What Are Your Thoughts On Distraction Lengthening Of The Clavicles?
Q: Dr. Eppley, I recently read a paper titled “CLAVICLE LENGTHENING BY DISTRACTION OSTEOGENESIS FOR CONGENITAL CLAVICULAR HYPOPLASIA”.
I’ve reached out to the surgeons who conducted the first paper and am waiting for a consultation.
My question for you is have you ever performed distraction osteogenesis of the clavicle.
I read your blog post discussing the two options, and how obviously the latter would require a far more dedicated patient. My main concern with the osteotomy and bone graft is that you cannot observe over time A) the aesthetic result that each mm provides the patient and B) the functional health of the glenohumeral joint. For instance if any issues were to arise during the distraction phase then the process could simply be halted and a plate fixation applied at that point.
It seems to me that standard limb lengthening of the legs/arms would be far more invasive and arduous than the clavicle, due to the surrounding musculature and arteries/nerves nearby.
A: Distraction osteogenesis is not quite as simple as you probably think it is. While the concept is straightforward and well known for over 30 years, the rate of distraction is much slower in the axial skeleton than the face and the time period of consolidation much longer. Given that external distraction devices would have to be worn in bilateral fashion for an extended period of time, the practicality of its use for elective shoulder widening is suspect particularly on a bilateral basis. If any ‘issues’ were to occur during the distraction phase, the distracter is not merely removed and plated. It would still require a bone graft for consolidation to occur.
While I have done plenty of mandibular and skull distractions I have never done one for the clavicles. The surgery is straightforward. The issues is the state of development of the distraction devices for a bone that lengthen so very rarely. (as you have found on one case study)
Dr. Barry Eppley
A detailed description and pictures of your concerns allows for the most informed response.