1
|
Johari AN, Anjum R. Lengthening in congenital posteromedial bowing of tibia: a follow-up series at skeletal maturity. Int Orthop 2024; 48:1439-1452. [PMID: 38594586 DOI: 10.1007/s00264-024-06160-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/20/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE Congenital posteromedial bowing (CPMB) of tibia is a rare, usually self-resolving condition that is present at birth. The data on the long-term outcome of lengthening, choice of fixator, outcome in early and late age groups, and complications is sparse, hence the need for this study. METHODS This retrospective study included 93 patients with 94 affected legs from 1991 to 2023. The patients were categorized into early (under 10 years) and late (10 years or above) intervention groups. Eighteen patients with nineteen lengthening episodes who attained skeletal maturity made the basis of this study and will be discussed in detail. RESULTS The outcome for the lengthening group at maturity was satisfactory, with 5.53 cm of average length gained per lengthening episode, a mean LLD of 0.31 cm at final follow-up, a mean age of 23.63 years (range 14-38 years), and an average follow-up of 12.51 years (range 3-28 years) post-lengthening, but the procedure was associated with difficulties like ankle stiffness, tibial valgus, pin tract infections, and fractures through regenerate. CONCLUSION This study represents a large single-centre series on CPMB. We recommend that surgery for lengthening should be done at an older age, close to skeletal maturity, wherever possible to reduce the risk of repeat lengthening procedures. Based on our experience, we recommend the use of a circular fixator. Uniplanar distractors should have an adequate number and spread of Schanz screws in each segment to reduce the risk of valgus malalignment of distracting segments of bone.
Collapse
Affiliation(s)
- Ashok N Johari
- ENABLE International Centre for Paediatric Musculoskeletal Care, Mumbai, 400016, India
| | - Rashid Anjum
- All India Institute of Medical Sciences (AIIMS) Vijaypur, Jammu, J&K, 180001, India.
| |
Collapse
|
2
|
Mainard N, Saghbini E, Pesenti S, Gouron R, Ilharreborde B, Lefevre Y, Haumont T, Sales de Gauzy J, Canavese F. Is posterior vertebral arthrodesis at the end of the electromagnetic rod lengthening program necessary for all patients? Comparative analysis of sixty six patients who underwent definitive spinal arthrodesis and twenty four patients with in situ lengthening rods. Int Orthop 2024; 48:1599-1609. [PMID: 38421434 DOI: 10.1007/s00264-024-06121-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Magnetically controlled growing rods (MCGR) should be removed or changed at most two years after their implantation in the treatment of patients with early-onset scoliosis (EOS) (Safety notice July 2021). However, in the face of patients at high risk of intraoperative complications and relying on the principle of auto-fusion of the spine, some surgeons would prefer a more wait-and-see attitude. The aim of this study was to report on patients who did not undergo final fusion at the end of the lengthening program with MCGR and to compare them with those who did. METHODS This was a multicenter study with ten centres. We collected all graduate patients with EOS who had received MCGR between 2011 and 2022. RESULTS A total of 66 patients had final fusion at the end of the lengthening program and 24 patients kept MCGRs in situ. The mean total follow-up time was 66 months (range, 25.3-109), and the mean follow-up time after final lengthening was 24.9 months (range, 3-67.7). Regarding the main curve and thoracic height, there was no significant difference in the percentage of correction over the whole follow-up between the two groups (p = 0.099, p = 0.176) although there was a significant difference between the end of lengthening and the last follow-up (p < 0.001). After completion of the lengthening program, 18 patients who had final fusion developed 24 of the 26 recorded complications (92.3%). CONCLUSION Contrary to the manufacturer's published safety notice, not all patients systematically benefited from the removal of the MCGRs. Although arthrodesis significantly improved the scoliotic deformity, no significant difference was found in terms of radiographic outcome between patients who underwent spinal fusion and those who kept the MCGRs in situ.
Collapse
Affiliation(s)
- Nicolas Mainard
- Department of Pediatric Surgery, Jeanne de Flandre Hospital, CHU Lille, Avenue Eugène Avinée, 59000, Lille, France.
| | - Elie Saghbini
- Orthopaedic and Reconstructive Surgery in Children, Hôpital Armand-Trousseau - AP-HP Is, 26 Avenue du Docteur Arnold Netter, 75012, Paris, France
| | - Sebastien Pesenti
- Pediatric Orthopedic Surgery, Hôpital de La Timone Enfants, 264 Rue Saint-Pierre, 13005, Marseille, France
| | - Richard Gouron
- Child Surgery, CHU Amiens-Picardie, 1 Rond-Point du Professeur Christian Cabrol, 80000, Amiens, France
| | - Brice Ilharreborde
- Department of Pediatric Orthopedic Surgery, Hôpital Robert-Debré, 48 Boulevard Sérurier, 75019, Paris, France
| | - Yan Lefevre
- Children's Surgery - Children's Hospital - Pellegrin Hospital Group, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France
| | - Thierry Haumont
- Department of Orthopedic, Trauma and Plastic Surgery, Hospital Mère Enfant, 59 Boulevard Pinel, 69500, Hospices Civils de LyonBron, France
| | - Jerome Sales de Gauzy
- Paediatrics - Orthopaedic, Traumatological And Plastic Surgery, Children's Hospital, 330, Avenue de Grande Bretagne - TSA, 70034 - 31059, Toulouse, France
| | - Federico Canavese
- Department of Pediatric Surgery, Jeanne de Flandre Hospital, CHU Lille, Avenue Eugène Avinée, 59000, Lille, France
- Faculty of Medicineof the , University of Lille Henri Warembourg, 2 Av Eugène Avinée, 59120, Loos, France
| |
Collapse
|
3
|
Rölfing JD, Kold S, Nygaard T, Mikuzis M, Brix M, Faergemann C, Gottliebsen M, Davidsen M, Petruskevicius J, Olesen UK. Pain, osteolysis, and periosteal reaction are associated with the STRYDE limb lengthening nail: a nationwide cross-sectional study. Acta Orthop 2021; 92:479-484. [PMID: 33757381 PMCID: PMC8428270 DOI: 10.1080/17453674.2021.1903278] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Observing serious adverse events during treatment with the Precice Stryde bone lengthening nail (NuVasive, San Diego, CA, USA), we conducted a nationwide cross-sectional study to report the prevalence of adverse events from all 30 bone segments in 27 patients treated in Denmark.Patients and methods - Radiographs of all bone segments were evaluated regarding radiographic changes in February 2021. We determined the number of bone segments with late onset of pain and/or radiographically confirmed osteolysis, periosteal reaction, or cortical hypertrophy in the junctional area of the nail.Results - In 30 bone segments of 27 patients we observed radiographic changes in 21/30 segments of 20/27 patients, i.e., 19/30 osteolysis, 12/30 periosteal reaction (most often multi-layered), and 12/30 cortical hypertrophy in the area of the junction between the telescoping nail parts. Late onset of pain was a prominent feature in 8 patients. This is likely to be a prodrome to the bony changes. Discoloration (potential corrosion) at the nail interface was observed in multiple removed nails. 15/30 nails were still at risk of developing complications, i.e., were not yet removed.Interpretation - All Stryde nails should be monitored at regular intervals until removal. Onset of pain at late stages of limb lengthening, i.e., consolidation of the regenerate, should warrant immediate radiographic examination regarding osteolysis, periosteal reaction, and cortical hypertrophy, which may be associated with discoloration (potential corrosion) of the nail. We recommend removal of Stryde implants as early as possible after consolidation of the regenerate.
Collapse
Affiliation(s)
- Jan Duedal Rölfing
- Orthopaedic Reconstruction and Children’s Orthopaedics, Aarhus University Hospital, Aarhus
- Department of Clinical Medicine, Aarhus University, Aarhus
| | - Søren Kold
- Department of Orthopaedics, Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg
| | - Tobias Nygaard
- Department of Orthopaedics, Limb Lengthening and Bone Reconstruction Unit, Rigshospitalet, Copenhagen
| | - Mindaugas Mikuzis
- Department of Orthopaedics, Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg
| | - Michael Brix
- Department of Orthopaedics, Odense University Hospital, Odense, Denmark
| | | | - Martin Gottliebsen
- Orthopaedic Reconstruction and Children’s Orthopaedics, Aarhus University Hospital, Aarhus
| | - Michael Davidsen
- Orthopaedic Reconstruction and Children’s Orthopaedics, Aarhus University Hospital, Aarhus
| | - Juozas Petruskevicius
- Orthopaedic Reconstruction and Children’s Orthopaedics, Aarhus University Hospital, Aarhus
| | - Ulrik Kähler Olesen
- Department of Orthopaedics, Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg
| |
Collapse
|
4
|
Abstract
INTRODUCTION Limb length discrepancy (LLD) is common in both the pediatric and adult population. Length inequalities can be due to a multitude of etiologies including congenital, developmental, and acquired causes. There has been little consensus on the morbidity of LLD and, as a result, the threshold necessary for treatment of LLD to prevent morbidity. Advances in magnetically controlled lengthening devices achieve greater accuracy and patient satisfaction and create an opportunity to lower the threshold for limb lengthening. DISCUSSION Asymptomatic LLD is relatively common in both pediatric and adult populations. Only ~10% of the population has equal leg length. LLD of <5 cm may lead to long-term morbidities such as scoliosis, lower back pain, gait abnormalities, stress on hip or knee joint, and lower extremity symptomatic versus asymptomatic osteoarthritis. The teaching in most orthopaedic textbooks is to adjust the shoe if symptomatic for discrepancies up to 2 cm; consider an orthotic, epiphysiodesis, or skeletal shortening for 2.5 to 5 cm; and possible limb reconstruction for >5 cm. The assumption is that there are no long-term consequences of mild LLD. However, data in recent literature show that small discrepancies may contribute to pathologic changes such as pain, gait abnormalities, and osteoarthritis. Major advances have been made in limb lengthening over the past 40 years. The increased accuracy and superior patient satisfaction of the magnetically controlled lengthening nail versus external fixation methods argue for including lengthening for LLD of <5 cm. CONCLUSION If mild LLD can cause long-term pathology, it is important to counsel families on the full range of options for limb equalization no matter the size of the discrepancy. The evolution in technology and understanding of limb lengthening has provided additional safe surgical options. Therefore, the historic treatment protocol for addressing limb differences may need to include lengthening for smaller discrepancies even <2 cm.
