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Histological study of the docking site after bone transport. Temporal evolution in a sheep model. Injury 2018; 49:1987-1992. [PMID: 30243653 DOI: 10.1016/j.injury.2018.09.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 09/12/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Bone transport appears to be a solution for segmental bone defects; specifically, the "docking site" is where the transported segment meets the target segment at the end of the process. A lack of its consolidation is one of the major causes of failure for this technique. Many studies have been performed in order to enhance the consolidation of the docking site, but histological changes occurring in it remain unknown. The aim of this study was to determine microscopic changes present in this area, from distraction to remodeling, in order to clarify the best options to facilitate the success of this technique. MATERIALS AND METHODS Ten adult sheep were submitted to bone transport using an Ilizarov external fixator. Histomorphometry and immunohistochemical studies were performed in the docking site to determine the main types of ossification, the evolutions of tissues and blood vessels and the distributions of collagen I and II. RESULTS Ossification was mainly intramembranous with some areas of endochondral ossification. Fibrous tissue was predominant until 98 days after surgery. The area occupied by blood vessels increased until 50 days after surgery, when it decreased slowly until the end of the study. CONCLUSIONS As far as the authors know, this is the first histological study performed in the docking site reporting the complete evolution of tissues until the end of remodeling, showing results contrary to those published by others authors. This could help to clarify information about its union and may be useful for future investigations about techniques for improving the consolidation of the docking site in humans.
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Clinical implication of sagittal translation in lengthening over nail of tibia. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:1579-85. [PMID: 24154867 DOI: 10.1007/s00590-013-1338-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 10/06/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE During the surgery of lengthening over nail (LON), we sometimes observe sagittal translation of proximal tibia (STPT) when the nail is inserted into the canal. We investigated the factors that lead to STPT and its clinical significance. METHODS We reviewed 35 consecutive patients who underwent bilateral tibial lengthening with LON. The following parameters were assessed to evaluate the factors that can lead to STPT; the level of tibia osteotomy (OT) in sagittal plane, the type of the nail, the nail entry point in sagittal/coronal planes, and the type of the OT. Then, the followings are analyzed to find any possible clinical significance of this phenomenon: the change of posterior proximal tibial angle (PPTA), the cortical healing index, and the translation of the sagittal mechanical axis (SMA) of the lower extremity. RESULTS The postoperative STPT was 3.04 ± 2.73 mm, and proximal location of the OT in relation to the nail bending point was found to increase STPT. The nail entry point in sagittal/coronal planes and the type of tibia OT had no significant correlations with STPT. It had no significant relations with the PPTA or cortical healing index. It pushed the SMA posteriorly, but the SMA was always anterior to the center of rotation of the knee joint. CONCLUSIONS Proximal location of the OT in relation to the nail bending point is related to STPT. However, it does not negatively influence cortical healing, posterior tibial slope, or SMA of the lower extremity.
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Adegbehingbe OO, Ojo OD, Abiola PO, Ariyibi AL, Oginni LM, Obateru JA. Distraction by a monotube fixator to achieve limb lengthening: predictive factors for tibia trauma. J Trauma Manag Outcomes 2013; 7:3. [PMID: 23672599 PMCID: PMC3658909 DOI: 10.1186/1752-2897-7-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 05/04/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Management of post trauma tibia bone gap varied with orthopedic surgeons' experience and tools available. Study aims to determine predictive factors for distraction by a monotube fixator (DMF) outcome in post tibia trauma limb length discrepancy. METHODS A prospective descriptive cross sectional study of post traumatized tibia bone gap and limb length discrepancy patients at tertiary hospitals. Patient's informed consent and institutional ethical committee approval were obtained. Bio-data, clinical and healing indexes were documented. DMF was applied for patient that met inclusion criteria. The Statistic tests used included the Chi-square, the Student's two-tailed t test, and the Wilcox on rank-sum test when appropriate. Mantel-Haenszel Common Odds Ratio (OR) and 95% confidence intervals for poor outcome potential risk factors were recorded. Bivariate correlation and logistic regression were evaluated. Significance level was set at a p value <0.05. RESULTS Thirty-six patients with mean age, 37.2 ± 10.3 year and male/female ratio of 1:1.25 had DMF applied. Motorcycle accident accounted for 50.0% of patients and diaphyseal segment was most commonly affected 25 (69.4%). The mean bone lengthened was 10.1 ± 4.0 cm (range: 5-21 cm) and mean duration of bone transport was 105.6 ± 38.2 days. The means of rate of distraction, healing index and percentage of lengthening were 0.99 ± 0.14 mm/day, 15.6 ± 4.3 days/cm and 38.0 ± 14.3 respectively. The mean follow up was 9.7 ±4.9 months (range: 2-17.0). Per operative complications varied and outcome was satisfactory in 30 (83.3%). Obesity (p <0.0001), multiple surgery (p = 0.012) and transfusion (p = 0.001) correlated to poor outcome. Percentage lengthening ≥ 50%, bone gap >10 cm, anemia, blood transfusion, general anesthesia administration, distraction rate >1 mm/day, osteomyelitis and prolong partial weight bearing were significant predictive factors for poor outcome in post traumatic tibia distraction. CONCLUSION Distraction by a monotube fixator appears effective in achieving correction >38.0% original tibia lengthening following traumatic bone gap. Predictive factors for poor outcome were useful for prognostication.
