Limb lengthening for deformities in Ollier’s disease: a systematic review

Abstract

Background The management of limb deformity, shortening, and bone defects in treatment of Ollier's disease is a major challenge. This study aims to summarize and compare the different surgical treatments, and to evaluate the outcome and possible prognostic factors of leg lengthening in these patients. Materials and methods A systematic review of the literature from 1993 to 2017 was performed. Nineteen articles were found including a total of 121 patients with limb deformities because of Ollier's disease. The mean patients' age at the time of first surgery was 12 years. A total of 272 segments were surgically treated (14 segments in the upper limbs) with variable techniques including osteotomies and external fixation, intramedullary nails, as well as epiphysiodesis and lengthening over nail. We studied the bone healing index (BHI), distraction index (DI), distraction time, gained length, total treatment time, and complications. Results Available implants and techniques allowed correction of patients' deformities (lengthening and correction of angular defects) in most cases. External fixators, circular or monolateral frames were the most commonly used technique. The Ilizarov external fixator was the most commonly used frame (196 segments). The BHI was significantly better when the external fixation was combined with intramedullary nails. Epiphysiodesis was most likely to be more associated with the past than to the present. Joint stiffness, infection, early consolidation, pathological fracture, deformity recurrence, delayed union, nonunion, neurapraxia, and overlengthening were the reported complications with an overall rate of 27.9%. Conclusions There is no consensus for the optimal surgical technique and implants for correction of limbs deformities in patients with Ollier's disease. External fixators most commonly circular are the most commonly used implants; however, complications do occur.

Lengthening the Lower Extremities of Children with Ollier’s and Maffucci’s Enchondromatosis Using Implantable Lengthening Nails

“…The available literature regarding outcomes of limb lengthening in patients with Ollier's disease is sparse. Angelini recently performed a systematic review, analyzing 19 studies, all retrospective, that evaluated limb lengthening in this subset of patients [10]. Ten case reports (≤3 patients), seven case series (≥4 patients), and two cohort studies presented 121 patients (272 bone segments, 13 upper extremity and 259 lower extremity).…”

“…Patients with Ollier's disease are at risk for premature consolidation and may require an even faster rate [10], and shorter intervals between serial radiographic evaluations. Patient 5 in our series experienced nail migration and this was likely due to preconsolidation of the regenerate and the force to distract the regenerate exceeded the force the enchondroma was exerting on the cross-locking screws.…”

“…Historically, external fixation has been the modality of choice for limb lengthening up until the introduction of implantable lengthening [9]. Previous studies have reviewed lower extremity limb lengthening with external fixation, but only case reports discuss using implantable lengthening nails [10][11][12].…”

Complication of lengthening and the role of post-operative care, physical and psychological rehabilitation among fibula hemimelia

“…Joint rigidity is usually known as a late-onset complication[ 55 ]. This happens because of long-term muscle contractures or can be attributed to rigidity of the joint following the amplified pressure on the joint surface during the elongation process[ 56 ].…”

International recognition of the Ilizarov bone reconstruction techniques: Current practice and research (dedicated to 100thbirthday of G. A. Ilizarov)

“…Monolateral external systems for femoral lengthening were used children and adolescents[ 59 ]. Despite the popularity of guided growth systems, the EF role in pediatric deformity correction is significant and can be played by different external devices that allow multiplanar corrections[ 62 ]. Nevertheless, Ollier's disease, fibrous dysplasia, osteogenesis imperfecta and other metabolic diseases are still great challenges for orthopedic surgeons[ 63 - 66 ].…”