Collapse
Affiliation(s)
- L Reid Boyce Nichols
- Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
| |
Collapse
|
5
|
Abstract
Limb lengthening continues to be a real challenge to both the patient and the orthopaedic surgeon. Although it is not a difficult operative problem, there is a long and exhausting postoperative commitment which can jeopardize early good results. I aim to review the history, evolution, biology, complications and current concepts of limb lengthening. Ilizarov's innovative procedure using distraction histeogenesis is the mainstay of all newly developing methods of treatment. The method of fixation is evolving rapidly from unilateral external fixator to ring fixator, computer assisted and finally lengthening intramedullary nails. The newly manufactured nails avoid many of the drawbacks of external fixation but they have their own complications. In general, the indications for limb lengthening are controversial. The indications have been extended from lower limb length inequality to upper extremity lengthening, including humeral, forearm and phalangeal lengthening. A wide range in frequency of complications is recorded in the English literature, which may reach up to 100% of cases treated. With developing experience, cosmetic lengthening has become possible using external or internal lengthening devices with an acceptable rate of problems.Level of evidence: V.
Collapse
Affiliation(s)
- Gamal A Hosny
- Benha University Hospitals, 11 Al Israa Al-Mohandeseen Street, Cairo, Egypt.
| |
Collapse
|
6
|
Abstract
The Precice nail is used to treat limb length discrepancies and has a low complication rate and a high patient satisfaction rate. While the Precice nail can be used for lengthening, unlike other lengthening nails, it can also be used for shortening. We report a 37-year-old female patient with a 14 cm limb length discrepancy that was treated with a new surgical technique using the shortening feature of the Precice nail. Following maximum possible lengthening using the nail and without waiting for union on the osteotomy line, the distal interlocking screws were removed, and the nail was shortened by external remote control with the help of the fixator. The distal interlocking screws were then reattached to continue lengthening. This surgical technique can be used safely and satisfactorily in cases with more shortness as we can correct the extremity length discrepancy using only one nail.
Collapse
Affiliation(s)
- Mesut Kariksiz
- Department of Orthopedics and Traumatology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey. E-mail.
| | | |
Collapse
|
7
|
Szymczuk VL, Hammouda AI, Gesheff MG, Standard SC, Herzenberg JE. Lengthening With Monolateral External Fixation Versus Magnetically Motorized Intramedullary Nail in Congenital Femoral Deficiency. J Pediatr Orthop 2019; 39:458-465. [PMID: 31503231 DOI: 10.1097/bpo.0000000000001047] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Limb lengthening for congenital femoral deficiency (CFD) with or without fibular hemimelia can be performed with both external and internal devices. The purpose of this study is to compare clinical outcomes of femoral lengthening utilizing monolateral external fixation versus a magnetically motorized intramedullary nail in patients with CFD with or without fibular hemimelia. METHODS This retrospective review included 62 patients with femoral lengthening, 32 patients had monolateral external fixation (group A), 30 patients had internal lengthening nail (group B). Mean age in years was 9.4±3.8 and 15.4±4.9 for groups A and B, respectively. Mean follow-up in years was 4.47±2.7 and 1.86±0.7 years for groups A and B, respectively. RESULTS Mean lengthening achieved was 5.6±1.7 and 4.8±1.4 cm for group A and group B, respectively (P=0.052). Mean distraction index was 0.7±0.2 mm/d for group A and 0.7±0.2 mm/d for the group B (P=0.99). Mean consolidation index for group A was 29.3±12.7 and 34.8±11.2 d/cm for group B (P=0.08). Mean arc of motion before surgery and at final follow-up were similar between groups (P=0.35). Group A had significantly less range of motion at the end of distraction (P=0.0007) and at consolidation (P<0.0001). Both groups had similar rates of obstacles and complications. A significant difference between groups was found in the total problems (P<0.001) specifically with pin site/superficial infection (P<0.0001). CONCLUSIONS The intramedullary nail had superior range of motion during the lengthening phase and at consolidation and an overall lower problem complication rate, while maintaining similar distraction and healing indices to monolateral external fixation. Internal lengthening nails represent a significant advance in technology for CFD lengthening. LEVEL OF EVIDENCE Level IV-therapeutic.
Collapse
Affiliation(s)
- Vivian L Szymczuk
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Ahmed I Hammouda
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
- Department of Orthopedics and Trauma, Al-Azhar University Hospitals, Cairo, Egypt
| | - Martin G Gesheff
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Shawn C Standard
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - John E Herzenberg
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| |
Collapse
|
8
|
Abstract
The Precice nail is used to treat limb length discrepancies and has a low complication rate and a high patient satisfaction rate. While the Precice nail can be used for lengthening, unlike other lengthening nails, it can also be used for shortening. We report a 37-year-old female patient with a 14 cm limb length discrepancy that was treated with a new surgical technique using the shortening feature of the Precice nail. Following maximum possible lengthening using the nail and without waiting for union on the osteotomy line, the distal interlocking screws were removed, and the nail was shortened by external remote control with the help of the fixator. The distal interlocking screws were then reattached to continue lengthening. This surgical technique can be used safely and satisfactorily in cases with more shortness as we can correct the extremity length discrepancy using only one nail.
Collapse
Affiliation(s)
- Mesut Kariksiz
- Department of Orthopedics and Traumatology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey. E-mail.
| | | |
Collapse
|
9
|
Abstract
Limb lengthening is now an accepted practice in orthopaedic surgery. The principles of distraction osteogenesis have become well established with the use of external fixators, utilizing both monolateral and ring fixators. Corticotomy technique, frame stability, lengthening rate and rhythm all contribute to the formation of bone regenerate and tissues. Complications are however common including pin-site infection, soft tissue tethering from the pins and wires resulting in pain, regenerate deformity from soft tissue forces or fracture following frame removal and patient intolerance of the frames during treatment. Surgical techniques have changed to try and minimise these complications. The use of intramedullary nails have been used in conjunction with an external fixator or inserted after lengthening has been achieved, to reduce fixator time and prevent regenerate deformity. Implant innovation has led to the production of intramedullary lengthening nails. The initial devices used ratchet mechanisms with rotation of the bone fragments to achieve lengthening (Bliskunov, Albizzia and ISKD). More accurate control of lengthening and a reduction in pain, resulting from the manual rotation of the leg required to achieve the ratchet progression, was achieved by the use of a transcutaneous electrical conduit powered by external high frequency electrical energy (Fitbone). The most recent implant uses an external remote controller which contains two neodymium magnets. These are placed over the nail on the skin and rotate which in turn rotates a third magnet within the intramedullary nail (Precice). This magnet rotation is converted by a motor to extend or retract the extendible rod. There are multiple nail sizes and lengths available, and early results have shown accurate control with few complications. With such promising outcomes the use of this lengthening intramedullary nail is now recommended as the implant of choice in femoral lengthening. This article is an historical account of the intramedullary device and the impact on limb lengthening.
Collapse
Affiliation(s)
- Peter R Calder
- The Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.
| | - Maritz Laubscher
- Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
| | - W David Goodier
- The Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| |
Collapse
|
10
|
Wigton MD, Nazir OF, Graves BR, Apel PJ, Li Z. Dorsal Distraction Plating and Lunate Decortication for Stage III Kienböck Disease: A Novel Technique. Tech Hand Up Extrem Surg 2017; 21:13-17. [PMID: 27984361 DOI: 10.1097/bth.0000000000000146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Kienböck disease (KD) is a progressive condition and difficult to manage. A number of treatment algorithms exist but there is no clear consensus as to which method produces the best outcome, particularly for Lichtman stage III disease. The majority of the current treatment options for KD emphasize lunate unloading and restoration of biology with bone graft. However, less attention has been given to the protection of the lunate during revascularization process. We report a novel technique of lunate decompression and bone grafting, combined with wrist distraction with or without radial shortening osteotomy via dorsal wrist bridge plating for the treatment of stage II-IIIa/b KD. This technique provides the advantages of distraction of the carpus unloading the lunate after bone grafting and during revascularization without the issues inherent to external fixation. In addition, this technique allows compression through a radial osteotomy site when performed. Our approach to the treatment of KD has incorporated this technique for patients with stage II or IIIa/b disease.
Collapse
Affiliation(s)
- Michael D Wigton
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC
| | | | | | | | | |
Collapse
|
11
|
Abstract
There are many techniques for limb lengthening. Lengthening over a plate is an alternative choice of fixation in children or when nailing is difficult. We present a new technique for tibial lengthening with using a monolateral external fixator over a lengthening plate.Lengthening over an intramedullary nail is a commonly used method in patients with short stature or limb-length discrepancy. However, in patients with a narrow and excessively sclerotic intramedullary cavity in the pediatric age group where the skeletal system has not yet fully developed, difficulties have been observed in lengthening methods with nailing.Therefore, in these cases, the use of lengthening techniques over a plate is an alternative treatment option. Nevertheless, in lengthening techniques over a plate, if one side of the osteotomy area cannot be fixed, associated mechanical axis problems have been reported.We applied tibia lengthening with external fixator assistance over a custom-made lengthening plate in a patient with sequelae of poliomyelitis. This new lengthening technique applied over a plate could be the solution to the problems observed in other lengthening techniques over a plate.
