A clinical case of treatment of deformity of the fourth ray of the hand in a teenager with brachymetacarpy

Brachymetacarpia is a rare congenital malformation (incidence less than 1:1000 of the population), characterized by shortening of one or more metacarpal bones, leading to deficient length of the corresponding hand rays. The pathology is more commonly observed in females. Currently, there are no generally accepted indications for surgical treatment of this pathology and no unified approach to selecting a surgical technique. Objective: To demonstrate, using a clinical case, the possibilities of brachymetacarpia correction with a mini external fixation device (mini-EFD), evaluate the advantages of this method and its results. Materials and methods. A clinical case of an 11-year-old female patient with a 16 mm shortening of the 4th ray of the right hand, pain syndrome, and functional impairments is presented. Surgical treatment was performed using a monolateral mini-EFD, osteotomy of the 4th metacarpal bone, and staged distraction. The results were evaluated using radiography, range of motion measurements, dynamometry, Visual Analog Scale (VAS) for pain, and the DASH questionnaire. Results. The length correction period was 25 days, with 34 days of stabilization in the external fixation device. After removal of the mini-EFD, restoration of the 4th ray length of the right hand and complete ossification of the regenerate were observed. The range of motion in the metacarpophalangeal joint was restored to 90 degrees (initially 70 degrees). The hand grip strength asymmetry was 10% with dominance of the right side (initially 5% with left side dominance). The VAS score decreased from 6 to 1 point, and the DASH score from 64 to 5 points. The patient was completely satisfied with the treatment outcome. Conclusions. Surgical treatment of patients with shortened hand rays is indicated when grasping function is impaired and pain syndrome is present. The use of mini-EFD is an effective method for correcting ray length in brachymetacarpia, providing controlled distraction, regenerate ossification, and precise lengthening. Fixation of osteotomized fragments in the mini-EFD provides sufficient stability for active movements in the hand joints, allowing early rehabilitation and achieving better functional results.

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