FUNCTIONAL RESTORATION OF THE PARTIAL HAND AMPUTEE USING DIGITAL DISTRACTION LENGTHENING. A CASE SERIES STUDY.
Authors: KumarTalele Mahesh , Shreedhar T. 
Published: July 2022

AIMS AND OBJECTIVES 1) To study the effect of digital lengthening in digital amputees MATERIALS AND METHODS: STUDY DESIGN: Retrospective and Prospective. SUBJECTS (SOURCE OF DATA):A retrospective and prospective study of the operated cases of digital lengthening in AIIPMR since 1994 was undertaken and their clinical records were reviewed and current follow up was done till June 2011.A prospective study of all cases of amputation of ngers coming to the AIIPMR OPD has been done.Those patients who full the inclusion criteria for study had been assessed for hand functions. Those patients who full the inclusion criteria for distraction digital lengthening had been advised regarding surgery and informed written consent has been taken prior to the procedure PERIOD OF STUDY : 2 years and 3 months (march 2009-june 2011) Inclusion criteria for study groups:1) Age above 5 years, 2) Both male & female 3) Digital amputees (excluding thumb) 4) Ability to understand and carry out the test method. 5) Absence of any other condition that may alter performance of tests to be done for hand function assessment. 6) Patients cooperative & willing for surgery. 7) Full ROM of proximal joints (wrist and elbow). Exclusion criteria for study groups: 1) Less than 5 years of age. 2) Thumb amputations 3) Inability to understand commands. 4) Presence of pain, any neurological decit or any musculoskeletal conditions (cicatrisation, nerve involvement, other deformities, other joint problems,) that impairs hand function. 5) Unwilling to take part in study 6) Restriction of ROM of proximal joints. After taking the relevant history, all patients fullling inclusion criteria for study were examined clinically at pretreatment, 30 days post intervention and 90 days post intervention with special emphasis on Length of nger Grip strengths Pinch strengths Minnesota manual dexterity test for Turning Minnessota manual dexterity test for Placing. METHODOLOGY A total selected sample size of 7 patients based on their baseline characteristics ( age, hand anthropometry, tip pinch , gross grip, Minnesota manual dexterity ) were operated cases for digital lengthening were performed. The following parameters were calculated: Range of Motion: Measured using a goniometer. Isometric Finger Pinch: Performed using the B & L Pinch Gauge . TIP PINCH STRENGTH (PINCH METER) Isometric Power Grip: Performed using the JAMAR Hand Dynamometer. GROSS GRIP STRENGTH ( JAMAR DYNAMOMETER) A more general classication, with the following categories: three pinch grips (tip pinch, lateral or key pinch, and tripod or chuck pinch) and three modes of gripping: (power grip, spherical or exion grip, and extension grip in intrinsic plus position).Minnesota Turning Time for 3 Trial. Minnesota Placing Time for 3 Trials SURGERY: DIGITAL DISTRACTION LENGTHENING The procedure was performed on those patients who had partially preserved proximal or middle or distal phalanx of sufcient length that would allow the xation of distractor and osteotomy. A total of 7 patients underwent digital lengthening of 12 digits in total. Each patient underwent single stage surgery involving one or two or three digits at one time only. nd Index 2 nger lengthening : Number of index nger lengthened : 6 Bone lengthened : proximal phalanx Mean length achieved : 2 cm rd 3 nger lengthening: Number of 3rd nger lengthened : 5 Bone lengthened : proximal phalanx Mean length achieved : 1.5 cm th Ring 4 nger lengthening: Number of ring nger lengthened : 1 Bone lengthened : proximal phalanx Mean length achieved : 2 cm CONCLUSION: Digital lengthening signicantly improved gross grip strength,grasp and tip pinch (thumb & index) strength and non signicantly improved Minnesota turning time , Minnesota placing time.AIMS AND OBJECTIVES 1) To study the effect of digital lengthening in digital amputees MATERIALS AND METHODS: STUDY DESIGN: Retrospective and Prospective. SUBJECTS (SOURCE OF DATA):A retrospective and prospective study of the operated cases of digital lengthening in AIIPMR since 1994 was undertaken and their clinical records were reviewed and current follow up was done till June 2011.A prospective study of all cases of amputation of ngers coming to the AIIPMR OPD has been done.Those patients who full the inclusion criteria for study had been assessed for hand functions. Those patients who full the inclusion criteria for distraction digital lengthening had been advised regarding surgery and informed written consent has been taken prior to the procedure PERIOD OF STUDY : 2 years and 3 months (march 2009-june 2011) Inclusion criteria for study groups:1) Age above 5 years, 2) Both male & female 3) Digital amputees (excluding thumb) 4) Ability to understand and carry out the test method. 5) Absence of any other condition that may alter performance of tests to be done for hand function assessment. 6) Patients cooperative & willing for surgery. 7) Full ROM of proximal joints (wrist and elbow). Exclusion criteria for study groups: 1) Less than 5 years of age. 2) Thumb amputations 3) Inability to understand commands. 4) Presence of pain, any neurological decit or any musculoskeletal conditions (cicatrisation, nerve involvement, other deformities, other joint problems,) that impairs hand function. 5) Unwilling to take part in study 6) Restriction of ROM of proximal joints. After taking the relevant history, all patients fullling inclusion criteria for study were examined clinically at pretreatment, 30 days post intervention and 90 days post intervention with special emphasis on Length of nger Grip strengths Pinch strengths Minnesota manual dexterity test for Turning Minnessota manual dexterity test for Placing. METHODOLOGY A total selected sample size of 7 patients based on their baseline characteristics ( age, hand anthropometry, tip pinch , gross grip, Minnesota manual dexterity ) were operated cases for digital lengthening were performed. The following parameters were calculated: Range of Motion: Measured using a goniometer. Isometric Finger Pinch: Performed using the B & L Pinch Gauge . TIP PINCH STRENGTH (PINCH METER) Isometric Power Grip: Performed using the JAMAR Hand Dynamometer. GROSS GRIP STRENGTH ( JAMAR DYNAMOMETER) A more general classication, with the following categories: three pinch grips (tip pinch, lateral or key pinch, and tripod or chuck pinch) and three modes of gripping: (power grip, spherical or exion grip, and extension grip in intrinsic plus position).Minnesota Turning Time for 3 Trial. Minnesota Placing Time for 3 Trials SURGERY: DIGITAL DISTRACTION LENGTHENING The procedure was performed on those patients who had partially preserved proximal or middle or distal phalanx of sufcient length that would allow the xation of distractor and osteotomy. A total of 7 patients underwent digital lengthening of 12 digits in total. Each patient underwent single stage surgery involving one or two or three digits at one time only. nd Index 2 nger lengthening : Number of index nger lengthened : 6 Bone lengthened : proximal phalanx Mean length achieved : 2 cm rd 3 nger lengthening: Number of 3rd nger lengthened : 5 Bone lengthened : proximal phalanx Mean length achieved : 1.5 cm th Ring 4 nger lengthening: Number of ring nger lengthened : 1 Bone lengthened : proximal phalanx Mean length achieved : 2 cm CONCLUSION: Digital lengthening signicantly improved gross grip strength,grasp and tip pinch (thumb & index) strength and non signicantly improved Minnesota turning time , Minnesota placing time.