[Upper limb lengthening. 47 clinical cases].

Between 1989 and 1993, the authors treated 39 patients by progressive bone lengthening in a total of 47 hands (17 post-traumatic and 30 congenital deformities). The Hoffman distractor was used in 34 cases and the Orthofix device was used in 13 cases. The percentage of lengthening obtained, compared to the initial bone length, was 87% for the hand skeleton and 47% for the forearm bones in congenital malformations while only 51% was obtained in post traumatic cases due to their older age and frequently associated skin problems. In 4 (8.5%) of these post-traumatic cases, the skin conditions had to be improved surgically. The average duration of treatment was 6.7 months, with a "healing" index (months/centimeters of lengthening obtained of 1.7. The time necessary to achieve complete bone healing was as long as the lengthening period. The complication rate was 34% (severe pain 8.5% delayed bone healing 8.5%, pin infections 6.3%, bone grafts 4.2%, tendon complications 2.1%), however none of these problems required pin removal. A complete failure was observed in two cases, followed by a second successful operation.