Collapse
Affiliation(s)
- Haci Bayram Tosun
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman
| | - Sancar Serbest
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
- Correspondence: Sancar Serbest, Department of Orthopaedics and Traumatology, Faculty of Medicine, Kırıkkale University, 71100 Kırıkkale, Turkey (e-mail: )
| | - Abuzer Uludag
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman
| | - Seyitali Gumustas
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman
| | - Suat Celik
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman
| |
Collapse
|
12
|
Baumhauer JF. Pearls: How to Place an Interposition Segmental Bone Block for Lengthening or Alignment. Clin Orthop Relat Res 2016; 474:1933-8. [PMID: 27255728 PMCID: PMC4965378 DOI: 10.1007/s11999-016-4907-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 05/19/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Judith F Baumhauer
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA.
| |
Collapse
|
13
|
Bhave A, Shabtai L, Ong PH, Standard SC, Paley D, Herzenberg JE. Custom Knee Device for Knee Contractures After Internal Femoral Lengthening. Orthopedics 2015; 38:e567-72. [PMID: 26186317 DOI: 10.3928/01477447-20150701-53] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 09/02/2014] [Indexed: 02/03/2023]
Abstract
The development of knee flexion contractures is among the most common problems and complications associated with lengthening the femur with an internal device or external fixator. Conservative treatment strategies include physical therapy, serial casting, and low-load prolonged stretching with commercially available splinting systems. The authors developed an individually molded, low-cost custom knee device with polyester synthetic conformable casting material to treat knee flexion contractures. The goal of this study was to evaluate the results of treatment with a custom knee device and specialized physical therapy in patients who had knee flexion contracture during femoral lengthening with an intramedullary lengthening femoral nail. This retrospective study included 23 patients (27 limbs) who underwent femoral lengthening with an internal device for the treatment of limb length discrepancy. All patients had a knee flexion contracture raging from 10° to 90° during the lengthening process and were treated with a custom knee device and specialized physical therapy. The average flexion contracture before treatment was 36°. The mean amount of lengthening was 5.4 cm. After an average of 3.8 weeks of use of the custom knee device, only 2 of 27 limbs (7.5%) had not achieved complete resolution of the flexion contracture. The average final extension was 1.4°. Only 7 of 27 limbs (26%) required additional soft tissue release. The custom knee device is an inexpensive and effective method for treating knee flexion contracture after lengthening with an internal device.
Collapse
|
14
|
Ness KK, Neel MD, Kaste SC, Billups CA, Marchese VG, Rao BN, Daw NC. A comparison of function after limb salvage with non-invasive expandable or modular prostheses in children. Eur J Cancer 2015; 50:3212-20. [PMID: 25459397 DOI: 10.1016/j.ejca.2014.10.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/20/2014] [Accepted: 10/06/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Modular and non-invasive expandable prostheses have been developed to provide a functional knee joint that allows future expansion as growth occurs in the contralateral extremity in children with bone sarcomas that require removal of the growth plate. This study aimed to evaluate the functional outcomes of paediatric patients who received either a non-invasive expandable or modular prosthesis for bone sarcomas arising around the knee. METHODS We evaluated clinician-reported, patient-reported and measured function in 42 paediatric patients at least one year (median age at assessment 19.1 years) after limb salvage surgery, and compared patients who received modular system prostheses (N = 29, median age 15.5), who did not require lengthening procedures to those who received non-invasive expandable prostheses (N = 13, median age 11.1) requiring lengthening procedures (median 5). RESULTS The number of revisions and time to first revision did not differ between the two groups. There were no differences between the two groups in total scores on the Enneking Musculoskeletal Tumor Society Scale, the Toronto Extremity Salvage Scale, and the Functional Mobility Assessment. Children with non-invasive expandable prostheses climbed stairs (11.93 ± 4.83 versus 16.73 ± 7.24 s, p = 0.02) in less time than those with modular prostheses. CONCLUSION Our results suggest that the non-invasive expandable prosthesis produces similar functional results to the more traditional modular prosthesis.
Collapse
|
15
|
Küçükkaya M, Karakoyun Ö, Sökücü S, Soydan R. Femoral lengthening and deformity correction using the Fitbone motorized lengthening nail. J Orthop Sci 2015; 20:149-54. [PMID: 25326815 PMCID: PMC4302230 DOI: 10.1007/s00776-014-0659-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 09/26/2014] [Indexed: 12/05/2022]
Abstract
BACKGROUND This study reports our results with retrograde Fitbone insertion in patients with femoral shortening and deformity. We also present our experience regarding the benefits, complications, and factors associated with complications of the Fitbone technique. METHODS Twelve males and ten females had femoral shortening and deformities treated using the retrograde Fitbone technique between 2009 and 2012. The etiologies were post-traumatic in 12 patients, poliomyelitis in four, cosmetic in two, congenital hypoplasia in two, achondroplasia in one, and Perthes sequela in one. RESULTS The follow-up time was 30.8 months. The mean lengthening was 5.8 (range 2-14) cm. The degree of acute angular correction was 9° (5-22°) in nine cases. The time to full weight-bearing was 5.9 months. The consolidation index was 1.07 (0.75-1.62) months/cm. Complete consolidation was obtained in all cases except two. Running back was observed in two cases. CONCLUSIONS The Fitbone technique allows accurate deformity correction. The rigid reamers allow the surgeon to use the Fitbone even in patients with a narrow medullary canal. As this might result in poor bone regeneration, thinner lengthening nails should be considered.
Collapse
Affiliation(s)
- Metin Küçükkaya
- Department of Orthopedics and Traumatology, İstanbul Bilim University, İstanbul, Turkey
- Büyükdere Cad. No:120 34394 Esentepe Şişli, İstanbul, Turkey
| | - Özgür Karakoyun
- Department of Orthopedics and Traumatology, Namık Kemal University, Tekirdağ, Turkey
- Namık Kemal Üniversitesi Tıp Fakültesi Dekanlığı Namık Kemal Mahallesi Kampüs, Caddesi No:1 Suleymanpasa, Tekirdağ, Turkey
| | - Sami Sökücü
- Department of Orthopedics and Traumatology, Metin Sabanci Baltalimani Osteopathic Training and Research Hospital, Istanbul, Turkey
- Rumeli Hisarı Caddesi No: 62, 34470 Baltalimanı İstanbul, Turkey
| | - Ramazan Soydan
- Department of Orthopedics and Traumatology, İstanbul Bilim University, İstanbul, Turkey
- Büyükdere Cad. No:120 34394 Esentepe Şişli, İstanbul, Turkey
| |
Collapse
|
16
|
Landge V, Shabtai L, Gesheff M, Specht SC, Herzenberg JE. Patient Satisfaction After Limb Lengthening With Internal and External Devices. J Surg Orthop Adv 2015; 24:174-179. [PMID: 26688988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
External fixation has long been used for limb lengthening but can result in many complications, such as tethering of the soft tissues, pain, decreased joint motion, scarring, and nerve injury. Recently, a controllable, telescopic, internal lengthening nail was developed to address many of these issues and hopefully improve the overall experience for the patient. The satisfaction rates of internal and external fixation for limb lengthening were compared in 16 patients, all of whom have experienced both methods. Thirteen out of 16 patients responded to a limb-lengthening questionnaire, developed by the authors for this patient population. Patients preferred the internal device with respect to overall satisfaction, reduced pain, ease of physical therapy, and better cosmetic appearance. When asked which device they would prefer if another surgery was required, all patients chose the internal device. From the patients' perspective, the internal lengthening device is an improvement over the traditional external fixator.
Collapse
|
17
|
Jenks M, Craig J, Higgins J, Willits I, Barata T, Wood H, Kimpton C, Sims A. The MAGEC system for spinal lengthening in children with scoliosis: A NICE Medical Technology Guidance. Appl Health Econ Health Policy 2014; 12:587-99. [PMID: 25172432 PMCID: PMC4232741 DOI: 10.1007/s40258-014-0127-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Scoliosis-structural lateral curvature of the spine-affects around four children per 1,000. The MAGEC system comprises a magnetically distractible spinal rod implant and an external remote controller, which lengthens the rod; this system avoids repeated surgical lengthening. Rod implants brace the spine internally and are lengthened as the child grows, preventing worsening of scoliosis and delaying the need for spinal fusion. The Medical Technologies Advisory Committee at the National Institute for Health and Care Excellence (NICE) selected the MAGEC system for evaluation in a NICE medical technologies guidance. Six studies were identified by the sponsor (Ellipse Technologies Inc.) as being relevant to the decision problem. Meta-analysis was used to compare the clinical evidence results with those of one conventional growth rod study, and equal efficacy of the two devices was concluded. The key weakness was selection of a single comparator study. The External Assessment Centre (EAC) identified 16 conventional growth rod studies and undertook meta-analyses of relevant outcomes. Its critique highlighted limitations around study heterogeneity and variations in baseline characteristics and follow-up duration, precluding the ability to draw firm conclusions. The sponsor constructed a de novo costing model showing that MAGEC rods generated cost savings of £9,946 per patient after 6 years, compared with conventional rods. The EAC critiqued and updated the model structure and inputs, calculating robust cost savings of £12,077 per patient with MAGEC rods compared with conventional rods over 6 years. The year of valuation was 2012. NICE issued a positive recommendation as supported by the evidence (Medical Technologies Guidance 18).
