to know all your options and the pro's and con's of each.

Good luck.

here are some links to websites and articles that will give you more information:
http://www.jbjs.org.uk/cgi/reprint/84-B/2/205.pdf (about callotasis bone distraction surgery for lengthening)
http://www.ejbjs.org/cgi/reprint/51/8/1638 (about metacarpal lengtening with a bone graft)