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Affiliation(s)
- Olayinka O Adegbehingbe
- Department of Orthopedic Surgery & Traumatology, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Owolabi D Ojo
- Federal Medical Centres, Department of Orthopedic Surgery, Ido-Ekiti, Nigeria
| | - Paul O Abiola
- Federal Medical Centres, Department of Orthopedic Surgery, Ido-Ekiti, Nigeria
| | - Abimbola L Ariyibi
- Federal Medical Centres, Department of Orthopedic Surgery, Ido-Ekiti, Nigeria
| | - Lawrence M Oginni
- Department of Orthopedic Surgery & Traumatology, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - John A Obateru
- Federal Medical Centres, Department of Orthopedic Surgery, Ido-Ekiti, Nigeria
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Song SH, Agashe MV, Huh YJ, Hwang SY, Song HR. Physeal growth arrest after tibial lengthening in achondroplasia: 23 children followed to skeletal maturity. Acta Orthop 2012; 83:282-7. [PMID: 22489887 PMCID: PMC3369156 DOI: 10.3109/17453674.2012.678802] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Bilateral tibial lengthening has become one of the standard treatments for upper segment-lower segment disproportion and to improve quality of life in achondroplasia. We determined the effect of tibial lengthening on the tibial physis and compared tibial growth that occurred at the physis with that in non-operated patients with achondroplasia. METHODS We performed a retrospective analysis of serial radiographs until skeletal maturity in 23 achondroplasia patients who underwent bilateral tibial lengthening before skeletal maturity (lengthening group L) and 12 achondroplasia patients of similar height and age who did not undergo tibial lengthening (control group C). The mean amount of lengthening of tibia in group L was 9.2 cm (lengthening percentage: 60%) and the mean age at the time of lengthening was 8.2 years. The mean duration of follow-up was 9.8 years. RESULTS Skeletal maturity (fusion of physis) occurred at 15.2 years in group L and at 16.0 years in group C. The actual length of tibia (without distraction) at skeletal maturity was 238 mm in group L and 277 mm in group C (p = 0.03). The mean growth rates showed a decrease in group L relative to group C from about 2 years after surgery. Physeal closure was most pronounced on the anterolateral proximal tibial physis, with relative preservation of the distal physis. INTERPRETATION Our findings indicate that physeal growth rate can be disturbed after tibial lengthening in achondroplasia, and a close watch should be kept for such an occurrence-especially when lengthening of more than 50% is attempted.
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Affiliation(s)
- Sang-Heon Song
- Institute for Rare Diseases and Department of Orthopaedic Surgery
| | | | - Young-Jae Huh
- Institute for Rare Diseases and Department of Orthopaedic Surgery
| | - Soon-Young Hwang
- Department of Biostatistics, Korea University Medical Center, Guro Hospital, Seoul, Korea
| | - Hae-Ryong Song
- Institute for Rare Diseases and Department of Orthopaedic Surgery
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Song SH, Kim SE, Agashe MV, Lee H, Refai MA, Park YE, Choi HJ, Park JH, Song HR. Growth disturbance after lengthening of the lower limb and quantitative assessment of physeal closure in skeletally immature patients with achondroplasia. ACTA ACUST UNITED AC 2012; 94:556-63. [PMID: 22434475 DOI: 10.1302/0301-620x.94b4.28375] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study evaluated the effect of limb lengthening on longitudinal growth in patients with achondroplasia. Growth of the lower extremity was assessed retrospectively by serial radiographs in 35 skeletally immature patients with achondroplasia who underwent bilateral limb lengthening (Group 1), and in 12 skeletally immature patients with achondroplasia who did not (Group 2). In Group 1, 23 patients underwent only tibial lengthening (Group 1a) and 12 patients underwent tibial and femoral lengthening sequentially (Group 1b). The mean lengthening in the tibia was 9.2 cm (59.5%) in Group 1a, and 9.0 cm (58.2%) in the tibia and 10.2 cm (54.3%) in the femur in Group 1b. The mean follow-up was 9.3 years (8.6 to 10.3). The final mean total length of lower extremity in Group 1a was 526.6 mm (501.3 to 552.9) at the time of skeletal maturity and 610.1 mm (577.6 to 638.6) in Group 1b, compared with 457.0 mm (411.7 to 502.3) in Group 2. However, the mean actual length, representing the length solely grown from the physis without the length of distraction, showed that there was a significant disturbance of growth after limb lengthening. In Group 1a, a mean decrease of 22.4 mm (21.3 to 23.1) (4.9%) was observed in the actual limb length when compared with Group 2, and a greater mean decrease of 38.9 mm (37.2 to 40.8) (8.5%) was observed in Group 1b when compared with Group 2 at skeletal maturity. In Group 1, the mean actual limb length was 16.5 mm (15.8 to 17.2) (3.6%) shorter in Group 1b when compared with Group 1a at the time of skeletal maturity. Premature physeal closure was seen mostly in the proximal tibia and the distal femur with relative preservation of proximal femur and distal tibia. We suggest that significant disturbance of growth can occur after extensive limb lengthening in patients with achondroplasia, and therefore, this should be included in pre-operative counselling of these patients and their parents.
