Friday, June 22, 2012

Finger Lengthening




Lengthening a finger or thumb may be a good treatment option for a number of conditions including symbrachydactyly, constriction band syndrome, and ulnar deficiency.  Essentially any congenital or traumatic condition that leads to a shortened digit (or digits) may interfere with function.  If lengthening that digit will help pinch or large object grasp (i.e., soda can), then the procedure is considered.  Typically it is one metacarpal or one phalanx bone that is lengthened although it can be done for more than one digit.  Typically we lengthen the most distal bone (i.e., the farthest bone out) if it is long enough to allow the fixator to be safely placed (more later). 

I believe in lengthening for function.  It can really make a huge difference because it will simply increase the number of activities that the child can accomplish with the affected hand.  I do NOT believe in lengthening for appearance.  There is some information on the web and some things I have heard from patients about “growing” new fingers.  This does not make a lot of sense to me for a lot of reasons.  I use lengthening devices for 1 or 2 digits with a specific functional goal in mind.

The procedure has some risks, the most common being skin infection.  Most kids treated with a lengthener will have a skin infection but usually it can be treated with antibiotics by mouth.  Some have more serious infections.  The next most common issue is that the bone may not form as fast as we would like or as fully as we would like and additional surgeries may be required to help this process.

Fixators are not just used for fingers and we commonly use them in the forearm for radial deficiency http://congenitalhand.wustl.edu/2012/05/fixator-for-radial-longitudinal.html and sometimes for ulnar deficiency http://congenitalhand.wustl.edu/search/label/Fixators .  

The idea is that we can place a fixator on a short bone and then slowly grow that bone.  Typically less than 1mm a day.  A family member turns a dial 3-4x/ day to gradually make the bone longer.  We have to carefully watch the xrays to make sure the body is responding by growing bone.  This process is painless and if the child is having pain, something is usually wrong.  We grow the bone as long as possible to help function.  The fixator is on during the lengthening process (may be months but depends on how much bone we grow) and then stays on a bit longer while the bone truly heals (after we stop turning the dial).  More information is always available through our website at http://ortho.wustl.edu/content/Patient-Care/3220/SERVICES/Hand-Wrist/Congenital-Hand-Disorders.aspx

 
 Here is one example.
This is an unusual form of cleft hand (central deficiency).  There is no thumb except the floppy "nubbin."



Another picture of unusual cleft hand with absent thumb


This is the xray.  Notice the lack of the thumb.  The thumb metacarpal measures 22mm- good enough to support a fixator.


We have placed the fixator to allow a gradual lengthening of the bone.


Another view of fixator for cleft hand lengthening of a thumb.


24 comments:

  1. You say you don't believe in lengthening for appearance, well for most with such abnormalities, appearance is a huge part of it as well.

    For those that have normal hands, they don't even have to think about them throughout the day, when waving, picking up a cup, shaking hands etc, or even just walking with them by your side. Its difficult to understand.

    Function is important, but appearance does have a huge mental and emotional impact as well.

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    1. Thank you for your comment. I couldn't agree with you more- appearance is very important and I should clarify my comment above.

      In most cases, in my opinion, lengthening a finger does NOT make a better looking finger for 2 reasons. First, because we can't create joints to allow the finger to bend, the finger sits straight. This does not appear natural. And second, when we stretch a finger, it becomes even more narrow and tapered in appearance. For both these reasons, a lengthened finger may look worse.

      So, I agree that finger and hand appearance are "huge." The best surgeries for patients with birth abnormalities of the hand are those that improve both function and appearance.

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  2. I have really short pinky fingers in both hands. The middle bone on each pinky finger seems to be the culprit. Many things slip out of my hands because of this condition and playing guitar and piano has its issues....even I love doing both....my range is hampered quite a bit...I wonder how much would it cost to lengthen both fingers and how long would it take...

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    1. Robby- thanks for writing. It is often the case that the middle bone (the middle phalanx) is the problem. It can just be short or can be short and angled (causing clinodactyly). Unfortunately, lengthening the pinky is a challenge and can lead to stiffness. While I won't say it is impossible, surgery would have challenges. Cost and time depend on many factors- sorry I can't be more specific. I hope that helps.

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  3. My girlfriend's little boy, 4 months old, has his pinky and thumb on his right, but the three digits in between are just tiny. They have nails and the doctor said they would grow in proportion to the rest of his hand. Could thus treatment be used to help him lengthen those middle 3 fingers? At least enough to help him grab handle bars, hammer, etc. ?

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    1. Trevor,

      Thank you for the question. By your description, your girlfriend's boy has symbrachydactyly. There is a fair amount of information on the blog about this diagnosis. I believe he has the cleft type of symbrachydactyly. The middle 3 fingers do not usually have much bony support but usually kids have pretty good use of the thumb and pinky. Sometimes efforts to improve the middle digits can make function worse by getting in the way (longer digits are stiff because the joints don't bend). Because of the lack of bony structure to the middle 3 digits and the risk of worsening function, we usually do not lengthen those short digits.

      Thank you.

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  4. Hey Charles,

    I have acromesomelic dysplasia and am an adult. My fingers and arms are very short and am interested to see how I can gain more length. At the moment I need to hands to holds cups and cans.

