Does Lengthening and Then Plating (LAP) Shorten Duration of External Fixation?

Abstract

Level III, therapeutic study (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.

Clinical Outcomes of Conversion Surgery from an External Fixator to an Iodine-Supported Titanium Alloy Plate

“…There are several cases which progressed to osteomyelitis [17][18][19]. Moreover, there are some reports on conversion operations following limb lengthening, in the same way as in the present case [9,[12][13][14]; however, it is difficult to evaluate them due to their small number of cases. A report by Harbacheuski, with the largest number of cases, had seven limbs with alignment changes, two limbs with infections, and two limbs with plate breakage, with extremely high complilcation rates [12].…”

“…Also, re-fracture following external fixator removal, which is a major complication with external fixators [6], can be prevented through plate conversion. Meanwhile, there is a report that states that this conversion operation has a high risk of infection because of the pin insertion site communicating with the outside the body [12].…”

“…Further, the fact that at least two operations are necessary, and the change in alignment accompanying conversion are also considered to be disadvantages [12,[17][18][19]. Naturally, this type of operation should be indicated for cases where the potential advantages are a favorable trade-off relative to the requirement for multiple surgeries.…”

“…Moreover, in regard to changes in alignment, we removed an external fixator after plate fixation, and it is less likely that an alignment change will occur intraoperatively. There is a report on an alignment change occurring post-operatively during follow-up observation [12]. Since a plate does not have equivalent fixation to that of ring-type external fixators, we provide careful postoperative instructions until the time when a certain degree of callus formation is observed at the limb lengthening part, deformity correction part, or the pseudarthrosis part, in order to prevent alignment change post-operatively.…”

“…Since locking plates started being used at the beginning of the 21st century, there have been several reports on surgery for conversion to plates with a concept of external fixation in the body. However, an external fixator removal site is connected to outside the body, and inserting internal fixation materials into the site raises concerns over infection risks; therefore, this method still has not been generally accepted as a therapy [12][13][14].…”