Lengthening of congenital forearm stumps

Jasiewicz, Barbara; Tesiorowski, Maciej; Kacki, Wojciech; Kasprzyk, Marcin; Zarzycki, Daniel

doi:10.1097/01.bpb.0000192056.60435.ea

Cited by 10 publications

(4 citation statements)

References 5 publications

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“…Most current limb lengthening techniques employ cumbersome devices and are fraught with high rates of complications. Intramedullary nail lengthening techniques with or without external fixator support have been shown to increase patient comfort relative to traditional all-external limb lengthening techniques [ 4 , 10 , 13 , 15 , 17 , 23 – 25 ]. Currently available devices using these techniques include the Albizzia nail, the ISKD® (Intramedullary Skeletal Kinetic Distractor) system (Orthofix Holdings, Inc. Lewisville, TX), and the FITBONE® intramedullary nail (WITTENSTEIN intens GmbH, Germany).…”

Section: Discussionmentioning

confidence: 99%

“…Occasionally, an intramedullary device is used to augment lengthening and decrease the total time needed in an external fixation device. This strategy has been shown to have favorable results compared to external fixation-only methods [ 13 , 15 , 17 , 18 , 23 – 25 ]. While newer intramedullary nail-only lengthening techniques have been introduced for orthopedic surgeries, these are designed primarily for intact limb lengthening [ 26 – 28 ].…”

Section: Introductionmentioning

confidence: 99%

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Novel intramedullary device for lengthening transfemoral residual limbs

et al. 2017

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BackgroundLower limb loss is a highly disabling medical condition that can severely impact a person’s quality of life. Recovery becomes especially challenging if an amputee has a short residual limb, which can complicate proper prosthetic fitting, causing discomfort, difficulties in suspension, and reduced mobility. Current limb lengthening techniques such as the Ilizarov apparatus and external fixators are cumbersome, uncomfortable, and have high complication rates. In this study, we investigated the effectiveness of a novel limb-lengthening device that uses intramedullary bone lengthening and requires only one percutaneous rod at the end of the limb during the distraction phase. Only the intramedullary nail remains after the distraction phase, and no external components are required during the consolidation phase. We hypothesize that this system would create a much easier experience for the patient.MethodsThe system was first tested in a mock surgical implantation using plastic femur bones. The device was then tested in a series of cadaveric experiments using pelvis-to-knee specimens by a group of surgeons. Surgeons evaluated the surgical insertion technique, soft tissue considerations, hardware fixation strategies, and the effectiveness of the distraction mechanism. Revisions and improvements to the device and surgical procedure were made based on the results from the cadaveric experiments.ResultsA questionnaire was given to two visiting surgeons following the final iteration of the device. The surgeons reported that the system effectively lengthened the limb, was sturdy, and could be installed efficiently. However, there remains a risk of infection and soft tissue imbalances, similar to that introduced by an external fixator device. Suggestions on how to improve the design of the device and mitigate infection through postoperative management and surgical standard of care will be considered for future clinical trials.ConclusionsThe described intramedullary residual limb-lengthening device has evolved from a prototype to a mature model tested in six cadaveric experiments to date. Further mechanical and functional testing is needed to finalize the device before testing in patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Novel intramedullary device for lengthening transfemoral residual limbs

et al. 2017

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“…Both the ulna and tibia were lengthened simultaneously with the Ilizarov method without soft tissue complications. Jasiewicz et al 40 described two cases of severe congenital forearm defects with inadequate length of the stumps that also involved treatment using Ilizarov. The total stump elongation was 4 cm and 5 cm and was enough for effective and functional limb prosthesis.…”

Section: Low Level Of Deficiencymentioning

confidence: 99%

Peromelia – congenital transverse deficiency of the upper limb: A literature review and current prosthetic treatment

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Martínez-Álvarez

et al. 2018

Journal of Children's Orthopaedics

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Peromelia or congenital transverse deficiency describes a truncation of the upper limb below various limb levels. Recommendations regarding treatment vary and are mainly based on expert opinions. This paper summarizes the current literature regarding the aetiology, pathogenesis and specifically treatment algorithms for children with peromelia. We performed a non-systematic review of the current literature from MEDLINE/PubMed to obtain comprehensive up-to-date information about peromelia, focusing on current recommendations for the treatment of peromelia (e.g. prosthetic fitting, external stump lengthening). The current literature lacks clear evidence as to whether prosthetic treatment is superior to prosthetic non-usage. However, based on the available studies, children with transradial or transhumeral peromelia should preferably be fitted with passive/cosmetic prostheses at the age between six and 24 months, followed by active/myoelectric devices at the age of 2.5 to four years. It remains controversial whether early myoelectric prosthetic fitting can reduce prosthesis rejection times; however, cognitive readiness and the ability to absolve a guided training programme are seen as important prerequisites for myoelectric fitting. Children with very short stumps may benefit from stump lengthening using external fixators and prosthetic modification. The treatment of children with peromelia generally requires a guided, multidisciplinary team approach. A training programme is essential to optimize individuals’ performance in the execution of activities of daily living and decrease rejection risks whenever a myoelectric device is prescribed. Myoelectric fitting should preferably be commenced at no later than four years of age. However, long-term reports on the benefits of prosthetic treatment are still pending.

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“…Specifically, the use of the external fixator in the upper extremity has been reported to treat posttraumatic deformities and the sequelae of infection, 1,5-12 as well as congenital deformities and deformities in the setting of tumor reconstruction. 7,10,[13][14][15][16][17][18] Outcomes have been shown to be functionally and psychologically beneficial. 1,17,19 This treatment modality may be a reasonable alternative in selected patients with severe deformities for whom it is less desirable to perform acute lengthening or hardware implantation, and in patients who may wish to avoid retained surgical implants and the morbidity of bone grafting.…”

mentioning

confidence: 99%