Rehabilitation post-distraction osteogenesis for brachymetacarpia: a case report

Distraction osteogenesis for brachymetacarpia has been described in several small case series and single case reports, but the rehabilitation required to optimize outcomes has not been reported. We present a case report describing the hand rehabilitation program of a 13-year-old girl with congenital brachymetacarpia who underwent distraction osteogenesis of the third metacarpal. Intense weekly hand therapy including desensitization, scar massage, range of motion exercises and splinting was essential up to 28 weeks postoperatively to address the progressive changes in the anatomical structures. At final follow-up, she had full active range of motion, no functional deficits in grasp or in-hand manipulation skills and resumed her participation in competitive baton twirling. Patient and family satisfaction with outcome was high. However, better education regarding the progressive symptoms with distraction and daily challenges of wearing an external fixator would have improved the overall experience. With a strong family commitment to rehabilitation and thorough patient education, distraction osteogenesis for brachymetacarpia has the potential to improve functional and aesthetic outcome in the hand. V.