Distraction Osteogenesis A Comparison of Corticotomy Techniques

Frierson, M A; Ibrahim, Kamal; Boles, Mark A.; Boté, H; Ganey, Tim

doi:10.1097/00003086-199404000-00004

Cited by 93 publications

(58 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Its disruption significantly decelerates bone formation [75,82]. Ilizarov and others firmly recommended corticotomies to preserve medullary blood flow [26,80,83].…”

Section: Osteotomy Techniques and Biology Of Callotasismentioning

confidence: 99%

“…Ilizarov and others firmly recommended corticotomies to preserve medullary blood flow [26,80,83]. However, this is difficult to perform and experimental work revealed that complete bone separation (osteotomy) is equally effective [76,82,[84][85][86][87]. Dual-energy X-ray absorptiometry (DEXA) and histomorphometrical studies showed that the periosteum produces up to five-fold more callus than bone marrow during lengthening [74,75,88,89].…”

Section: Osteotomy Techniques and Biology Of Callotasismentioning

confidence: 99%

“…Insufficient stability and/or vascularity (e.g. thermal damage) entail micro-haemorrhages and necrosis with the subsequent formation of (fibro-)cartilage, cystic necrosis and, eventually, non-union [8,27,82].…”

Section: Osteotomy Techniques and Biology Of Callotasismentioning

confidence: 99%

See 2 more Smart Citations

Current concepts of leg lengthening

Hasler

Krieg

2012

Journal of Children's Orthopaedics

102

View full text Add to dashboard Cite

Any lower limb discrepancy may be equalised by conservative means (insoles, prosthesis and orthosis). However, their long-term acceptance is low in regard to function, costs, expenditure and appearance. Timely epiphysiodesis is the best option in uniplanar deformities with adequate remaining growth and for patients whose predicted final body height is above the 50th percentile. However, many patients present late or with multi-planar deformities, which warrant more sophisticated operative approaches. The history of surgical bone lengthening comprises 100 exciting years of struggling, development and ongoing learning. The initial strategy of acute or rapid incremental distraction had lasted almost half a century until Ilizarov recognised the benefits of biological periosteum-preserving osteotomies and incremental lengthening at slow rates (1 mm/day) at a 4 × 0.25-mm daily rhythm, well appreciated as callotasis. In parallel, ring and wire constructs made complex three-dimensional axial, translational and rotational bone moulding possible. Taylor Spatial Frames—built on hexapod strut-linked platform technology as known from flight simulators—took limb correction to a more reliable, more precise and aesthetical level, all the more that the whole process became web-based. It represents state-of-the-art methodology and technology for complex, multi-plane deformities. Due to the significant risk of secondary malalignment, indications for lengthening by unilateral fixation have shrunken to moderate amounts of length disparity and uni- to bi-planar deformities in patients with still open physes. Mechanical or motorised, minimally invasively placed nails prevent muscle fixation and, therefore, ease rehabilitation, increase patient comfort and potentially shorten the overall time of sick leave and refrain from sports activities. Hence, they offer a valuable alternative for low-grade complexity situations. It remains to be proved if the significantly higher implant costs are compensated by lower treatment costs. Overall, limb lengthening, particularly in combination with multi-planar deformity correction, can still be an arduous endeavour. In any case, wise judgement of the patient’s deformity, medical and biological situation, psychosocial environment, selection of the appropriate method and hardware, as well as meticulous operating technique by an experienced surgeon are the cornerstones of successful outcomes.

show abstract

“…Its disruption significantly decelerates bone formation [75,82]. Ilizarov and others firmly recommended corticotomies to preserve medullary blood flow [26,80,83].…”

Section: Osteotomy Techniques and Biology Of Callotasismentioning

confidence: 99%

Section: Osteotomy Techniques and Biology Of Callotasismentioning

confidence: 99%

See 1 more Smart Citation

Current concepts of leg lengthening

Hasler

Krieg

2012

Journal of Children's Orthopaedics

102

View full text Add to dashboard Cite

show abstract

“…Instability due to fixator constructs that allow excessive motion between the distracted bone segments (9, 10) may lead to local hemorrhage and the formation of islands of cartilage. Local dysvascularity of one or both distracted surfaces can occur secondary to thermal necrosis; for example, from uncooled power tools (61) or from a high-energy injury such as that resulting from a widely displaced or comminuted osteotomy (1). The resultant ischemic tissue may fail to form bone and could result in a fibrous or cartilaginous non-union (5,6,8).…”

Section: Factors Affecting Angiogenesis and Mineralizationmentioning

confidence: 99%

Angiogenesis and Mineralization During Distraction Osteogenesis

et al. 2002

View full text Add to dashboard Cite

Distraction osteogenesis is currently a standard method of bone lengthening. It is a viable method for the treatment of short extremities as well as extensive bone defects, because large amounts of bone can be regenerated in the distraction gap. Mechanical stimulation by distraction induces biological responses of skeletal regeneration that is accomplished by a cascade of biologic processes that may include differentiation of pluripotential tissue, angiogenesis, mineralization, and remodeling. There are complex interactions between bone-forming osteoblasts and other cells present within the bone microenvironment, particularly vascular endothelial cells that may be pivotal members of a complex interactive communication network in bone. Regenerate bone forms by three modes of ossification, which include intramembranous, enchondral, and transchondroid ossifications, although intramembraneous bone formation is the predominant mechanism of ossification. In this review we discussed the coupling between angiogenesis and mineralization, the biological and mechanical factors affecting them, the cellular and molecular events occurring during distraction osteogenesis, and the emerging modalities to accelerate regenerate bone healing and remodeling.

show abstract

“…However, the oscillating saw which produces heat and plugging of the bone channels (Paley and Tetsworth 1991) is rarely used in lengthening procedures. Frierson et al (1994) showed significant delay in bone healing by use of oscillating saw in an animal study. Eralp et al (2004) showed in a study which compared Gigli saw and drill hole osteotomy that Gigli saw produces a better callus formation in lengthening.…”

Section: External Fixatormentioning

confidence: 96%