Limb lengthening and three-dimensional deformity corrections

Koržinek, Krešimir; Tepic, S.; Perren, S.M.

doi:10.1007/bf00636172

Cited by 32 publications

(15 citation statements)

References 16 publications

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“…The site of the osteotomy also influences callus formation. Fewer complications were observed when the osteotomy was metaphyseal (1,4,7,9,13,(15)(16)(17)(18); this seems to be related to the presence of spongy bone, which consolidates easily; the existence of fewer muscular insertions; and the fact that less damage is done to the vascularization, particularly the medullary artery, which is highly ramified at this point. The latter has been demonstrated by angiographic studies (2,15), which show that diaphyseal corticotomy interrupts the endomedullary vessels in 90% of cases.…”

Section: Discussionmentioning

confidence: 97%

Relationship Between Radiologic Morphology of the Bone Lengthening Formation and Its Complications

Forriol¹,

Iglesias²,

Arias³

et al. 1999

Journal of Pediatric Orthopaedics, Part B

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SUMMARYThe objective was to study the different types of lengthened bone regeneration and their development during the various phases of the process to correlate them with patient factors and the surgical technique used, and to establish a possible relation between the development of the bone lengthening formation and the problems or complications. The authors studied the radiographs of a random group of 55 patients taken at three points during the course of treatment. The callus was classified with regard to its transverse diameter and the presence or absence of hypodense areas. The overall callus type was significantly influenced by the etiology, the osteotomy site, and the percentage lengthened. The percentage by which the limb was lengthened at the beginning of the process influences the overall morphology of the callus. Poor callus had been lengthened the most, atrophic callus the least. There was a correlation between the morphology of the overall callus at the end of treatment and the percentage lengthened, and between the percentage lengthened and the presence of bands at the end of treatment. The authors also found a significant correlation between age and the appearance of bands at the end of distraction. A central band was found among younger patients. The type of osteotomy affected the overall callus at the end of distraction and at the end of treatment and also influenced the transverse diameter. All the elongations with poor bone formation at the end of treatment were found to have undergone a diaphyseal osteotomy. The most common complication at the first follow-up and at the end of distraction was angulation. The diameter of the callus and the presence of bands at the end of treatment were significantly related to the complications. Fracture occurred in the first 2 weeks after removal of the external fixator in 88% of cases and in the third and fourth week in the rest. However, the segment had no significant influence on the appearance of complications. Lengthened callus with incomplete trabecular formations and hypodense areas at the end of the treatment has a high risk of fracture at the end of treatment. Callus with axial deviation, hypodense areas, or an insufficient transverse diameter during the lengthening procedure must be manipulated so that it reaches the maturing phase in better condition.

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Section: Discussionmentioning

confidence: 97%

Relationship Between Radiologic Morphology of the Bone Lengthening Formation and Its Complications

Forriol¹,

Iglesias²,

Arias³

et al. 1999

Journal of Pediatric Orthopaedics, Part B

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“…The overall percentage of complications in the literature is high, exceeding 100% [4,5,6,7,14,15,16,18,19,20,23]. Although the muscles and fasciae grow as the limb is extended, problems can arise when the muscle growth rate is slower than the lengthening of the bone.…”

