Toe phalangeal grafts in congenital hand anomalies

The results of 73 toe phalangeal grafts were reviewed in order to determine the effects of age and operative technique on subsequent growth of the transferred phalanx. Minimum length of follow-up care for inclusion in the study was 1 year (mean, 42 months). Physeal openness and growth of transferred phalanges were determined from standard x-ray films. Physeal openness rates were 94% for those operated on before 1 year of age, 71% for those 1-2 years of age, and 48% for those older than 2 years of age. Mean growth rates were 1.0 ± .2 mm, 1.0 ± 0.6 mm, and 0.5 ± 0.5 mm per year, respectively, for these three age groups. Extraperiosteal dissection of the transferred phalanx, tendon and collateral ligament reattachment, and patient age under 12 months had a statistically beneficial effect on maintaining physeal openness.