Pediatric Pain Patterns During Ilizarov Treatment of Limb Length Discrepancy and Angular Deformity

Young, Nancy L.; Bell, Deborah F.; Anthony, Alison

doi:10.1097/01241398-199405000-00015

Cited by 66 publications

(56 citation statements)

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“…Limb lengthening in patients with congenital limb deficiency has been a challenge for surgeons; most studies to date have used external fixation for this purpose, which is associated with many complications such as pin tract infection, poor regenerate formation, preconsolidation, pain and refractures [3,7,8,15,23,26,39]. To our knowledge, the safety and effectiveness of using an intramedullary lengthening device in patients with congenital shortening have not been previously studied.…”

Section: Discussionmentioning

confidence: 99%

Internal Lengthening Device for Congenital Femoral Deficiency and Fibular Hemimelia

Shabtai

Specht

Standard

et al. 2014

Clin Orthop Relat Res

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Background Patients with congenital limb shortening can present with joint instability, soft tissue contractures, and significant leg length discrepancy. Classically, lengthening is done with external fixation, which can result in scarring, pin site infection, loss of motion, and pain. We therefore developed an alternative to this approach, a new, controllable, internal lengthening device for patients with congenital limb shortening.

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Section: Discussionmentioning

confidence: 99%

Internal Lengthening Device for Congenital Femoral Deficiency and Fibular Hemimelia

Shabtai

Specht

Standard

et al. 2014

Clin Orthop Relat Res

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“…The first healing response occurs in week 2-3, often accompanied by loss of appetite and depression, triggered by mental stress and unknown outcome [15,24]. Pain is initially caused by stretching of the periosteum, muscle spasms, contractions due to wire or pin transfixation, and later also due to pin-and wire-related soft tissue and bone inflammation.…”

Section: Outcomes and Complicationsmentioning

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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“…Successful limb lengthening and reconstruction requires a team approach, because patients undergoing limb lengthening and reconstruction may require assistance with rehabilitation and daily maintenance [3,4,39,45,58]. As such, a poor support system and familial and/or environmental problems may compromise postoperative self-care, rehabilitation, and outcome [36,47,52].…”

Section: Introductionmentioning

confidence: 99%

“…As such, a poor support system and familial and/or environmental problems may compromise postoperative self-care, rehabilitation, and outcome [36,47,52]. Undergoing limb lengthening and reconstruction also requires mental stability, resilience, and good coping skills to manage increasing pain, limited mobility, and treatment fatigue [10,11,15,19,35,41,58]. This is crucial, because unaddressed psychological, emotional, and behavioral disturbances have been shown to complicate rehabilitation [2,20,38,40].…”

Section: Introductionmentioning

confidence: 99%

Clinical Implications of Psychosocial Factors on Pediatric External Fixation Treatment and Recommendations

Richard

Nguyen

Birch

et al. 2015

Clin Orthop Relat Res

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Background Pediatric limb reconstruction using circular external fixation is a prolonged treatment that interrupts patients' daily function. Patient personality characteristics and expectations may interfere with planned treatment, making complicated medical procedures more challenging. The aims of this study are to identify factors impacting treatment outcome and recommendations for preoperative evaluation and planning. Questions/purposes (1) Are there group differences between patients with and without a preexisting mental health condition(s) in terms of unplanned reoperations? (2) Does the number of surgical procedures before current external fixator placement correlate with the number of unplanned readmissions, unplanned reoperations, and days spent in circular external fixation? (3) Are there group differences between single-compared with two-parent households in terms of inpatient narcotic doses, length of inpatient stay, number of unplanned readmissions, length of readmission(s), and/or unplanned outpatient clinic visits? (4) Does patient age at the time of surgery have an impact on treatment duration, postoperative complications, and treatment outcome? Methods This is a retrospective chart review of pediatric patients who underwent limb reconstruction between 2008 and 2012. Patients with limb length discrepancy [ 4 cm or severe angular deformity and who agreed to intervention were treated with circular external fixation. Sixty-seven patients were included; 16 patients were excluded. Statistical analyses included Pearson r correlation and t-test. Results Patients who reported preexisting mental health diagnosis (13%) had more unplanned reoperations than patients who did not (no mental health diagnosis; 87%) (mental health diagnosis 3.4 ± 10.3 versus no mental health diagnosis 0.2 ± 0.5 reoperation[s], p = 0.022). Number of previous surgical procedures correlated with number of unplanned reoperations (r = 0.448, p \ 0.001), number of unplanned readmissions (r = 0.375, p \ 0.001), and number of days in an apparatus (r = 0.275, p = 0.018). Compared with patients from two-parent households, patients from single-parent households received a greater number of inpatient narcotic doses (singleparent 129 ± 118 versus two-parent 73 ± 109 doses, p = 0.039), longer length of inpatient stay (single-parent 73 ± 63 versus two-parent 40 ± 65 days, p = 0.036), more unplanned readmissions (single-parent 0.4 ± 0.1 versus two-parent 0.2 ± 0.2 readmission, p = 0.024), longer hospitalization when readmitted (single-parent 5 ± 11 versus two-parent 1 ± 3 day(s), p = 0.025), and fewer unplanned outpatient visits (single-parent 0.2 ± 0.8 versus two-parent 0.9 ± 1.1 visit, p = 0.005). Apparatus applications with successful outcome had higher average age than those with poor outcome (successful outcome 16 ± 3 versus poor outcome 13 ± 4 years old, p = 0.011). Age at time of apparatus application correlated with One or more of the authors (JGB, MKS, AMC), or a member of his or her immediate family, has or may receive payments ...

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Pediatric Pain Patterns During Ilizarov Treatment of Limb Length Discrepancy and Angular Deformity

Cited by 66 publications

References 0 publications

Internal Lengthening Device for Congenital Femoral Deficiency and Fibular Hemimelia

Internal Lengthening Device for Congenital Femoral Deficiency and Fibular Hemimelia

Current concepts of leg lengthening

Clinical Implications of Psychosocial Factors on Pediatric External Fixation Treatment and Recommendations

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