SCIENTIFIC ARTICLE Carpal Growth and Function After Pediatric Transcarpal Hand Replant: Case Report Greg Merrell, MD, Wendell Heard, MD, Min Jung Park, MD, Paul Ramos, PA, Manuel F. Dasilva, MD This case discusses the technique, postoperative course, and functional outcomes 5 years after an amputation between the cartilaginous anlages of the growing carpus in a 7-year-old boy. The lunate remained attached to the arm, whereas the scaphoid and the remainder of the carpus were contained within the amputated part. After 5 years, the patient had 94% growth compared to the other side, a Minnesota dexterity test in the 75th percentile, 0/10 pain, near-normal sensation, grip strength 17% of the other side, and lateral pinch 79% of the other side. (J Hand Surg 2008;33A:1354– 1357. Copyright © 2008 by the American Society for Surgery of the Hand. All rights reserved.) Key words Amputation, transcarpal, pediatric. A MORE COMPLETE UNDERSTANDING of the growth potential and functional recovery in pediatric limb replantation is needed. There have been reports on pediatric replantations and the associated postoperative function and epiphyseal growth, but most have focused on digital replantations. 1,2 Other reports in the literature describing outcomes of hand replantations either do not contain pediatric cases 3–6 or do not stratify results into those from pediatric versus adult patients, 7,8 or do not list the age of patients. 9 Two case series of limb replantations in children contain limited functional outcome data. 10,11 Other reports of pediatric replants aggregate functional results of wrist-level replants with more distal metacarpal or digit replants. 12 Another se- ries with 3 distal forearm or wrist-level replants re- ported that 2 patients required revision amputations. 13 One report of a successful pediatric distal forearm level replant contains little information regarding surgical technique and few details of the functional results. 14 Of the papers discussing specifically hand replanta- tions in the pediatric population, we were unable to identify any that discussed the particular challenge and outcomes of an amputation between the cartilaginous anlages of the growing carpus. For these reasons, we present a detailed description of the surgical technique, rehabilitation, and functional results after replantation in a 7-year-old boy of an amputation through the prox- imal row of the carpus. CASE REPORT A 7-year-old right-handed boy presented acutely after complete amputation of his left hand as a result of a log splitter accident. Radiographic and physical examina- tion demonstrated an amputation through the proximal row of the carpus. There was a small chondral injury to the proximal scaphoid; however, there was no other fracture given a path of the force through the skin, capsule, lunotriquetral (LT), and scapholunate (SL) lig- aments. This was a perilunate-type transection, leaving the lunate and a small scaphoid chondral fragment contained within the proximal stump and the remainder of the carpus within the amputated segment (Figs. 1 and 2). The cold ischemia time before arrival to the operat- ing room was 4.5 hours. The proximal arm and the amputated portion were debrided of devitalized tissue and all structures were tagged. A combination of 3 radiocarpal K-wires and an external fixator were used for stabilization. The scaph- oid was aligned with its proximal chondral fragment, From the Indiana Hand Center, Indianapolis, IN; Brown University Department of Orthopaedics, Prov- idence, RI; Department of Orthopedic Surgery, Hospitals of University of Pennsylvania, Philadelphia, PA; The Warren Alpert Medical School of Brown University, Providence, RI. Received for publication December 5, 2007; accepted in revised form April 23, 2008. No benefits in any form have been received or will be received related directly or indirectly to the subject of this article. Corresponding author: Greg Merrell, MD, Indiana Hand Center, 8501 Harcourt Rd, Indianapolis, IN 46260; e-mail: gregmerrell@gmail.com. 0363-5023/08/33A08-0014$34.00/0 doi:10.1016/j.jhsa.2008.04.020 1354  ©  ASSH  Published by Elsevier, Inc. All rights reserved.