Distractor Breakage in Cranial Distraction Osteogenesis for Children with Craniosynostosis

Abstract

Cranial distraction osteogenesis has been applied as a mode of therapy to patients with various types of craniosynostosis. Several minor complications during distraction have been reported in the previous literature, including infection, device exposure, and dislocation and distortion of the device. To our knowledge, this is the first report of 2 cases of spontaneous device breakage during cranial distraction osteogenesis. Two infant patients were diagnosed with shunt-induced microcephalies. The ages of the 2 patients were 8 and 12 months. Their head circumferences were 3 percentiles below that of normal children of the same age. Distraction osteogenesis advancement to the frontal skull and the orbital bar was performed with two distractors. We distracted a total of 7.0 and 14.4 mm at a rate of 0.6–1.5 mm per day before device breakage occurred 7 and 25 days after the distraction activation, respectively. Both patients underwent reoperation to exchange the broken device for further distraction. To prevent further device breakage, we suggest increasing the rate of distraction, placing stronger or more devices, or relieving the scalp retraction pressure probably by extensive dissection of the subcutaneous layers or multiple incisions into the galeal layers.

The Trans-Sutural Distraction Osteogenesis for 22 Cases of Craniosynostosis: A New, Easy, Safe, and Efficient Method in Craniosynostosis Surgery

“…In our present study of 22 TSDO procedures, we observed 2 cases (9.1%) of pin site discharge which seemed to be similar to the previously reported 11.1–21.1% after distraction osteogenesis methods [4,8,35]. Other complications after TSuDO comprised of distractor malfunction due to distractor breakage in 1 case (4.5%), and this is a very rare event as the only report of such an occurrence was 2 cases after rotating distraction osteogenesis by the present author [34]. The above 2 cases of distractor breakage are attributed to the fact that only 1–2 distractors were employed for rotating distraction osteogenesis in order to reduce costs.…”

“…Complications of distraction osteogenesis that have been found in previous studies are pin site infection, meningitis, discharge, device exposure, bone fracture, dislocation, shaft slippage, distortion of device, and distractor breakage [4,5,6,8,20,33,34,35]. In our present study of 22 TSDO procedures, we observed 2 cases (9.1%) of pin site discharge which seemed to be similar to the previously reported 11.1–21.1% after distraction osteogenesis methods [4,8,35].…”

Rotating Distraction Osteogenesis in 23 Cases of Craniosynostosis: Comparison with the Classical Method of Craniotomy and Remodeling

“…Distractor breakage was observed in 2 cases (8.7%) that have already been reported by our group [31]. There have been no reports of distractor breakage by other authors.…”

Cranial vault expansion by distraction osteogenesis

“…In another 2 patients, osseous fusion occurred before the full amount of distraction had been achieved. 32 Although 2 patients' distracters came to the end of their tracks a day earlier than expected, and 2 others required 2 additional days of turning to achieve the prescribed distraction, we believe these occurrences to be the result of cumulative inaccuracies in making the prescribed 360° rotations twice daily. Turning of the distracter screws was tolerated very well, with patients showing minimal discomfort and anxiety.…”