    Could this technique be used to help me get a better grip?

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    1. Thrush,
      While fingers can be lengthened, in my experience, it does not help significantly with grip. The fingers can actually be stiffer after a lengthening surgery. But if you need length to help with pinch (thumb and index finger especially), lengthening can make sense- this is my personal 'favorite' reason for surgery.

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  5. Hello,

    I have clubbed thumbs; specifically, the bones in my tips of my thumbs are short and broad. Would lengthening benefit such a condition or would it be more likely to lead to decreased mobility?

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    1. Lauralot,
      "Clubbed' thumbs is something we see relatively commonly although few people ever complain about it functionally. I do believe there is a strong genetic connection (not sure if family members also have it). In my patients, I have not recommended surgery for this. Good luck.

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  6. My 16 month old daughter lost the tip of her right index finger in an accident about 7 months ago. It was severed at the first joint so she is missing the entire distal bone and fingernail and nail bed. The hand surgeon that did the amputation revision on her said she should not have any limitations, however I notice she favors the other hand (her left) and points with her middle finger instead of the index finger when she does use her right hand. Im not sure if she will be left handed or is favoring the left hand because of the injury that has happened on her right hand. Would this lengthening treatment be something we should consider for her?

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    1. Jill,

      Thank you for the question and I am sorry to hear about your daughter's fingertip. I agree with the hand surgeon that typically this type of amputation is very well tolerated. Over time, kids typically adapt quite well to these injuries and use the hand normally. I would not recommend lengthening in this situation.
      Good luck and while it has already been 7 months, I hope and expect that over time, she will continue to improve.

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  7. I have a shortened ring finger on my left hand. I have full function and no pain. I have went to my doctor and he said I should just deal with it. I will be engaged in the next year or so and am terrified to wear a ring on that finger because the part where it sits is so much shorter than the rest of my fingers. I know it sounds stupid but I could be wearing a very expensive ring with a high risk of it slipping off. It is also chubby compared to the rest. Will doctors not do surgery unless there is something wrong? It seemed that way when I talked to mine.

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    1. Shannon, thank you for the question. Most importantly, you have full function and no pain. While fingers can be lengthened, there are risks in doing so and surgery could worsen your function. So while each patient and hand are considered individually, I am doubtful that lengthening makes sense in your case. Hopefully you can find a ring that fits well! Good luck.

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  8. I have very short fingers for an adult. At first glance, my hands are actually rather attractive, but I can't reach more than five white keys on a piano--and even that is stretching it. My hands are not in proportion to my height at all. Would surgery help me play the piano better?

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    1. Rose. Thank you for the question. While it is clearly tough for me to answer, there is chance that you have brachydactyly (short fingers), which can be isolated or can be associated with some webbing.

      If there is increased webbing between the fingers, deepening the web spaces can make a difference for the piano. I hope this helps. Good luck!

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  9. HI I'm zach from South Africa, I'm still 19y old and 175cm tall. I have really short fingers with a lowset pinky, plus I feel pain in my finger joints so I'm not sure it it's because it's so short and it never truly caught my eye until I noticed that my hand size is the same as my girlfriend's who is about half my size. Do you know what is wrong?

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    1. Zachary,
      Unfortunately, I am not immediate certain what is going on with your hands. It could be a metacarpal length issue. The diagnosis may be affected by whether this is one side or both. For example, if one side only, this may represent symbrachydactyly (see blog for pictures). But certainly, a hand surgeon will be able to give you some information.

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  10. Hi
    My daughter had a zip line accident about 18 months ago. She severed the top part of her finger. She has since had surgery but the finger is shorter and the nail bed grows in a direction around the finger causing her a pinching type feeling. We are wondering if this surgery is somehting we should consider to help her be more comfortable.

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    1. Hello. While this blog is primarily about kids born with hand differences, I certainly treat patients with hand trauma. Its sounds like your daughter may have a hook nail based on a shortened distal phalanx. Often, if painful, surgery can be helpful. However, the usual treatment is eliminating the nail entirely. The other simple option is just to keep the nail trimmed short. I hope this is helpful.

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  11. Hi Charles my 1.5yo daughter was born with symbrachtyly type 2 in two of her left Hand, she got Surgery last year she got transferred a piece of bone of her toes and they put them in both fingers to lenghten a little bit,they look much better but I would like to ask you if there is something else we could do to make them look better. Also her index finger is stiff she can't bend it, I would like you to check her case and give me some other treatment option I would really appreciate it, thanks a lot in advance.

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    1. Octavio,
      It sounds like your daughter is receiving care from a surgeon with experience. Unfortunately, there is typically not another surgery to help appearance. Also stiff digits are not uncommon in the diagnosis of symbrachydactyly. I hope this is helpful. Good luck.

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  12. I have small hands and short fingers in proportion to my height. I sometimes find it hard to get a grip on a baseball.
    The appearance if my fingers bothers me immensely.
    Can my fingers be lengthened even slightly? Please let me know.

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    1. Rarely do we recommend lengthening multiple digits- especially for appearance reasons as there are a number of possible complications.

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