Comparison of distraction epiphyseolysis and partial metaphyseal corticotomy in leg lengthening

Abstract

We have used Ilazorov's method of distraction epiphyseolysis for leg lengthening since 1977 and his new method of corticotomy or compactotomy since 1983. The first method was carried out in 22 lower limbs with an average lengthening of 8.25 cm (range 4 to 18 cm); included in this group are 2 patients with achondroplasia in whom both legs were lengthened 12 cm. In the second method, a corticotomy is carried out at the metaphyseal-diaphyseal junction followed by distraction in Ilazorov's apparatus (4 x 0.25 mm a day). We lengthened 30 legs; included are 5 patients who had both legs lengthened from between 8 and 12 cm. In the remainder an average of 7.9 cm of lengthening was achieved (range from 4 to 15 cm). The index for the treatment time per cm achieved (time from operation until full weight-bearing per cm of lengthening) was shorter after distraction epiphyseolysis than after corticotomy. Complications were also a little less after the latter procedure. Distraction epiphyseolysis has to be limited to children from aged 12 years until growth ceases. The advantage with corticotomy is that it can be done at any age from 5 to 30 years. Care is needed in both cases to avoid complications.

Complications of bone lengthening

“…However for Paley [21] muscle problems predominated, while Guarniero et al [14] rank superficial and deep infections of the pins among the greatest problems. High complication rates are found in patients with congenital short femurs [13] when compared to dysplastic patients of low stature, probably because the latter experience fewer difficulties in moving their joints; their muscles and vessels are longer than their bones [9,10] and the condition of their tissues prior to lengthening is generally better [7].…”

“…The risk of joint stiffness increases dramatically when the bone is lengthened by more than 15% [8], and Franke et al [9] maintain that lengthening should not exceed 25-40% of the original bone length, except in cases of achondroplasia. It is important with physeal distraction to be especially careful to avoid damaging the growth and articular cartilage when inserting pins into the epiphysis.…”

Open Fractures and Infection

“…An attractive alternative in extensive defects represents the primary shortening of the extremity with consecutive osteotomy and callus distraction after wound healing (10,17,19,33,38). Up to 10 % of the lower leg's length can be shortened without problems but soft tissue and bone defects should be in the same segment to achieve wound coverage without tension (70).…”

“…They require complex procedures for the treatment of bony defects after radical debridement and/or decortication. In cases of segmental and large osseous defects secondary reconstruction by osteotomy and bone segment transport (10,17,33) or the transplantation of vascularized bone grafts (69, 75) may be required. Here the whole complex of repeated debridements and reconstructive surgery, peri-operative physiotherapy and psychotherapy as well as the compliance and environment of the patient is required to obtain a successful out-come.…”

The diameter of callus in leg lengthening 28 tibial lengthenings in 14 patients with achondroplasia

“…Although distraction osteogenesis using callotasis (De Bastiani et al 1987, Ilizarov 1990) has improved the treatment of limb lengthening, late fracture still occurs (Franke et al 1990, Paley 1990, Vade and Eissenstat 1990, Guidera et al 1991.…”