Multiplier Method for Prediction of Adult Height in Patients with Achondroplasia

Paley, Dror; Matz, A.; Kurland, David B.; Lamm, Bradley M.; Herzenberg, John E.

doi:10.1097/01.bpo.0000161095.15845.7d

Cited by 16 publications

(11 citation statements)

References 6 publications

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“…This study confirms that ELL planning should consider, the total height gains desired based on prediction of adult height using the achondroplasia or hypochondroplasia growth charts [21,22,24]. To achieve the desired gain in height, the adolescent-onset strategy should be chosen if the goal is under 30cm.…”

Section: Discussionsupporting

confidence: 69%

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Extensive Limb Lengthening for Achondroplasia and Hypochondroplasia

Paley¹

2021

Preprint

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Extensive limb lengthening (ELL) was completed in 75 patients: 66 achondroplasia and 9 hypochondroplasia. The average lengthening was 27cm for achondroplasia (12-40cm) and 17cm for hypochondroplasia (range 10-25cm). There were 48 females and 27 males. Lengthening was done either by 2-segment (14 patients; both tibias and/or both femurs) or by serial 4-segment lengthenings (64 patients; both femurs and tibias same time). Most patients also had bilateral humeral lengthening. Lengthenings were either juvenile-onset (31), adolescent-onset (38) or adult-onset (6). The average age at final follow-up was 26 years old (range 17-43 years). There were few permanent sequelae of complications. The most serious was one paraparesis. All patients returned to activities of normal living and only one was made worse by the surgery (paraparesis). This is the first study to show that ELL can lead to increase of height into the normal height range. Previous studies showed mean increases of height of up to 20cm, while this study consistently showed an average increase of 30 cm (range 15-40cm) for juvenile-onset and increase of 26cm (range 15-30cm) for adolescent-onset. This results in lower normal height at skeletal maturity for males and females. The adult-onset had a mean increase of 16.8 (range 12-22cm). This long-term follow-up study shows ELL can be done safely even with large lengthenings and that 4-segment lengthening may offer advantages over 2-segment lengthening. While the majority of cases were performed using external fixation, implantable limb lengthening promises to be an excellent alternative and perhaps an improvement.

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Section: Discussionsupporting

confidence: 69%

“…The average male height in achondroplasia is 132cm with the low end of height range being 118cm and the high end 146cm [21,22]. The low end of normal height range for a male is 160cm.…”

Section: Discussionmentioning

confidence: 99%

Extensive Limb Lengthening for Achondroplasia and Hypochondroplasia

Paley¹

2021

Preprint

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“…We used the multiplier method described by Paley et al 38 to calculate the overall leg-lengthening required. This method was originally described for predicting the leg-lengthening required in patients with achondroplasia.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction with callus distraction for nonunion with bone loss and leg shortening caused by suppurative osteomyelitis of the femur

Zhang

Liu

et al. 2007

The Journal of Bone and Joint Surgery. British volume

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We present a retrospective study of 27 patients treated by callus distraction using a unilateral external fixator of our own design for nonunion with bone loss and shortening of the femur caused by suppurative osteomyelitis. The unilateral external fixator was used either alone or in combination with an intramedullary nail. The mean age of the patients was 13.6 years (8 to 18). The fixator was used alone in 13 patients and with an intramedullary nail in 14. The bone results at a mean follow-up of 88 months (37 to 144) were excellent in 16 patients and good in 11. The functional results were excellent in 18 patients and good in nine. However, four patients still had draining sinuses at the latest follow-up. A residual deformity greater than 7 degrees was present in seven femora, but this did not adversely affect function or require further treatment.

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“…Paley tables were used to predict final height at skeletal maturity. 25 The predicted height was added to the length achieved in the limb to assess final predicted height in those children who had not achieved maturity.…”

Section: Aterials and M Ethodsmentioning

confidence: 99%

Limb lengthening in achondroplasia

Chilbule

Dutt

Madhuri

2016

IJOO

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Background:Stature lengthening in skeletal dysplasia is a contentious issue. Specific guidelines regarding the age and sequence of surgery, methods and extent of lengthening at each stage are not uniform around the world. Despite the need for multiple surgeries, with their attendant complications, parents demanding stature lengthening are not rare, due to the social bias and psychological effects experienced by these patients. This study describes the outcome and complications of extensive stature lengthening performed at our center.Materials and Methods:Eight achondroplasic and one hypochondroplasic patient underwent bilateral transverse lengthening for tibiae, humeri and femora. Tibia lengthening was carried out using a ring fixator and bifocal corticotomy, while a monolateral pediatric limb reconstruction system with unifocal corticotomy was used for the femur and humerus. Lengthening of each bone segment, height gain, healing index and complications were assessed. Subgroup analysis was carried out to assess the effect of age and bone segment on the healing index.Results:Nine patients aged five to 25 years (mean age 10.2 years) underwent limb lengthening procedures for 18 tibiae, 10 femora and 8 humeri. Four patients underwent bilateral lengthening of all three segments. The mean length gain for the tibia, femur and humerus was 15.4 cm (100.7%), 9.9 cm (52.8%) and 9.6 cm (77.9%), respectively. Healing index was 25.7, 25.6 and 20.6 days/cm, respectively, for the tibia, femur and humerus. An average of 33.3% height gain was attained. Lengthening of both tibia and femur added to projected height achieved as the 3rd percentile of standard height in three out of four patients. In all, 33 complications were encountered (0.9 complications per segment). Healing index was not affected by age or bone segment.Conclusion:Extensive limb lengthening (more than 50% over initial length) carries significant risk and should be undertaken only after due consideration.

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Multiplier Method for Prediction of Adult Height in Patients with Achondroplasia

Cited by 16 publications

References 6 publications

Extensive Limb Lengthening for Achondroplasia and Hypochondroplasia

Extensive Limb Lengthening for Achondroplasia and Hypochondroplasia

Reconstruction with callus distraction for nonunion with bone loss and leg shortening caused by suppurative osteomyelitis of the femur

Limb lengthening in achondroplasia

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