Shortening osteotomy and flexor-extensor tendon balance

Barbara Craggs, B Van Mierlo, Ck Goorens, Moustapha Hamdi

Research output: Chapter in Book/Report/Conference proceedingMeeting abstract (Book)

Abstract

Introduction
Lower arm injuries with soft tissue loss can be so extensive that primary suture of tendons, nerves, and arteries is not possible. Each gap can be bridged by either tendon grafts in case of severed tendons, conduits or grafts for nerve repair, and venous grafts for arterial repair. Textbooks and articles refer to the so called shortening osteotomy as a way of making primary repair possible despite tissue loss. Unfortunately no articles up to date actually describe the technical execution of shortening osteotomy for the treatment of partial amputation, or do they explore the biophysical consequences of a shortening osteotomy and functional outcome.

Material and Methods
In this article we describe two patients who were treated with a shortening osteotomy with good functional outcome in our unit following traumatic, partial amputation. Using these two cases as a base, we elaborated on the technical execution, biophysical consequences and functional outcome of shortening osteotomy. More specifically we looked at the effect of the shortening osteotomy on intact tendons, i.e in the case described what is the effect on the intact extensor tendons that have not been shortened and may seem too long?

Discussion
Bone shortening allows direct arterial repair without a vein graft and so shortens ischemia time and decreases the incidence of fasciotomy. It also enhances the quality of nerve repair by facilitating tensionless nerve coaptation after trimming. End-to-end neurorrhaphy remains the gold standard for transected nerve repair, if repair is tension free. The work of Tarbary, Goldspink and Crawford have shown that muscle fibres adapt rapidly; the fibre length will accommodate to its new resting position by lengthening or shortening so that at rest the fibre is neither loose nor tight. In other words it does not seem necessary to surgically shorten the intact extensor tendons in case of flexor tendon repair after shortening osteotomy.

Conclusion
In case of partial amputations shortening osteotomy is advocated by several authors as standard therapy although a true work-up of shortening osteotomy in partial amputation and its functional outcome is lacking in the current literature. Based on our clinical experience and those in the available literature the amount of shortening depends on the nerve gap (up to 7cm) that needs to be bridged. There is no biophysical reason to shorten the intact tendons because of natural accommodation of fibre length to its new resting position.
Original languageEnglish
Title of host publicationTendon Disorders and Injuries: Basic Knowledge, Advances in Diagnosis and Treatment
Subtitle of host publication22nd Brussels Hand/Upper Limb International Symposium
Pages103-103
Publication statusPublished - 24 Jan 2014
Event22nd Brussels Hand/Upper Limb International Symposium - Genval, Belgium
Duration: 24 Jan 201425 Jan 2014

Conference

Conference22nd Brussels Hand/Upper Limb International Symposium
CountryBelgium
CityGenval
Period24/01/1425/01/14
OtherTendon Disorders and Injuries at the Upper Limb: Basic Knowledge, Advances in Diagnosis and Treatment

Keywords

  • shortening osteotomy

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