Collapse
Affiliation(s)
- Michelle Jenks
- York Health Economics Consortium, University of York, Level 2, Market Square, York, YO10 5NH, UK,
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Abstract
Corrective osteotomy is a well established operative option for correction of predominantly congenital skeletal deformities on the growing skeleton. The indications for the use of a suitable corrective instrument result partly from the location, severity of the deformity and the presence of concomitant leg length discrepancies. External fixators are predominantly used for correction of combined deformities. For isolated leg length differences limb lengthening nails can be implanted but only after growth plates have become closed; however, only a few combined deformities can be addressed in this way. Often several surgical steps are necessary. A careful treatment plan can only be created if the analysis of the deformity is carried out with appropriate parameters and a correct prognosis of the further development. The aim of this paper is to describe the indications for the corrective instruments, the planning of corrections and the presentation of typical indications for axis correction and limb lengthening.
Collapse
Affiliation(s)
- F Schiedel
- Abteilung für Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland,
| | | |
Collapse
|
19
|
Yin Q, Sun Z, Gu S, Bao Y, Wei X, Song S. [EFFECTIVENESS COMPARISON OF USING BONE TRANSPORT AND BONE SHORTENING-LENGTHENING FOR TIBIAL BONE AND SOFT TISSUE DEFECTS]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2014; 28:818-822. [PMID: 26462341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To compare the effectiveness using bone transport and bone shortening-lengthening by Ilizarov technique for tibial bone and soft tissue defects. METHODS Between January 2004 and May 2012, 31 patients with tibial bone and soft tissue defects were managed by Ilizarov technique, the clinical data were retrospectively analyzed. Bone transport was used in 18 cases (group A), and bone shortening-lengthening in 13 cases (group B). There was no significant difference in age, gender, type of fracture, defect location, size of bone and soft defects, and time from injury to operation between 2 groups (P > 0.05). Postoperative complications were observed; Paley's criterion was used to assess the bone healing and function recovery of the limb. RESULTS All the flaps survived and healing of wounds by second intention was obtained in all cases of group A; healing of wounds by first intention was obtained in 1 case, delayed healing in 3 cases, and healing by second intention in 9 cases in group B. All patients were followed up 1.5-4.5 years (mean, 2.4 years). Pin loosening or pin tract infection occurred in 15 cases of group A and in 10 cases of group B, and limb length discrepancy in 1 case of group B; there was no significant difference in the rate of complication (χ2 = 0.003, P = 0.955). In the distracted zone, all fractures healed naturally with excellent scale. The healing time was (251 ± 39) days in group A, and was (239 ± 45) days in group B, showing no significant difference (t = 0.800, P = 0.430); the healing index was (4.26 ± 0.19) d/mm in group A, and was (4.13 ± 0.19) d/mm in group B, showing no significant difference (t = 1.775, P = 0.086). In the bone defect zone, natural healing was obtained in 12 cases and healing after second operation or bone grafting in 6 cases, with healing time of (341 ± 55) days (excellent in 17 cases and good in 1 case) in group A; natural healing was obtained in 11 cases and healing after second operation or bone grafting in 2 cases, with the healing time of (295 ± 62) days (excellent in 12 cases and good in 1 case ) in group B; and there was significant difference in the healing time (t = 2.195, P = 0.036), but no significant difference in the healing scale (Z = -1.693, P = 0.091). At last follow-up, the function recovery was excellent in 7 cases, good in 6 cases, and fair in 5 cases in group A, and was excellent in 3 cases, good in 6 cases, and fair in 4 cases in group B, showing no significant difference (Z = -0.660, P = 0.509). CONCLUSION Using bone transport or bone shortening-lengthening by Ilizarov technique for tibial bone and soft tissue defects, the overall outcomes are similar, but the healing of bone defect zone is faster when using bone shortening-lengthening.
Collapse
|
20
|
Pizones J, Rodríguez-López T, Zúñiga L, Sánchez-Mariscal F, Álvarez-González P, Izquierdo E. [Treatment of juvenile scoliosis: Increasing the lengthening interval with the growing rod technique should not necessarily compromise thoracic growth]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014; 58:297-302. [PMID: 24857049 DOI: 10.1016/j.recot.2014.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 03/25/2014] [Accepted: 03/26/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Serial lengthening with growing rods is recommended every six months for the treatment of early onset scoliosis. The objective of this study was to evaluate the longitudinal growth of the thorax and control of the deformity in a series of patients with juvenile scoliosis when time intervals were increased between lengthenings. MATERIAL AND METHODS Retrospective study of eight patients. The following variables were measured: the Cobb angle, the apical vertebral translation, the coronal balance, thoracic T1-L1 length, thoracic T5-T12 kyphosis, the proximal junctional kyphosis (PJK) angle, and the lumbar lordosis. Complications were recorded. RESULTS Five idiopathic and three syndromic scoliosis cases (mean age 9.4 ± 1.5 years) were evaluated. The initial surgery was followed by with an average of two distractions per patient. The mean time between distractions was 15.7 months. The final coronal main curve correction was 58%. Apical translation and coronal balance were improved and maintained after the surgeries. The thoracic (T1-L1) preoperative length was 20.8 cm, the postoperative length was 24.4 cm, and the final length was 26 cm. At the end of follow-up, the average growth of the thorax was 5.2 cm. The preoperative (T5-T12) kyphosis was 33.5°, and final 32.1°. The change in the PJK angle was 2.5° at the end of follow-up. Most complications were related to instrumentation. Two superficial wound infections were encountered. CONCLUSION For less severe juvenile scoliosis patients treated with growing rods, spacing out lengthenings over more than a year can decrease the number of surgeries, while still controlling the deformity and allowing longitudinal thoracic growth.
Collapse
Affiliation(s)
- J Pizones
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Getafe, Madrid, España.
| | - T Rodríguez-López
- TR Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Marqués de Valdecilla, Santander, España
| | - L Zúñiga
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Getafe, Madrid, España
| | - F Sánchez-Mariscal
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Getafe, Madrid, España
| | - P Álvarez-González
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Getafe, Madrid, España
| | - E Izquierdo
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Getafe, Madrid, España
| |
Collapse
|
21
|
Yin Q, Sun Z, Gu S, Wei X, Song S, Ma Y. [Repair of large tibial bone and soft tissue defects by shortening-lengthening method]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2013; 27:1462-1465. [PMID: 24640366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To investigate the effectiveness of shortening-lengthening method using Ilizarov technique for repairing large tibial bone and soft tissue defects. METHODS Between January 2006 and December 2011, 12 patients with large tibial bone and soft tissue defects were treated by shortening-lengthening method using Ilizarov technique. There were 8 males and 4 females with an average age of 39.3 years (range, 18-65 years). The causes were injury in 8 cases and chronic infection in 4 cases. The area of soft tissue defect was 5 cm x 4 cm to 20 cm x 16 cm, and the length of tibial bone defect was 4.5-8.0 cm with an average of 6.2 cm. RESULTS Incision in the lengthening area healed by first intention; healing of wounds by first intention was achieved in 6 cases, delayed healing in 2 cases, and secondary healing in 4 cases, with no common peroneal nerve injury. All patients were followed up 18-54 months with an average of 29 months. In the lengthening area, the bone healing time was 180-365 days (mean, 267 days), and the healing index was 3.8-4.3 days/mm (mean, 4.1 days/mm). In the shortening area, the bone healing time was 195-380 days (mean, 297 days) in the others except 1 case who was repaired with bone grafting. Mild pin-related infection and loosening were observed in all cases, but no infection occurred in the lengthening or shortening area. At last follow-up, weight bearing of the leg was fully recovered in 12 cases. According to Mazur's criteria, the function of ankle was excellent in 2 cases, good in 6 cases, and fair in 4 cases. Nine patients had equal limb length, and 3 patients had shortened length less than 2 cm. CONCLUSION Shortening-lengthening method using Ilizarov technique has the advantages of simple surgery, less complications, easy to close the wound, and good effectiveness in repairing of large tibial bone and soft tissue defects.
Collapse
|
22
|
García-Renedo RJ, Carranza-Bencano A, Delgado-Calle J, Núñez-Samper M, Llanos-Alcázar LF. [Disruption of anterointernal weight bearing: sequelae of surgical treatment of hallux valgus]. Acta Ortop Mex 2012; 26:393-397. [PMID: 24712209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Sequelae of forefoot surgery range between 30 and 40%; the most frequent ones are transfer metatarsalgia and deformity relapse. Forefoot surgery complications disrupt biomechanics. Anterointernal weight bearing alteration is most frequent, due to involvement of the metatarsal, the phalanx or both. Metatarsophalangeal arthrodesis normalizes the length of the first ray and pressure transmission. The use of this technique has made it possible to confirm pain relief, as well as improved function and a better cosmetic result, which allows the patient to wear ormal footwear.
Collapse
|
23
|
Laumen A, Lammens J, Vanlauwe J. Reduction of treatment time in external ring fixation using the monofix device. Acta Orthop Belg 2012; 78:543-547. [PMID: 23019790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
One of the disadvantages of the Ilizarov method is the long treatment time needed for extensive lengthening or complex deformity correction. To minimize the discomfort of the circular frame the authors have introduced a 'frame reduction' technique in which the ring frame is converted towards a unilateral fixator, the 'Monofix'. Both its efficacy and patient satisfaction encouraged the authors to apply this method on a routine basis since 1998 for lower and upper limb corrections. The technique is demonstrated, its indications and potential problems are discussed.