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Affiliation(s)
- S H Song
- Korea University Medical Center, Guro Hospital, Institute for Rare Diseases and Department of Orthopaedic Surgery, 80 Guro-dong, Guro-gu, Seoul 152-703, Korea
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Wee J, Akins RE, Mackenzie WG, Seliktar R, Levine DG, Richardson DW, Dodge GR, Rahman T. Development of a Force-Driven Distractor for Distraction Osteogenesis. J Med Device 2011. [DOI: 10.1115/1.4005321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Distraction osteogenesis is a routine surgical procedure to lengthen a long bone. A fixed lengthening rate is typically used. We investigate measuring forces continuously and producing a variable distraction rate. A motorized distractor was instrumented with a load cell to measure the forces developed in a limb during distraction osteogenesis. The motor moves 2.6 μm at each step, with a variable frequency depending on the distraction rate. The forces were measured every 15 s and used to change the rate on the autodistractor. The autodistractor, load cell, data logger, controller, and battery pack were all mounted on a monolateral rail fixator, which was tested on a sheep that underwent tibial lengthening. Results show the feasibility of continually recording forces in vivo. The lengthening rate changed automatically, based around a threshold force of 300 N. Findings indicate that force readings are feasible and practical with a simple device. Force determination may provide an additional means to evaluate tissue integrity in real-time and away from the clinic. An automatic variable rate device could improve limb lengthening.
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Affiliation(s)
- Jinyong Wee
- School of Biomedical Engineering, Drexel University, Philadelphia, PA 19104
| | - Robert E. Akins
- Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803
| | - William G. Mackenzie
- Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803
| | - Rahamim Seliktar
- School of Biomedical Engineering, Drexel University, Philadelphia, PA 19104
| | - David G. Levine
- Widener Hospital, The University of Pennsylvania School of Veterinary Medicine, 382 West Street Road, Kennett Square, PA 19348
| | - Dean W. Richardson
- Widener Hospital, The University of Pennsylvania School of Veterinary Medicine, 382 West Street Road, Kennett Square, PA 19348
| | - George R. Dodge
- Department of Orthopaedic Surgery, University of Pennsylvania, 424 G Stemmler Hall, 36th Street and Hamilton Walk, Philadelphia, PA 19104-6081
| | - Tariq Rahman
- Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803
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Using distraction forces to drive an autodistractor during limb lengthening. Med Eng Phys 2011; 33:1001-7. [PMID: 21531604 DOI: 10.1016/j.medengphy.2011.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 03/01/2011] [Accepted: 04/01/2011] [Indexed: 11/21/2022]
Abstract
Distraction osteogenesis can result in high forces developing in the limb. To determine and control the distraction forces (DF), a motorized distractor driven by feedback from DF was developed and used to lengthen the tibiae of 6 sheep undergoing distraction osteogenesis. The forces were measured continually, and, in 4 of the sheep, a force threshold was set, above which an increase in rate was initiated. The rate kept increasing to a set limit if forces remained above the threshold; otherwise, the rate was decreased. Radiographs were acquired biweekly, and muscle samples were analyzed from both the operated and contralateral limbs upon termination of the experiment. Results demonstrated a drop in DF associated with increased lengthening rate, attributed to separation of the callus as indicated by radiography. Histological evidence of muscle damage generally correlated with higher DF levels. There was a significant decrease in muscle fiber diameter in lengthened relative to contralateral limbs. Collectively, the results demonstrated the use of a force-driven distraction system and support the need for considering force data in regulating distraction rates to achieve optimal clinical outcomes.
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Wee J, Rahman T, Seliktar R, Akins R, Levine D, Richardson D, Dodge GR, Thabet AM, Holmes L, Mackenzie WG. Force feedback in limb lengthening. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2010:5109-5112. [PMID: 21095804 DOI: 10.1109/iembs.2010.5626190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A new variable-rate distraction system using a motorized distractor driven by feedback from the distraction force was designed. The distractor was mounted on a unilateral fixator and attached to the tibiae of 6 sheep that underwent distraction osteogenesis. The sheep were divided equally into 3 groups. In group 1, the forces were recorded but were not used to drive the lengthening rate. In group 2, force feedback was used and the desired distraction force level was set to 300 N and the initial rate was 1 mm/day. Group 3 also underwent force feedback with the desired force limit at 300 N, but the rate change was initiated earlier, at 200 N. The distraction force was recorded at 15 second intervals throughout the distraction phase and stored onboard the distractor.
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Affiliation(s)
- Jinyong Wee
- School of Biomedical Engineering Science and Health Systems, Drexel University, Philadelphia PA, USA.
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