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

Abstract

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.

Effects of timing of low‐intensity pulsed ultrasound on distraction osteogenesis

“…However, the greatest problem remains the long healing time. External fixation carries the risk of pin tract infection, malalignment, joint stiffness, and late fracture of the regenerate [8,9,22]. Shortening of the period of external fixation would reduce costs, complications, and the burden on the patient.…”

Noninvasive Quantitative Assessment of Bone Healing after Distraction Osteogenesis

“…AP (c) and lateral (d) radiographs at presentation of the regenerate collapse moderately above chance. This high variability as to when surgeons find it appropriate to remove an external fixator may contribute, along with other factors (such as primary diagnosis), to the large cited rate of refracture after frame removal (3% to 50%) [18][19][20][21][22].…”

“…Starr et al [17] found that the decision to remove an external fixator based on radiographic assessment alone resulted in intra-observer and inter-observer variability moderately above chance. This high variability as to when surgeons find it appropriate to remove an external fixator may contribute, along with other factors (such as primary diagnosis), to the large cited rate of refracture after frame removal (3% to 50%) [18–22].…”