Bone lengthening (distraction osteogenesis): a literature review

Abstract

Distraction osteogenesis (DO) is a surgical technique widely used in orthopedic surgery for the treatment of various pathological conditions such as leg length discrepancy, bone deformity or bone defects. The basic principle of the callotasis technique includes performing a transverse bone section before gradually distracting the two bone segments. New bone tissue is generated in the gap between the two segments. Bone regeneration during DO is believed to occur in response to the longitudinal mechanical strain applied to the callus during healing. One of the limitations of this technique is the long period of time required for the newly formed bone tissue to mineralize and consolidate. Various studies have reported that among growth factors, bone morphogenetic proteins (BMPs) may play a central role in the molecular signaling cascade leading to bone renegeration and remodeling in a DO procedure. Ongoing research is aimed at developing methods to accelerate bone consolidation in order to reduce the time required to obtain consolidation. One of these methods is to test the ability of exogenous BMPs to increase bone regeneration and accelerate bone consolidation.

Bone Regeneration Based on Tissue Engineering Conceptions — A 21st Century Perspective

“…Large bone defects (>5 cm) may be treated with bone segment transport or free vascularized bone transfer (49), as the use of an autologous bone graft alone is not recommended because of the risk of graft resorption despite good soft tissue coverage (50). The vascularised fibula autograft (51) and the Ilizarov method (52)(53)(54) are the most commonly used treatment methods for larger bone defects; however, complications are common and the process can be laborious and painful for the patient as she/he may be required to use external fixation systems for up to one and half years (49,(55)(56).…”

Clinical evaluation of patients submitted to osteogenic distraction in the lower limb at a university hospital

“…The external fixator should be maintained for an extended period, until the consolidation, which can lead to surgical, social, and psychological complications 6, 10, 11, 12. On average, the present patients underwent over four surgeries until the end of treatment, using a dynamic fixator for 2 years and with several complications, but approximately 90% of them did not experience serious sequelae.…”

“…In 1969, Ilizarov and Ledyaev 5 were able to fill the bone defect and extend the limb after debridement of the infected bone and, at the same time, correct deformities. Their method was revolutionary by the standards of orthopedic treatments of the time 1, 6, 7…”

Osteoneogenesis due to periosteal elevation with degradable and nondegradable devices in Göttingen Minipigs

“…To enhance this effect, other groups performing PDO and GBR used cortical perforations under their devices for the initiation of bleeding and the possible inflow of mesenchymal stem cells, hypothesizing that these events are the origin of new bone formation (Oda et al, 2009;Rompen et al, 1999;Sailhan, 2011). One could reason that the lack of such perforations in our study was the reason for the minimal bone M A N U S C R I P T…”