Neuromuscular injury during limb lengthening: A longitudinal follow-up by rabbit tibial model

Chuang, Tien-Yow; Chan, Rai-Chi; Chin, Lin-Show; Hsu, Tao-Chang

doi:10.1016/s0003-9993(95)80580-x

Cited by 16 publications

(4 citation statements)

References 11 publications

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“…Current complications are often soft tissue-related, including neurologic and vascular injuries and muscle contractures leading to joint subluxations and axial deviations (25). Neuromuscular abnormalities have also been detected following limb lengthening (6). Complications associated with the behavior of soft tissues are not a new development; they were observed by Codivilla in 1905, when he noted, "The difficulties to be encountered in lengthening a shortened limb, are found to be greater as regards the fleshy parts, than as regards the bone" (7).…”

mentioning

confidence: 99%

Limb lengthening promotes muscle growth

Day

Moreland

Floyd

et al. 1997

Journal Orthopaedic Research

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Studies of limb lengthening have demonstrated successful bone formation in the distraction gap. Failure of the muscle units to lengthen leads to many complications that significantly limit the success of this approach; it is, therefore, of paramount importance to characterize the behavior of the muscle during limb lengthening. In this study, tibiae of adult rabbits were lengthened for 10 days at a rate of 1 mm/day. The proliferative ability of the lengthened muscle was characterized using bromodeoxyuridine, a thymidine analogue that is incorporated during cell division, and desmin, a muscle-specific marker. We observed a large number of proliferating cells, specifically in the lengthened muscle, that were co-localized with many desmin-positive cells. The presence of bromodeoxyuridine nuclei inside desmin-positive muscle fibers suggests that limb lengthening promotes muscle growth by triggering myoblast proliferation and fusion into the lengthened muscle. Our findings are consistent with those of other studies in the reviewed literature that also suggest that limb lengthening promotes muscle growth.

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mentioning

confidence: 99%

Limb lengthening promotes muscle growth

Day

Moreland

Floyd

et al. 1997

Journal Orthopaedic Research

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“…In the experimental setting, various studies in larger animals have investigated the influence of distraction osteogenesis mainly on normal neural tissue, and have focused on the determination of the optimal distraction rate [31][32][33][34][35] that would result in the fewest morphologic changes (intraneural swelling); that was determined to be at the most 1 mm/day. Nerve distraction has also been studied in the rat sciatic nerve model by Margiotta et al 36 who applied direct tension to the proximal stump of a severed sciatic nerve that was subjected to distraction, in order to use it in a second stage for reconstruction, thus avoiding the need for interposition nerve grafting to bridge the gap.…”

Section: Figurementioning

confidence: 99%

Distraction Osteogenesis Using IGF-I after Nerve Microreconstruction

Papakonstantinou¹,

Shiamishis²,

Bates³

et al. 2002

J reconstr Microsurg

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The discipline of limb lengthening has undergone numerous advances over the last few years. The neurologic complications surrounding this procedure are well established and described in the clinical setting, and can be deleterious for the patients in distraction osteogenesis protocols. The specific aims of the reported project were: 1) to determine the ability of IGF-I to enhance nerve regeneration in repaired nerves that are subjected to distraction only 4 weeks after nerve repair, and 2) to determine if a low dose of IGF-I applied at the time of the repair is neuroprotective to repaired nerves at this early time window. Forty adult male Sprague-Dawley rats were randomized into eight groups (n=5). Four groups (Groups A to D) underwent distraction of the femoral bone following sciatic nerve repair, and four groups served as controls (Groups E to H). Nerve reconstruction was achieved by end-to-end nerve repair (four groups, two with distraction [A, B] and two without [E, F]) and by interposition nerve grafting (four groups, two with distraction [C, D] and two without distraction [G, H]). A low dose of IGF-I was administered at the time of nerve microreconstruction. Distracted groups, despite the administration of IGF-I, demonstrated no signs of nerve regeneration, as assessed by sciatic functional index (SFI), electrophysiologic studies, and quantitative and qualitative histologic studies. Non-distracted groups showed signs of nerve regeneration. The 4-week time interval between nerve repair and distraction did not provide enough time for nerve regeneration to be completed, even if the repair was exposed to a low dose of IGF-1.

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“…It is a particular concern in an orthopedic setting because it can lead to impairment of limb function. While the magnitude of correction and lengthening that can be tolerated by neurovascular structures has not yet been established, it is related to the amount of lengthening that nerves have to undergo, the rate of correction, and the anatomic relationship nerves have to their surrounding bones and soft tissues [3].…”

Section: Introductionmentioning

confidence: 99%

Use of Ultrasound in Detection and Treatment of Nerve Compromise in a Case of Humeral Lengthening

Rozbruch

Fryman

Bigman

et al. 2011

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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The development of iatrogenic nerve lesions during and following limb lengthening procedures present a challenge to orthopedic surgeons. Early treatment of nerve damage is critical in salvaging full function of the nerve. Precise location of damage, however, must be determined in order to appropriately administer treatment. We report a patient with a short humerus caused by a growth arrest undergoing a 7-cm lengthening who developed a neurapraxic injury of the radial nerve. Nerve compromise was noted 1 month into the lengthening program. Nerve conduction studies and electromyography could not be used to determine the precise site of injury. Likewise, magnetic resonance imaging and computed tomography were contraindicated and inconclusive, respectively, due to the presence of a metallic external fixation device. High-resolution ultrasonography (US) findings, however, correlated with our clinical examination of the patient's radial nerve function and permitted identification of the precise site of nerve involvement. Treatment was administered by removing a causative half-pin. Several days following treatment, nerve function returned to normal. There are a limited number of articles in the literature regarding nerve injuries associated with limb lengthening and their corrective treatments. The outcome of this case underscores the usefulness of US over various other diagnostic techniques under certain circumstances.

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Neuromuscular injury during limb lengthening: A longitudinal follow-up by rabbit tibial model

Cited by 16 publications

References 11 publications

Limb lengthening promotes muscle growth

Limb lengthening promotes muscle growth

Distraction Osteogenesis Using IGF-I after Nerve Microreconstruction

Use of Ultrasound in Detection and Treatment of Nerve Compromise in a Case of Humeral Lengthening

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