Collapse
|
24
|
Suksathien Y, Suksathien R. Clinical study of a new design multifunction dynamic external fixator system for bone reconstructions. J Med Assoc Thai 2011; 94:1224-1229. [PMID: 22145508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Fractures with related problems including intercalary bone defect, shortening, and malunion are still major problems in orthopedic practice. The Ilizalov's circular external fixator device has several advantages for bone reconstruction but also has certain drawbacks such as its bulkiness and complicated mounting. To maintain the advantages of Ilizalov's original concept and combine with the simplicity of monolateral frame, a new design multifunction dynamic external fixator system was developed to overcome the drawbacks. OBJECTIVE To evaluate the clinical results and complications of a new design multifunction dynamic external fixator system for bone reconstructions. MATERIAL AND METHOD Twenty patients requiring reconstructions between 2006 and 2009 participated in this study. The new design multifunction dynamic external fixators were used in 11 tibial and two femoral intercalary defects for bone transportation, three tibial and one femoral lengthening, and three tibial malunion correction (45, 60 and 75 degrees). RESULTS In bone transportation, new bone formation and union at the docking site were achieved in all patients. The mean new bone formation was 5.8 cm (range 3.5-14) in tibia and 4.3 cm (range 3.5-5) in femur. The mean healing index was 46.3 days/cm (range 42-60) in tibia and 93.9 days/cm (range 85.7-102) in femur. In bone lengthening, new bone formation and union were achieved in all patients. The mean amount of elongation was 3.5 cm (range 3-4) in tibia and 5 cm in femur. The mean healing index was 71.1 days/cm (range 68.6-76) in tibia and 73 days/cm in femur. In malunion correction, the mean correction time was 65 days (range 35-84) and the mean healing time was 187.3 days (range 154-212). CONCLUSION The new design multifunction dynamic external fixator system was successfully used for bone transportation, bone lengthening, and malunion correction with good results and low complications. It is simple, safe, and easy to use.
Collapse
Affiliation(s)
- Yingyong Suksathien
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand.
| | | |
Collapse
|
25
|
Ganger R, Radler C, Chomiak J, Handlbauer A, Grill F, Dungl P. [Complications after femoral lengthening with ring fixators in congenital femoral deficiency]. Acta Chir Orthop Traumatol Cech 2011; 78:61-66. [PMID: 21375968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE OF THE STUDY Congenital femoral deficiency (CFD) is a rare and complex deformity. The results and complications of surgical correction of this deformity using ring fixators (Ilizarov/Taylor Spatial Frame) have been evaluated. MATERIAL AND METHODS We retrospectively reviewed a consecutive series of 30 patients with CFD, between the ages of 3.3 and 17 years (mean, 9.3 years), with 35 lengthening procedures. Ten cases were treated with an Ilizarov frame, 25 cases with a Taylor Spatial Frame (TSF). RESULTS The average lengthening at femoral osteotomy was 44.3 mm. Nine patients underwent an additional tibial lengthening by an average of 24.2 mm. The total lengthening was 50.5 mm (28-85 mm). A fracture after removal of the fixator occurred in 25.7% of the cases, and a pin-site infection with the subsequent need of operative revision was found in 8.5%. A subluxation of the knee joint was observed in 11.4% and a persistent limitation of the knee joint range of motion in 22.8%. CONCLUSIONS Despite several complications, the use of ring fixators, especially the TSF, is an effective method for treatment of this complex deformity. The complication rate was similar with the use of either ring fixator. Some complications can be decreased with experience. The risk of knee dislocation can be reduced by joint bridging and fractures after frame removal can be avoided by prophylactic rodding.
Collapse
Affiliation(s)
- R Ganger
- Ortopedická nemocnice Speising, oddělení dětské ortopedie, Vídeň, Rakousko
| | | | | | | | | | | |
Collapse
|
26
|
Eralp L, Kocaoglu M, Bilen FE, Balci HI, Toker B, Ahmad K. A review of problems, obstacles and sequelae encountered during femoral lengthening : uniplanar versus circular external fixator. Acta Orthop Belg 2010; 76:628-635. [PMID: 21138218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
There is currently a consensus regarding the superiority of circular type external fixators over uniplanar fixators for lengthening of the tibia, but femoral lengthening is still subject to the surgeon's preference. This study compares the occurrence rates of significant problems, obstacles and sequelae between these two techniques. Fifty patients (29 male, 21 female), with a mean age of 20 years were assigned to a circular type fixator group (54 lengthening segments), whereas 60 patients (29 male, 31 female), with a mean age of 20 years were assigned to a uniplanar fixator group (67 lengthening segments). The incidence of knee stiffness was significantly higher in the circular external fixator group (031 per segment) compared to the uniplanar external fixator group (0.13 per segment) (p < 0.05). The incidence of pain during lengthening was higher in the circular external fixator group, and patient satisfaction was higher in the uniplanar external fixator group. We recommend the uniplanar external fixator as a preferable device for femoral lengthening.
Collapse
Affiliation(s)
- Levent Eralp
- Istanbul University, Istanbul Medical School, Turkey
| | | | | | | | | | | |
Collapse
|
27
|
Abstract
The purpose of this article is to address the isolated causes of osseous central metatarsalgia that are related to an elongated metatarsal and brachymetatarsalgia. The authors focus on surgically addressing shortened and elongated metatarsals, surgical complications, and revisional surgery.
Collapse
Affiliation(s)
- Catherine A Casteel
- Department of Podiatry, Hunt Regional Medical Center of Greenville, 4215 Joe Ramsey Boulevard, Greenvillle, TX 75401, USA.
| | | | | |
Collapse
|
28
|
Lampasi M, Launay F, Jouve JL, Bollini G. Femoral lengthening over elastic stable intramedullary nailing in children using the monolateral external fixator. Musculoskelet Surg 2009; 93:57-64. [PMID: 19711002 DOI: 10.1007/s12306-009-0032-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2009] [Accepted: 04/29/2009] [Indexed: 05/28/2023]
Abstract
The authors report preliminary results of femoral lengthening performed with monolateral external fixation over elastic stable intramedullary nailing in children. Seven femoral lengthenings were performed in six patients, at a mean age at surgery of 6.6 years (range 1.5-12 years). All lengthenings were performed due to limb length discrepancy (congenital hypoplasia in four patients, growth arrest secondary to neonatal infective osteoarthritis in one, type II sacral agenesis in one). In six cases the elastic nails realised a bipolar ascending construct, in one case a descending construct. Cases were reviewed at a mean time from removal of external fixator of 34.2 months (range 15-75 months). The mean lengthening obtained was 4.8 cm (range 3.8-6.0 cm). Mean consolidation index was 42.9 days/cm. No case of axial deviation requiring surgery and no case of deep infection were recorded. No case of fracture of the regenerate occurred after removal of the external fixator. There were two premature consolidations requiring mobilisation under general anaesthesia, and a case of failure of consolidation requiring surgery. The technique reported provides indisputable biomechanical advantages, particularly increasing stability at the site of osteotomy. The characteristics of implants make this method ideal for lengthenings in children.
Collapse
Affiliation(s)
- Manuele Lampasi
- Department of Paediatric Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy.
| | | | | | | |
Collapse
|
29
|
Ramseier LE, Exner GU. [Lengthening of proximal femoral focal deficiency using a hybrid fixation with inclusion of the knee joint]. Orthopade 2007; 36:582, 584-7. [PMID: 17443312 DOI: 10.1007/s00132-007-1075-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND A major problem in lengthening a short femur in proximal focal deficiency of the femur (PFFD) is the development of contractures and dislocation of the hip and knee joint. The knee joint is particularly prone to dislocation because of the cruciate ligament insufficiency associated with PFFD. Axis deviations also need specific attention. PATIENTS AND METHODS In four patients (age 2.5-11 years) with PFFD (PAPPAS class III in one patient and VII in three patients), five femoral lengthenings with mechanical axis corrections were performed by the callotasis technique using a hybrid fixation system (Monotube/Triax) connecting the femur and the tibia with a fixed hinged knee joint to protect the knee against contracture and dislocation. RESULTS All patients retained their hip and knee function. Hip flexion contracture during lengthening may make inclusion of the hip joint into the fixation system necessary, but was not carried out in the four patients presented. CONCLUSION Four consecutive lengthenings of the femur with focal deficiency were carried out under protection by a hinged knee bridging external fixator. A dislocation could be prevented in all patients. We consider that such a system could be used during these lengthening procedures.