Section: Discussionmentioning

confidence: 99%

Complications of bone lengthening

Aquerreta

Forriol

Cañadell

1994

International Orthopaedics

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SUMMARYBone lengthening is a surgical method which requires meticulous technique, continuous attention, and satisfactory cooperation on the part of the patient. The absence of common criteria makes it difficult both to classify the complications which arise, and to compare them with, those of other authors. We report the complications in a group of 61 patients who were studied prospectively. Disorders of the lengthening callus accounted for 45% of oil complications, and a further 33% arose in the joints. The remainder occurred in the bone, the apparatus and the soft tissues, of which the most common were stiffness of the joints, axial deviations and loosening of the pins, while articular subluxation, fractures with angulation and delayed consolidation occurred less frequently. In our study, the overall number of complications per lengthening process was 2.1. In bilateral lengthening, the rate was 1 per segment, while in unilateral cases the mean was 2.7. Problems which we defined as severe, requiring that the lengthening had to be halted, occurred in 1.8% of the total complications. The aetiology of the length discrepancy has an important role in the complications which occur in each segment. Over twice as many problems occur in asymmetrical lengthening procedures as in patients where lengthening is symmetrical. RÉSUMÉL'allongement osseux est une intervention chirurgicale qui demande une technique méticuleuse, une surveillance médicale continue et une coopération satisfaisante du patient. En l'absence de critères communs il est difficile de classer les complications et de comparer avec les résultats d'autres auteurs. Si l'on analyse les complications selon leur localisation on, constate que les problèmes concernant le cal représentent 45% du total et ceux des articulations 33%, soit un total d'environ 75% pour ces deux catégories. Les 25% restants se situent au niveau de l'os lui-même, du fixateur et des parties molles. Les incidents les plus fréquents sont les raideurs articulaires, les déviations axiales et l'ostéolyse autour des fiches, tandis que les subluxations, les fractures avec angulation et retard de consolidation s'observent moins souvent. Dans notre étude le total des complications est de 2.1 par allongement. Dans les allongements symétriques il est de 1 par segment, alors que dans les allongements asymétriques il s'élève è 2.7%. Les problèmes que nous considérons comme graves, c'est à dire ceux qui compromettent le processus d'allongement représentent 1.8% du total des complications. L'étiologie joue un rôle important dans les complications qui surviennent au niveau de chaque segment. Les complications des allongements asymétriques sont deux fois plus fréquentes que celles des allongements symétriques.

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“…There are two main practices prescribed for managing pin/wire site and skin interfaces. 710,6,17 The traditional occlusive one in which such sites are covered with sterile dressings after adequate cleaning and usually such dressing are applied alternate days. But the problem in rural part of India is accessibility to such sterile dress ings.…”

Section: 71015mentioning

confidence: 99%

Study on Outcome of Complex Lower Limb Problems treated by Ring External Fixator and Evolvement of Practices toward its Acceptability

Shrivastava¹,

Khan²,

Rathi³

et al. 2017

The Journal of Medical Sciences

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Introduction:In the developing world, there is still lack of accessibility and availability of adequate health care. In rural population this further gets limited, due to meager immediate resource at disposition and lack of availability of transports to adequate set ups. This cross-sectional study is undertaken among our rural patients who had undergone this treatment to understand what difficulties they had faced during such treatments and their acceptability toward such treatment. This study was undertaken with the aim to find out the acceptability and adaptability among the rural population for Ilizarov ring fixators. Materials and methods:The study consisted of 88 consecutive cases (91 lower limbs) of all age groups, who completed the treatment by Ilizarov methodology between July 2005 and July 2012. A retrospective analysis of the procedure was done through the medical records in terms of preoperative, intra operative, and after the complete treatment. These were analyzed for limb lengthening in centimeters, correction of deformities, total wearing duration, and final outcome. Subsequently, these patients/parents were interviewed with a questionnaire to assess the self-accessibility (ease) toward self-care; selfdistraction; self-adaptability-comfort during wearing time and the difficulties faced. Results:Overall the functional outcome was excellent in 18, good in 50, fair in 8, and poor in 4. Out of 91 patients, 67 (73.6%) followed up and could be evaluated for adaptability toward Ilizarov fixator. Overall, 91.04% were satisfied with the treatment by Ilizarov fixator. In the remaining the main reason for not accepting the Ilizarov method was difficulty in commuting in the public transport, ugly and threatening looks of fixator with so many wires crossing the leg. Conclusion:Ilizarov method is a very effective tool for managing the complex lower limb problems, especially among the population with low resources. It will ensure delivery of a very low-cost solution offered to the needy patients, wherein otherwise due to multiplicity of problems, integral solution is difficult to achieve within their resources.

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Limb lengthening and three-dimensional deformity corrections

Cited by 32 publications

References 16 publications

Relationship Between Radiologic Morphology of the Bone Lengthening Formation and Its Complications

Relationship Between Radiologic Morphology of the Bone Lengthening Formation and Its Complications

Complications of bone lengthening

Study on Outcome of Complex Lower Limb Problems treated by Ring External Fixator and Evolvement of Practices toward its Acceptability

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