Limb lengthening by callus distraction: Complications in 53 cases operated 1980-1991

Abstract

We reviewed our first 53 lengthenings performed in 45 patients with an average age of 19 years at the time of lengthening. The shortening was congenital in 16 patients, post-traumatic in 15 and had various causes in the 14 remaining. 31 femurs and 22 tibias with an average shortening of 6 and 5 cm, respectively, were lengthened 6 (2-14) cm. The aim was achieved in all but 4 patients, where lengthening had to be discontinued due to complications. Potential complications of lengthening can be numerous but, if recognized, can in most cases be dealt with during the extended lengthening procedure. 38 cases of pin-tract infections healed with antibiotics. Restricted motion in one or more joints was registered in 49 cases during lengthening; minor restriction of joint motion persisted in 14 patients. 28 cases had angular deviations during lengthening. After additional surgery all but 10 could be corrected. 4 fractures occurred after removal of the external fixator. The total number of complications was 146, and of these 76 were minor, 42 moderate and 28 severe. 36 of the 42 patients available to follow-up were satisfied with the results of the lengthening procedure.

Leg Lengthening With a Motorized Nail in Adolescents

“…The complication rate of external fixators in adults seems to depend on three main factors: the length of distraction, the number of pins, and the age of the patient [1,10,13,28,30,31,38]. In children, length of distraction seemed to have little effect on the consolidation index, whereas an increase of angular corrections greater than 30°w as related to poor consolidation index [12].…”

“…The use of external fixators is associated with a high rate of severe complications between 24% and 117% [1,10,12,13,28,30,31,38]. Combinations of intramedullary nails and external fixators also show a high rate of complications in adults [15,25,26,31,35].…”

“…Even after removal, additional complications such as malalignment and refractures often occur [31,36,38].…”

“…Muscle contractures and joint stiffness are additional complications associated with this method [22,30]. In cases in which callus distraction is combined with axis correction, secondary axial deformity [30,38] and fractures of the newly formed bone [11,30,35] might occur. Restriction in joint mobility [22] and therefore increased disability accompany the long periods of treatment, which delay rehabilitation and return to normal daily activities.…”

“…Leg lengthening by external fixation is associated with various complications ranging from 1.0 to 2.8 per patient [10,13,28,30,31,38]. Transfixation of soft tissue by pins or wires is intrinsic to the method and thus difficulties such as pain [14,30,41] and pin tract or deep infections [10,30] are commonly encountered.…”