Collapse
Affiliation(s)
- L E Ramseier
- Orthopädische Universitätsklinik Zürich, Balgrist, Forchstr. 340, 8008 Zürich.
| | | |
Collapse
|
30
|
Eralp L, Kocaoglu M, Yusof NM, Bulbul M. Distal tibial reconstruction with use of a circular external fixator and an intramedullary nail. The combined technique. J Bone Joint Surg Am 2007; 89:2218-24. [PMID: 17908899 DOI: 10.2106/jbjs.f.01579] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Distal tibial reconstruction with use of an external fixator when there is bone loss, limb-length discrepancy, and/or ankle instability is associated with many problems. The technique of limb-lengthening, ankle arthrodesis, and segmental transfer over an intramedullary nail has been introduced to overcome these problems. The present study investigates this combined technique. METHODS Between 2002 and 2005, six patients, who ranged from seventeen to seventy years old, underwent distal tibial reconstruction and ankle arthrodesis with use of a circular external fixator and an intramedullary nail to treat a distal tibial defect following resection for chronic osteomyelitis or tumor or to treat a limb-length discrepancy combined with ankle instability. Functional and radiographic results were evaluated, with use of the criteria described by Paley et al., at an average follow-up of thirty-four months. RESULTS The mean size of the bone defects in three patients was 5.3 cm (2, 7, and 7 cm), and the mean amount of the limb-shortening in four patients was 5.25 cm (range, 4 to 6 cm). The mean external fixation time was 3.5 months, and the mean external fixator index was 0.57 mo/cm. There was no recurrence of infection in the two patients with osteomyelitis. All six patients had excellent bone results, and the functional results were excellent for two patients and good for four patients. There were four complications, three of which were categorized, according to Paley, as a problem (a difficulty that occurs during lengthening and is resolved without operative intervention) and one that was categorized as an obstacle (a difficulty that occurs during lengthening and needs operative treatment). CONCLUSIONS The combined technique is an improvement over the classic external fixation techniques of distal tibial reconstruction with ankle arthrodesis. It reduces the duration of external fixation, thus increasing patient acceptance, and it is associated with a low complication rate facilitating more rapid rehabilitation.
Collapse
Affiliation(s)
- Levent Eralp
- Department of Orthopaedics and Traumatology, Istanbul Medical School, Istanbul University, Capa 34390, Istanbul, Turkey.
| | | | | | | |
Collapse
|
31
|
Rancont CM. Chronic psoas syndrome caused by the inappropriate use of a heel lift. J Am Osteopath Assoc 2007; 107:415-8. [PMID: 17908834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Heel lifts are commonly recommended for patients to manage the pain and discomfort of leg length discrepancies. However, used inappropriately, orthotics can create additional pain instead of alleviating it. In the case described, a 79-year-old male physician used a recommended heel lift for a perceived leg length discrepancy after right hip arthroplasty. Six months postsurgery, chronic, intractable pain developed in his hip and groin. He underwent a battery of tests to locate the pain, but its source remained elusive. Osteopathic evaluation and radiographic examination revealed an absence of leg length discrepancy and the presence of chronic psoas syndrome. Osteopathic manipulative treatment was prescribed and heel lift therapy discontinued, and the patient reported complete remission from pain.
Collapse
|
32
|
Abstract
Combining a circular fixator with a percutaneously inserted locking plate has all of the same advantages that lengthening over an intramedullary nail provides but eliminates the concern with regard to creating a deep infection in the medullary canal. It also can be applied to virtually any bone in any age group of patients without any concern with regard to causing avascular necrosis, fat embolism, or physeal injury. The design of the locking plate prevents loss of fixation and protects against bending of the regenerate bone after frame removal. This study represents a description of the surgical technique and a retrospective examination of the first 6 patients treated using this technique. The average age of the patients is 7.6 years, and the average duration of follow-up is 10 months. All 6 patients achieved solid union of the lengthening site and full, unassisted weight bearing with excellent range of motion. The mean lengthening was 3.52 cm, which represents an average of 14.6% of the overall bone length. The mean duration of external fixation was 45 days, and the mean external fixation index was 0.42 mo/cm. The mean distraction rate was 0.85 mm/d. There were 3 serious and 2 severe complications noted. The serious complications included the development of a premature consolidation and a translational deformity of the regenerate in 1 patient, requiring a revision corticotomy, and a fall of a second patient 3 months after fixator removal, causing a fracture at the superior edge of his locking plate. The 2 severe complications were an 11-degree and an 18-degree residual procurvatum deformity that developed during lengthening. In conclusion, lengthening with the assistance of a percutaneously inserted locking plate provides an alternative method to lengthening over an intramedullary nail, applicable to children with open physes.
Collapse
Affiliation(s)
- Christopher A Iobst
- Department of Orthopedic Surgery, Miami Children's Hospital, Miami, FL 33155, USA.
| | | |
Collapse
|
33
|
Kiss S, Pap K, Vízkelety T, Terebessy T, Balla M, Szoke G. The humerus is the best place for bone lengthening. Int Orthop 2007; 32:385-8. [PMID: 17323094 PMCID: PMC2323419 DOI: 10.1007/s00264-007-0327-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Accepted: 12/23/2006] [Indexed: 10/23/2022]
Abstract
The aim of this study was to examine the effectiveness of lengthening the humerus in children and young adults. Between 1984 and 2005, the Orthopaedic Department of Semmelweis University elongated 11 humeri (ten patients) for reasons of congenital hypoplasia (four cases), osteomyelitis (three cases), epiphyseolysis, growth plate closure after irradiation and obstetrical paralysis (one case each). The study cohort consisted of five females and five males, with an average age at the time of surgery of 17.8 years (range: 12-31 years). In every case, the lengthening was performed with a unilateral Wagner fixator. The lengthening protocol was 1 mm distraction daily (callotasis) after a 7-day latency period. The fixator was removed after total bone healing. Plate fixation or bone transplantation was not used. The average rate of lengthening was 6.2 cm (4.5-10.5 cm), and the achieved lengthening was 27% (range: 16-44%). The average healing index was 32 day/cm. One patient who suffered from temporary radial paresis, and temporary flexion contracture of the elbow was regarded as a complication following placement of the fixator. Based on our results, humeral shortening can effectively be treated with the unilateral Wagner fixator. The main difference between the original Wagner method and our approach is that we were able to leave the fixator in the humerus until total bony reconstruction so there was no need for plate fixation or bone transplantation.
Collapse
Affiliation(s)
- Sándor Kiss
- Department of Orthopaedics, Semmelweis University of Budapest, Budapest, 27 Karolina street, 1113, Hungary.
| | | | | | | | | | | |
Collapse
|
34
|
Shadi M, Koczewski P. [Humeral lengthening with a monolateral external fixator in achondroplasia]. Pediatr Endocrinol Diabetes Metab 2007; 13:121-4. [PMID: 17880818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
INTRODUCTION In achondroplasia patients the shortening of upper limb (mainly the arms) is an important part of pathology in addition to low stature. Not all patients who are treated for increasing their height decided to have humeral lengthening and the indication for treatment is not only for cosmetic, psychological aspects but also limitation of upper limb function like self-services and personal hygiene. MATERIAL AND METHODS 5 patients were evaluated (4 girls and 1 boy) at age of 14 to 18 years (mean 15.7) in whom 10 humeral lengthening were do-ne using monolateral external fixator "Pumed". All patients have lower limb lengthening with the Ilizarov method 4-5 years before humeral lengthening. Observation time was 6 to 34 months (mean 20). In all cases the Pumed external fixator was fixed to humerus by 4 Schanz screws, open humeral distraction osteotomy was done below the insertion of deltoid muscle. In one case 15 degrees anteflexion correction was done intraoperatively. Distraction began at 5-6th day postoperatively with rate of 1 mm/day. Because of hypertrophic bone regenerate the distraction rate was often increased up to 1.5 mm/day. RESULTS 8 to 9 cm lengthening was achieved (mean 8.5) which represents more than 50% of the primary segmental length. The average time of fixator application was 7 months and the lengthening index ranged from 0.8 to 1.1 months/cm (average 0.85). No shoulder and elbow joint range of motion deterioration was observed. At the follow-up transient radial nerve palsy was observed in one case after acute limb axis correction. CONCLUSIONS Humerus lengthening, in achondroplasia patients with the use of monolateral external fixator is an effective and reliable method of treatment, with relatively low lengthening index. Monolateral External Fixator are well tolerated by patients.
Collapse
Affiliation(s)
- Milud Shadi
- Katedra i Klinika Ortopedii Dzieciecej i Traumatologii UM im K. Marcinkowskiego w Poznaniu
| | | |
Collapse
|
35
|
McCarthy JJ, Mark AK, Davidson RS. Treatment of angular deformities of the tibia in children: acute versus gradual correction. J Surg Orthop Adv 2007; 16:118-122. [PMID: 17963654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This is a retrospective review of 25 tibial osteotomies (in 19 patients) performed with either acute or gradual correction to determine the outcome of treatment and incidence of neurovascular complications. Patients undergoing gradual correction had fewer neurovascular complications and greater correction than those undergoing acute correction (27 degrees vs. 18 degrees, respectively). It was concluded that gradual correction tends to be a safer technique for the treatment of tibial deformities and allows greater correction.
Collapse
Affiliation(s)
- James J McCarthy
- Shriners Hospitals for Children, 3551 North Broad Street, and Temple University Health Sciences Center, Philadelphia, PA 19140, USA.
| | | | | |
Collapse
|
36
|
Verheyen CCPM. Clinical tip: distraction technique for restoring length of the fibula in ankle fractures. Foot Ankle Int 2006; 27:867-8. [PMID: 17054893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
37
|
Abstract
BACKGROUND Different methods and devices are used to perform lengthening and deformity reconstruction in the tibia. Recently, the Taylor spatial frame (TSF) has been introduced as a computer-assisted and versatile external ring fixator. Lengthening index (LI) and complications are important result parameters, and the aim of this study was to review our first 20 tibial segments operated with the TSF and to compare the results with our experience of using the traditional Ilizarov external fixator (IEF). PATIENTS AND METHODS We lengthened 20 tibial segments in 20 patients with the TSF. The results were compared with those of 27 tibial segments from 27 patients that were lengthened with the IEF. All segments were operated on with monofocal osteotomies. RESULTS In the overlapping zone of comparable lengthening distances between 2.4 and 6.0 cm, the LI of 2.4 and 1.8 months/cm was not significantly different between the TSF and IEF groups, respectively (p = 0.17). This non-significant difference was confirmed after adjustment for age. INTERPRETATION We found no difference between the TSF and IEF frames regarding LI and complication rate. However, rotational, translational, and residual deformity correction is easier to perform with the TSF.
