Limb Lengthening by Means of Subcutaneous Osteotomy

Kawamura, B; Hosono, S; Takahashi, Tsuyoshi; Yano, T; Kobayashi, Yoshio; Shibata, Noriyoshi; Shinoda, Yukihide

doi:10.2106/00004623-196850050-00001

Cited by 101 publications

(39 citation statements)

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“…No wonder that the clinical challenges of muscle distraction and subsequent decrease of adjacent joint range of motion go in parallel with the amount of lengthening. This is reflected by histological changes after lengthening of more than 30 % of its original length [22,[116][117][118][119], as the whole muscle from origin to insertion is stretched [81]. The elastic limit of stretched muscles (strength-strain curve) is 10-15 % of the length at rest.…”

Section: Effects Of Bone Lengthening On Surrounding Tissuesmentioning

confidence: 99%

Current concepts of leg lengthening

Hasler

Krieg

2012

Journal of Children's Orthopaedics

102

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Any lower limb discrepancy may be equalised by conservative means (insoles, prosthesis and orthosis). However, their long-term acceptance is low in regard to function, costs, expenditure and appearance. Timely epiphysiodesis is the best option in uniplanar deformities with adequate remaining growth and for patients whose predicted final body height is above the 50th percentile. However, many patients present late or with multi-planar deformities, which warrant more sophisticated operative approaches. The history of surgical bone lengthening comprises 100 exciting years of struggling, development and ongoing learning. The initial strategy of acute or rapid incremental distraction had lasted almost half a century until Ilizarov recognised the benefits of biological periosteum-preserving osteotomies and incremental lengthening at slow rates (1 mm/day) at a 4 × 0.25-mm daily rhythm, well appreciated as callotasis. In parallel, ring and wire constructs made complex three-dimensional axial, translational and rotational bone moulding possible. Taylor Spatial Frames—built on hexapod strut-linked platform technology as known from flight simulators—took limb correction to a more reliable, more precise and aesthetical level, all the more that the whole process became web-based. It represents state-of-the-art methodology and technology for complex, multi-plane deformities. Due to the significant risk of secondary malalignment, indications for lengthening by unilateral fixation have shrunken to moderate amounts of length disparity and uni- to bi-planar deformities in patients with still open physes. Mechanical or motorised, minimally invasively placed nails prevent muscle fixation and, therefore, ease rehabilitation, increase patient comfort and potentially shorten the overall time of sick leave and refrain from sports activities. Hence, they offer a valuable alternative for low-grade complexity situations. It remains to be proved if the significantly higher implant costs are compensated by lower treatment costs. Overall, limb lengthening, particularly in combination with multi-planar deformity correction, can still be an arduous endeavour. In any case, wise judgement of the patient’s deformity, medical and biological situation, psychosocial environment, selection of the appropriate method and hardware, as well as meticulous operating technique by an experienced surgeon are the cornerstones of successful outcomes.

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Section: Effects Of Bone Lengthening On Surrounding Tissuesmentioning

confidence: 99%

Current concepts of leg lengthening

Hasler

Krieg

2012

Journal of Children's Orthopaedics

102

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“…The mean lengthening of the tibia was 6.45 cm, which was 16% of the preoperative limb length. The lengthening value was within the safe limit which most authors reported as not more than 15% of the preoperative length of the treated locomotor segment [3,5,23]. In practice, much larger singlestep elongations of up to 25% of the preoperative leg length are performed.…”

Section: Discussionmentioning

confidence: 86%

“…W przypadku goleni wydłużono je średnio o 6,45 cm, co stanowiło 16% jej wyjściowej długości. Wielkość wydłużenia mieściła się w bezpiecznych granicach, które według większo-ści autorów nie powinny przekraczać 15% wyjściowej długości leczonego segmentu ruchowego [3,5,23]. W praktyce niejednokrotnie jednoetapowo wykonuje się znacznie większe wydłużenia sięgające nawet 25% wyjściowej długości wydłużanego odcinka.…”

Section: Discussionunclassified

Gait analysis in children after the lengthening of the lower limb by the Ilizarov technique

Szydłak

Famuła

Gaździk

et al. 2017

Ann. Acad. Med. Siles.

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WstępOsteogeneza dystrakcyjna, jako metoda leczenia zaburzeń osi i skrótów kończyn dolnych, jest procesem długotrwałym, co niekorzystnie wpływa na stan funkcjonalny narządu ruchu oraz psychikę dziecka. W związku z powyższym celem pracy była analiza parametrów czasoprzestrzennych chodu oraz porównanie wyników leczenia u dzieci po wydłużeniu goleni i uda metodą Ilizarowa.Materiał i metodyBadania wykonano u 40 dzieci z asymetrią kończyn dolnych leczonych w Katedrze i Oddziale Klinicznym Ortopedii w Sosnowcu w latach 2000–2006. U każdego dziecka wykonano zabieg osteogenezy dystrakcyjnej metodą Ilizarowa. Grupa została podzielona na dwie podgrupy: grupę I stanowiło 20 dzieci po wydłużeniu goleni metodą Ilizarowa, grupę II stanowiło 20 dzieci po wydłużeniu uda metodą Ilizarowa. Analiza chodu została przeprowadzona przy użyciu systemu do analizy ruchu firmy Zebris i polegała na przejściu po wytyczonej ścieżce o długości ok. 2 metrów. Platforma reagowała na nacisk, dzięki czemu można było oceniać reakcje sił podłoża oraz parametry czasoprzestrzenne chodu. Po zakończonym pomiarze otrzymano raport zawierający dane badanych parametrów.WynikiZ przeprowadzonych badań wynika, że zarówno u dzieci z wydłużanym udem, jak i golenią trzy z pięciu subfaz fazy podporu kończyną operowaną i nieoperowaną uległy wydłużeniu a dwie skróceniu w stosunku do norm wg J. Perry. Subfazy, które zostały wydłużone, to: zapoczątkowanie kontaktu, przejęcie ciężaru, przygotowanie przenoszenia, natomiast skrócenie czasu trwania poszczególnych subfaz odnotowano w pełnym podporze oraz fazie odbicia.WnioskiLepsze wyniki uzyskano po wydłużeniu uda niż goleni metodą Ilizarowa u dzieci ze skróceniem kończyny dolnej. Stereotyp chodu u dzieci po wydłużeniu kończyn odbiega od normy.

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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: 99%

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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Limb Lengthening by Means of Subcutaneous Osteotomy

Cited by 101 publications

References 0 publications

Current concepts of leg lengthening

Current concepts of leg lengthening

Gait analysis in children after the lengthening of the lower limb by the Ilizarov technique

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

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