Callus formation in the humerus compared with the femur and tibia during limb lengthening

Tanaka, Kihachiro; Nakamura, Kozo; Matsushita, T.; Horinaka, Susumu; Kusaba, Ikuo; Kurokawa, Takahide

doi:10.1007/s004020050242

Cited by 15 publications

(9 citation statements)

References 3 publications

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“…Complications using monolateral fixators in humeral lengthening are less than for other long bones (Tanaka et al 1998, Hosny 2005, Shadi and Koczewski 2007, Kim et al 2012). Also, when compared with other lengthening devices, the complication rates appear to be lower with monolateral fixators.…”

Section: Discussionmentioning

confidence: 99%

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Role of hybrid monolateral fixators in managing humeral length and deformity correction

et al. 2013

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Background and purpose Humeral lengthening and deformity correction are now being done increasingly for various etiologies. Monolateral external fixators have advantages over traditional Ilizarov circular fixators; they are easy to apply, they are less bulky, and they are therefore more convenient for the patient. We assessed the effectiveness of hybrid monolateral lateral fixators in humeral lengthening and deformity correction.Methods We retrospectively reviewed 23 patients (40 humeri) with various pathologies who underwent lengthening—with or without deformity correction using monolateral external fixator—between 2003 and 2008. Mean age at the time of the surgery was 14 (10–22) years. The mean follow-up time was 3.4 (1–7) years.Results The average duration of external fixator use was 8.3 (6–19) months. The mean lengthening achieved was 8.8 (4–11) cm and percentage lengthening was 49% (19–73). The healing index was 28 (13–60) days/cm. The major complications were refracture in 3 humeri and varus angulation of 2 humeri. The minor complications were superficial pin tract infection (6 segments), transient radial nerve palsy (1 segment), and elbow flexion contracture (5 segments). All complications resolved.Interpretation Hybrid monolateral fixators can be used for humeral lengthening and deformity correction. The advantage over circular fixators is that they are less bulky and patients can perform their day-to-day activities with the fixator in situ.

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Section: Discussionmentioning

confidence: 99%

“…Gradual distraction osteogenesis using either monolateral fixators or circular fixators is the preferred treatment for humeral lengthening and correction of deformity (Cattaneo et al 1990, Tanaka et al 1998, Kashiwagi et al 2001, Lee et al 2005, Kiss et al 2008). However, circular fixators are bulky and difficult to apply, especially bilaterally.…”

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confidence: 99%

Role of hybrid monolateral fixators in managing humeral length and deformity correction

et al. 2013

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“…This is because callus formation in the humerus during distraction proceeds at a higher rate than in the femur. Tanaka et al 5 reported that there was no significant difference in callus formation in the humerus and femur at eight weeks. We found that the mean PVR of the femur was similar to that of the humerus up to 20 weeks, but showed a significant difference after 20 weeks.…”

Section: Discussionmentioning

confidence: 97%

Comparison between upper and lower limb lengthening in patients with achondroplasia

Song

et al. 2012

The Journal of Bone and Joint Surgery. British volume

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Lengthening of the humerus is now an established technique. We compared the complications of humeral lengthening with those of femoral lengthening and investigated whether or not the callus formation in the humerus proceeds at a higher rate than that in the femur. A total of 24 humeral and 24 femoral lengthenings were performed on 12 patients with achondroplasia. We measured the pixel value ratio (PVR) of the lengthened area on radiographs and each radiograph was analysed for the shape, type and density of the callus. The quality of life (QOL) of the patients after humeral lengthening was compared with that prior to surgery. The complication rate per segment of humerus and femur was 0.87% and 1.37%, respectively. In the humerus the PVR was significantly higher than that of the femur. Lower limbs were associated with an increased incidence of concave, lateral and central callus shapes. Humeral lengthening had a lower complication rate than lower-limb lengthening, and QOL increased significantly after humeral lengthening. Callus formation in the humerus during the distraction period proceeded at a significantly higher rate than that in the femur. These findings indicate that humeral lengthening has an important role in the management of patients with achondroplasia.

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“…Many authors reported a higher rate of bone formation during distraction of the humerus [20, 21]. The healing index was 29.1 cm (range 22–35 days) after lengthening in 10 patients with achondroplasia who had no complications or sequelae [19].…”

Section: Discussionmentioning

confidence: 99%

Humeral lengthening and deformity correction

Hosny

2016

Journal of Children's Orthopaedics

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IntroductionIlizarov principles and hybrid fixation have improved the results of humeral lengthening. We reviewed the literature on humeral lengthening using different fixators with regard to indications, operative technique, results and complications. We also retrospectively reviewed 56 segments in 46 patients treated with humeral lengthening and deformity correction using Ilizarov external fixation. The etiology was achondroplasia (10 patients), epiphyseal injury (8 cases), infection (11 cases) and Erb’s palsy (17 cases). The average age at surgery was 14 years (range 8–20 years). The patients were assessed clinically and radiographically and DASH score was available for 36 segments. Follow-up ranged from 1−11 years. The magnitude of lengthening achieved ranged from 5−15.5 cm with an average of 9 cm. The average healing index was 29.5 cm (range 26–37 days). The percentage of area of lengthening to the original length ranged from 25 to 100% with an average of 55%. The average DASH (available for 36 segments only) score ranged from 15−40 preoperatively to 7−16 (P = 0.04) at last follow-up. Functionally, all the patients returned to their preoperative jobs and daily activities including sports.ComplicationsComplications included pin track infection in 46 segments, radial nerve palsy which recovered completely in 2 patients, fracture of the regenerate in 7 cases and premature consolidation of the regenerate in one case.ConclusionHumeral lengthening, whether unilateral or bilateral, is a valid method that improves the outcome following arm shortening and deformity correction, including angulation and rotation. Extensive lengthening up to 100% of the original length could be achieved without increasing the risk of complications.Level of evidenceIV, retrospective cohort.

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Callus formation in the humerus compared with the femur and tibia during limb lengthening

Cited by 15 publications

References 3 publications

Role of hybrid monolateral fixators in managing humeral length and deformity correction

Role of hybrid monolateral fixators in managing humeral length and deformity correction

Comparison between upper and lower limb lengthening in patients with achondroplasia

Humeral lengthening and deformity correction

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