Collapse
Affiliation(s)
- Leif Pål Kristiansen
- Rikshospitalet-Radiumhospitalet Medical Center, Biomechanics Laboratory, Orthopaedic Department, University of Oslo, Oslo, NO-0027, Norway.
| | | | | |
Collapse
|
38
|
Placzek R, Ruffer M, Deuretzbacher G, Heijens E, Meiss AL. The fixation strength of hydroxyapatite-coated Schanz screws and standard stainless steel Schanz screws in lower extremity lengthening : a comparison based on a new torque value index: the fixation index. Arch Orthop Trauma Surg 2006; 126:369-73. [PMID: 16628428 DOI: 10.1007/s00402-006-0142-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2004] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Lengthening procedures are often complicated by loosening of pins. It has been reported that coating with hydroxyapatite improves fixation and reduces the rate of pin-track infection. MATERIALS AND METHODS We compared 47 hydroxyapatite-coated Schanz screws (HA screws) in 12 monolateral fixators mounted at the University Hospital Hamburg-Eppendorf with 45 standard stainless steel screws in 9 monolateral fixators mounted at the St Josefs-Hospital Wiesbaden by measuring the insertion and extraction torque values. The average implantation period was 7 months for the hydroxyapatite-coated screws and 5.4 months for the uncoated screws. We established the quotient of the maximum extraction torque over insertion torque which shows the change in the fixation strength with respect to time, the fixation index. It eliminates the influence of the varying pin-bone contact. RESULTS There was no significant difference in the rate of infection. In the Schanz screws without signs of infection the index was 1.92 for the HA screws and 0.76 for the stainless steel screws (P = 0.0002) giving evidence of the improvement of the fixation by the coating. CONCLUSION HA coating resulted in improved fixation of Schanz screws in bone and may be useful in prolonged external fixation of the lower leg. The fixation index proved to be a simple tool for the evaluation of the fixation strength of Schanz screws.
Collapse
Affiliation(s)
- R Placzek
- CMSC, Paediatric Orthopaedic Section, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13533 Berlin, Germany.
| | | | | | | | | |
Collapse
|
39
|
Lindsey RW, Gugala Z, Milne E, Sun M, Gannon FH, Latta LL. The efficacy of cylindrical titanium mesh cage for the reconstruction of a critical-size canine segmental femoral diaphyseal defect. J Orthop Res 2006; 24:1438-53. [PMID: 16732617 DOI: 10.1002/jor.20154] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The authors developed a novel technique for the reconstruction of large segmental long bone defects using a cylindrical titanium mesh cage (CTMC). Although the initial clinical reports have been favorable, the CTMC technique has yet to be validated in a clinically relevant large animal model, which is the purpose of this study. Under general anesthesia, a unilateral, 3-cm mid-diaphyseal segmental defect was created in the femur of an adult canine. The defect reconstruction technique consisted of a CTMC that was packed and surrounded with a standard volume of morselized canine cancellous allograft and canine demineralized bone matrix. The limb was stabilized with a reamed titanium intramedullary nail. Animals were distributed into four experimental groups: in Groups A, B, and C (six dogs each), defects were CTMC reconstructed, and the animals euthanized at 6, 12, and 18 weeks, respectively; in Group D (three dogs), the same defect reconstruction was performed but without a CTMC, and the animals were euthanized at 18 weeks. The femurs were harvested and analyzed by gross inspection, plain radiography, computed tomography (CT), and single photon emission computed tomography (SPECT). The femurs were mechanically tested in axial torsion to failure; two randomly selected defect femurs from each group were analyzed histologically. Groups A, B, and C specimens gross inspection, plain radiography, and CT, demonstrated bony restoration of the defect, and SPECT confirmed sustained biological activity throughout the CTMC. Compared to the contralateral femur, the 6-, 12-, and 18-week mean defect torsional stiffness was 44.4, 45.7, and 72.5%, respectively; the mean torsional strength was 51.0, 73.6, and 83.4%, respectively. Histology documented new bone formation spanning the defect. Conversely, Group D specimens (without CTMC) demonstrated no meaningful bone formation, biologic activity, or mechanical integrity at 18 weeks. The CTMC technique facilitated healing of a canine femur segmental defect model, while the same technique without a cage did not. The CTMC technique may be a viable alternative for the treatment of segmental long bone defects.
Collapse
Affiliation(s)
- Ronald W Lindsey
- Department of Orthopaedic Surgery, Baylor College of Medicine, 6560 Fannin, Suite 1900, Houston, Texas 77030, USA.
| | | | | | | | | | | |
Collapse
|
40
|
Abstract
This article represents a review of the author's experience with the Wagner lengthening device. Forty patients between 6 and 20 years of age underwent 44 lengthenings of the lower extremity by Wagner's technique (34 femoral and 10 tibial) between February 1977 and January 1999. Shortening was congenital in origin in 24 patients. Lengthening achieved averaged 5.69 cm for the femur and 4.3 cm for the tibia. No complication was observed in 50% of the lengthenings (category I). At least one complication modified the program and necessitated further surgery and general anesthesia in 45.45% of lengthenings (category II). The program was not completed in one patient and complications resulted in a sequela in another patient, representing 4.54% of lengthenings (category III). Twenty-one of the 22 lengthenings without complication were at the femur. Complications were more frequent in patients with a congenital origin. Many complications but no disastrous problems were encountered. Lengthening is better tolerated in children older than 10 years of age. Thirty-nine patients completed their program and were left with less than 2.5 cm discrepancy at the end of growth. The average follow-up was 8.10 years.
Collapse
|
41
|
Abstract
During the last decade, external fixation for the pediatric foot and ankle has evolved as a result of advances in technology (eg, Taylor spatial frame, hydroxyapatite-coated external fixator pins) and preoperative deformity planning. Although complications are common, most are minor and can be addressed nonoperatively while treatment continues. This article reviews the indications and applications of external fixation for soft tissue contractures, idiopathic and teratologic clubfoot, osteotomies, metatarsal lengthening, tibial lengthening, and foot and ankle trauma.
Collapse
Affiliation(s)
- Bradley M Lamm
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, MD 21215, USA.
| | | | | | | | | |
Collapse
|
42
|
Aleksyniene R, Eckardt H, Bundgaard K, Lind M, Hvid I. Effects of parathyroid hormone on newly regenerated bone during distraction osteogenesis in a rabbit tibial lengthening model. A pilot study. Medicina (Kaunas) 2006; 42:38-48. [PMID: 16467612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE The overall purpose of the study is to determine the effects of parathyroid hormone (PTH) (1-34) on bone formation in regenerated and surrounding bone of distracted callus during limb lengthening in rabbits. Additionally the aim of the pilot study is to titrate the optimal dose of PTH for distraction osteogenesis treatment in rabbits' tibial lengthening model. MATERIALS AND METHODS A total of 18 rabbits underwent right tibia lengthening by callus distraction. Lengthening was started 5 days postoperatively 1 mm/day for a 10-day period and consolidation of 20 days followed. Rabbits were divided into three groups: group I received PTH (1-34) treatment at a dose of 5 microg/kg/day, group II received treatment with PTH (1-34) at a dose of 25 microg/kg/day; group III rabbits were treated with saline. After euthanasia, tibiae of both legs were dissected free, kept frozen and underwent x-ray analysis, dual x-ray absorptiometry-scanning, microcomputed tomography scanning and three-dimensional evaluation and mechanical test followed. RESULTS Over all, during distraction osteogenesis in a new regenerated bone, PTH (1-34) treatment with two different doses of 5 microg/kg/day and 25 microg/kg/day increased callus cross-sectional area, callus bone mineral density and bone mineral content, bone volume density; dramatically increased trabecular number with slight increase in trabecular thickness, whereas decreased trabecular separation, bone surface density and decreased degree of anisotropy when compared to control group animals. CONCLUSION PTH (1-34) treatment improved mineralization, structural indices of regenerated distracted rabbits' tibiae, whereas treatment at a dose of 25 microg/kg/day PTH (1-34) was significantly more effective than 5 microg/kg/day PTH(1-34) dose treatment when compared to control group. Bigger dose has been chosen for the main study.
Collapse
|
43
|
Abstract
Patients with short lower-extremity amputation stumps exhibit poor prosthetic fit and inefficient gait. Often they are fit at the next-higher prosthetic level, increasing energy consumption. This study aimed to characterize the risk/benefit ratio of stump lengthening with planar external fixators. All patients lengthened for functionally short amputation stumps were reviewed. Outcome measures included changes in prosthetic use, soft tissue problems, qualitative gait analysis, and surgical complications. Patients averaged 15.1 years of age at surgery, with 4.1 years of follow-up. The average lengthening index was 9.2 mm/mo. Femoral lengthenings obtained more length (8.7 vs. 6.9 cm). After treatment, prosthetic skin-related complications decreased and qualitative gait parameters improved. Most (85%) wore a standard prosthesis for their amputation level after surgery, whereas none could before. There were 1.4 complications per patient, all successfully surgically treated. Lengthening is time-consuming and associated with frequent complications but results in improved gait and energy consumption.
Collapse
Affiliation(s)
- Richard E Bowen
- Shriners Hospitals for Children, Los Angeles, California 90020, USA.
| | | | | | | |
Collapse
|
44
|
Abstract
BACKGROUND Long-term application of an external fixator to treat leg-length discrepancy and short stature often causes complications, such as pin-tract infection or loss of range of motion at the knee or ankle (or both). Prolonged fixator use also interferes with the activities of daily living. To minimize such problems, we have combined intramedullary nailing with external fixation. Using this technique, the external fixator can be removed more quickly after completing the lengthening. METHODS We combined intramedullary nailing with lengthening in 13 tibias (8 patients) and then compared these cases with 17 standard tibial lengthenings (16 patients) using an external fixator alone. In both groups we excluded patients who had a history of previous bone infection, open fracture, immature bone, soft tissue compromise, antineoplastic chemotherapy, or bone deformity of a severity that required gradual deformity correction. We also excluded cases with lengthening of less than 3 cm. RESULTS The mean external fixation index differed significantly between the two groups, but the consolidation index did not. Mean operating time for lengthening combined with intramedullary nail placement was approximately 60 min longer than for standard lengthening without nail placement; intraoperative blood loss was not greater in the nailing group. Complications related to the external fixator were far fewer in the combined intramedullary nailing and lengthening group compared with the control group, and callus formation was satisfactory for both groups. CONCLUSIONS A combination of intramedullary nailing and external fixation produces callus formation as good as that obtained by the standard Ilizarov method of lengthening. Furthermore, this combined procedure decreases the external fixation time and is associated with fewer complications.
Collapse
Affiliation(s)
- Koji Watanabe
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Japan
| | | | | | | | | | | |
Collapse
|
45
|
Karlen LKP, Yinusa W, Yan LS, Wang KW, Hoi LY, John LCY. Analysis of scar formation after lower limb lengthening: influence on cosmesis and patient satisfaction. J Pediatr Orthop 2005; 24:706-10. [PMID: 15502574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Limb lengthening aims to reduce limb length discrepancy, improve cosmesis, and permit more functional mobility. Scarring, however, is a major concern of patients. In this study 25 patients (27 lengthening sites) were assessed; 6 sites were lengthened with Orthofix and 21 sites with Ilizarov. Altogether, 452 pin tract scars were assessed. The mean scar length was 11.5 mm in the Ilizarov group (n=415) and 54.1 mm in the Orthofix group (n=37). The mean scar width was 5.6 mm in the Ilizarov group and 11.5 mm in the Orthofix group. The mean patient satisfaction was 7.3 in the Orthofix group and 5.5 in the Ilizarov group. The mean Vancouver score was 0.66 in the Ilizarov group and 3.1 in the Orthofix group. The scars were shorter and cosmetically better in the Ilizarov group, but patients were more satisfied in the Orthofix group because there were fewer scars. Patients were also more satisfied with the thigh scars than with the leg scars because clothing can easily cover the thigh scars.
Collapse
Affiliation(s)
- Law Ka Pui Karlen
- Occupational Therapy Department, The Duchess of Kent Children's Hospital at Sandy Bay, Hong Kong, China.
| | | | | | | | | | | |
Collapse
|
46
|
Ohnishi I, Kurokawa T, Sato W, Nakamura K. Measurement of the tensile forces during bone lengthening. Clin Biomech (Bristol, Avon) 2005; 20:421-7. [PMID: 15737450 DOI: 10.1016/j.clinbiomech.2004.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2004] [Revised: 08/19/2004] [Accepted: 10/25/2004] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the effects of lengthening frequency on mechanical environment in limb lengthening. METHODS Tensile forces were continuously monitored using a load sensor attached to a unilateral external fixator. Twenty patients were monitored. Ten patients were with acquired femoral shortening, and five of them underwent quasi-continuous lengthening of 1440 steps per day, and the other five received step lengthening twice a day. The other 10 patients were with achondropalsia. Five of them underwent the same quasi-continuous lengthening, and the other five received the same step lengthening. The circadian change and the daily course of the tensile forces were assessed and compared between quasi-continuous lengthening and step lengthening. FINDINGS As for circadian change, an acute increase in the force took place simultaneously with each step of lengthening in the step-lengthening group, but very little change of the baseline force level was seen during quasi-continuous lengthening. As for daily course of the tensile force, it increased almost linearly in both lengthening frequency groups in the initial stage of lengthening. No significant difference of the average force increment rate in this phase was recognized between the quasi-continuous and step lengthening groups irrespective of the etiologies. INTERPRETATION The lengthening frequency greatly affected the circadian change of the tensile force, but did not affect the increment rate of the force in the linear phase.
Collapse
Affiliation(s)
- Isao Ohnishi
- Faculty of Medicine, Department of Orthopaedic Surgery, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku Tokyo, 113-0033, Japan.
| | | | | | | |
Collapse
|
47
|
Xia HT, Peng AM, Luo XZ, Qin SH, Han YL, Zhang BZ, Shi WY. [Combined external skeletal fixation instrumentation with locked intramedullary nailing for tibia lengthening]. Zhonghua Wai Ke Za Zhi 2005; 43:495-8. [PMID: 15938904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To shorten the time of external skeletal fixation on legs, and enhance quality of limb lengthening, avoid complications of shortening, bending, twisting and etc. METHODS Insert pin transcortical to attack external skeletal fixation simultaneously, put un-reaming locked intramedullary nail (do not insert distal locked screw) into endosteum of lengthening bone. After the legs achieved predetermined length, insert distal locked screw and then remove external skeletal fixation, locked intramedullary nail, then maintain consolidation of rehabilitation. RESULTS The group lengthened legs for 412 cases. The range of lengthening was 3 to 18 cm. Mean length was 7.6 cm. The mean time for needed external skeletal fixation was 20 d/cm. The mean time of osteogenesis was 56 d/cm. For complications, there were 3 tibias ununion cases and 1 varus ankle. All cases were treated undergoing twice. CONCLUSIONS The method reduces the time for needed external skeletal fixation visibly, enhances the quality of limb lengthening remarkably, prevents complications of shortening new bone, deformity, bending and re-fracture which do not effect the healing time. This is a new choice of limb lengthening.
Collapse
Affiliation(s)
- He-tao Xia
- Beijing Institute of External Skeletal Fixation Technology, Beijing 100039, China.
| | | | | | | | | | | | | |
Collapse
|
48
|
Ettl V, Wild A, Thorey F, Kirschner S, Krauspe R, Raab P. Deformitätenkorrektur am Unterarm bei Kindern mit multipler kartilaginärer Exostosenkrankheit. ACTA ACUST UNITED AC 2005; 143:106-11. [PMID: 15754240 DOI: 10.1055/s-2004-836251] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM Deformity of the forearm with shortening and bowing is common in children with multiple cartilaginous osteochondromas. The objective of this study was to evaluate the benefit of ulnar lengthening using an external fixateur in these patients. METHOD 9 patients (10 cases) underwent surgery of the forearm between 1995 and 2001 and were evaluated using a standard protocol. The mean follow-up was 33.6 months, the mean age at operation 8.9 years. All patients were treated with ulnar lengthening, in 6 cases combined with an excision of the osteochondromas. RESULTS Four out of ten patients did show an improvement in postoperative forearm rotation, two deteriorated and 4 presented unchanged. Wrist motion improved in 7 patients and remained unchanged in 3. The postoperative radial articular angle showed an improvement in 6, the carpal slip in 9 of the patients. The preoperative radial head dislocation in one patient remained unchanged postoperatively. CONCLUSION The authors advocate this therapeutic concept for the correction of forearm deformity in multiple hereditary osteochondromas to prevent a progression of the deformity and to establish carpal stability. A significant improvement of forearm and wrist function could not be reached.
Collapse
Affiliation(s)
- V Ettl
- Orthopädische Klinik, König-Ludwig-Haus, Lehrstuhl für Orthopädie, Würzburg, Deutschland
| | | | | | | | | | | |
Collapse
|
49
|
Hatzokos I, Gigis I, Marinou A, Pournaras J. Bone lengthening for correction of limb length discrepancy in a patient with Klippel-Trenaunay syndrome: a case report. Acta Orthop Belg 2004; 70:623-6. [PMID: 15669469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- Ippokratis Hatzokos
- 1st Orthopaedic Department, G Papanikolaou General Hospital, Thessaloniki, Greece.
| | | | | | | |
Collapse
|
50
|
Abstract
BACKGROUND In limb-lengthening, the quest for increased patient comfort and a reduced period of external fixation has led to techniques such as lengthening over an intramedullary nail. The goals of this study were to investigate the rate and types of complications encountered during lengthening over an intramedullary nail and to identify solutions to these complications. METHODS Forty-two segments (thirty-five femora and seven tibiae) in thirty-five patients were lengthened. The mean age of the patients was 26.6 years, the mean amount lengthened was 6.3 cm (range, 2.5 to 11.5 cm), the mean external fixation index was 18.7 days/cm, and the mean lengthening index was 31.2 days/cm. The patients were followed for a mean period of forty-four months postoperatively. RESULTS Eighteen complications occurred in sixteen (38%) of the forty-two segments for a rate of 0.43 complication per segment. Complications were classified, according to the system of Paley et al., as two problems, thirteen obstacles, and three sequelae. Sixteen of them required additional surgical interventions. A preoperative score of >6.5 on the system of Paley et al., a lengthening of >6 cm, and a lengthening percentage of >21.5% of the original bone length were indicators of a higher probability of the occurrence of complications. CONCLUSIONS Lengthening over an intramedullary nail provides increased patient comfort and reduces the external fixation period. If the problems encountered are treated aggressively, the result of the treatment can be quite satisfactory.
Collapse
Affiliation(s)
- Mehmet Kocaoglu
- Department of Orthopaedics and Traumatology, Istanbul Medical School, Istanbul University, Capa, 34390 Topkapi, Istanbul, Turkey.
| | | | | | | | | |
Collapse
|