Serial bone mineral density ratio measurement for fixator removal in tibia distraction osteogenesis and need of a supportive method using the pixel value ratio

Song, Sang Heon; Agashe, Mandar; Kim, Tae Young; Sinha, Shivam; Park, Young Eun; Kim, Seung Ju; Hong, Jin; Song, Sang Youn; Song, Hae Ryong

doi:10.1097/bpb.0b013e32834f04f3

Cited by 21 publications

(22 citation statements)

References 20 publications

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“…Premature removal of the fixator after a lengthening procedure can result in gradual bending or acute fracture of the regenerate 15. Attempts are being made constantly to establish objective guidelines for early and safe removal of a fixator using a sensitive and quantitative measurement technique 16. The present study reports CT scan findings in patients undergoing limb lengthening.…”

Section: Discussionmentioning

confidence: 94%

Radiomorphological Manifestations of Femoral and Tibial Cortical Bones at Different Stages of Limb Lengthening

Дьячкова

Новиков

Дьячков

et al. 2019

IJOO

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Background: There has been a lot of research done on Ilizarov's limb lengthening; however, very few publications focus on the quantitative assessment of the distractional bone regeneration in tibial and femur lengthening. Data regarding quality of the bone after lengthening are needed to consider the time of frame removal and develop a rehabilitation program. Materials and Methods: Computed tomography (CT) assessment of a parent bone was performed on 136 patients with limb length discrepancy and bone deformity of various etiologies before and after lengthening. Transosseous osteosynthesis technique with the Ilizarov's external fixation was used for limb lengthening and deformity correction in all the cases. A 64-slice scanner was used for CT assessments. Specific Roentgen-negative units of the Ilizarov apparatus and techniques for interpreting CT findings were employed for artifact-free densitometric assessment. Results: Cortical density of the femur and tibia in patients with limb length discrepancy and bone deformity of various etiologies was shown to have differences as compared to the contralateral limb. The lengthening process was accompanied by decreased cortical density of the segment being lengthened, and the decrease in the density was greater in the areas adjacent to the distractional bone regeneration. The cortical structure underwent characteristic changes. Osteonal density of the cortical bone was higher in the norm and at long term followup as compared to the density of external and internal plates. Conclusion: Cortical bone of the femur and tibia in patients with limb length discrepancy and bone deformity of various etiologies showed various preoperative local densities of external, internal, and osteon layers. The cortical bone demonstrated heterogenic structures with resorption areas of various magnitude and density, with minimal values at the boundary with regenerate bone during distraction and fixation with frame on and at short-term followup. Complete organotypical restructuring of the bone was shown to occur at a 1-to-3-year followup depending on the etiology of the disease and amount of lengthening performed.

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Section: Discussionmentioning

confidence: 94%

Radiomorphological Manifestations of Femoral and Tibial Cortical Bones at Different Stages of Limb Lengthening

Дьячкова

Новиков

Дьячков

et al. 2019

IJOO

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“…Several techniques including CT scan, ultrasound, dual energy X-ray absorptiometry (DEXA), and Orthometry, have been used to evaluate the regenerate and determine when the external fixator should be removed. [14][15][16][17][18][19] Plain radiographs are, however, usually used to decide when the external fixation should be removed as this is simple and inexpensive. The incidence of early fracture (16%) in our series suggested difficulty in determining the timing of removal of the fixation by radiological appearances alone.…”

Section: Discussionmentioning

confidence: 99%

Early and late fracture following extensive limb lengthening in patients with achondroplasia and hypochondroplasia

Kitoh

Mishima

Matsushita

et al. 2014

The Bone & Joint Journal

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Two types of fracture, early and late, have been reported following limb lengthening in patients with achondroplasia (ACH) and hypochondroplasia (HCH). We reviewed 25 patients with these conditions who underwent 72 segmental limb lengthening procedures involving the femur and/or tibia, between 2003 and 2011. Gender, age at surgery, lengthened segment, body mass index, the shape of the callus, the amount and percentage of lengthening and the healing index were evaluated to determine predictive factors for the occurrence of early (within three weeks after removal of the fixation pins) and late fracture (> three weeks after removal of the pins). The Mann‑Whitney U test and Pearson's chi-squared test for univariate analysis and stepwise regression model for multivariate analysis were used to identify the predictive factor for each fracture. Only one patient (two tibiae) was excluded from the analysis due to excessively slow formation of the regenerate, which required supplementary measures. A total of 24 patients with 70 limbs were included in the study. There were 11 early fractures in eight patients. The shape of the callus (lateral or central callus) was the only statistical variable related to the occurrence of early fracture in univariate and multivariate analyses. Late fracture was observed in six limbs and the mean time between removal of the fixation pins and fracture was 18.3 weeks (3.3 to 38.4). Lengthening of the tibia, larger healing index, and lateral or central callus were related to the occurrence of a late fracture in univariate analysis. A multivariate analysis demonstrated that the shape of the callus was the strongest predictor for late fracture (odds ratio: 19.3, 95% confidence interval: 2.91 to 128). Lateral or central callus had a significantly larger risk of fracture than fusiform, cylindrical, or concave callus. Radiological monitoring of the shape of the callus during distraction is important to prevent early and late fracture of lengthened limbs in patients with ACH or HCH. In patients with thin callus formation, some measures to stimulate bone formation should be considered as early as possible.

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“…The fixator was removed in the clinic with mild oral sedation when the callus showed full corticalization in 3 cortices (when the pixel value ratio was equal to 1), [16][17][18] after which patients were given an abductor brace to use for approximately 3 months. Patients were asked to follow up every 2 weeks during the time when the fixator was applied, every 3 months for the first year, and then yearly thereafter.…”

Section: Surgical Techniquementioning

confidence: 99%

Subtrochanteric Valgus Osteotomy With Monolateral External Fixator in Hips for Patients With Severe Cerebral Palsy

Agashe¹,

Song²,

Tong³

et al. 2013

Orthopedics

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Subtrochanteric valgus osteotomy has been used for painful hip joint dislocation in patients with severe cerebral palsy. The goal of this study was to evaluate 11 patients (17 hips) with severe cerebral palsy who had chronically dislocated and painful hips treated with subtrochanteric valgus osteotomy using a monolateral external fixator. A retrospective review was performed of 11 patients (average age, 17.8 years) with severe quadriplegic cerebral palsy with flexion-adduction contractures due to chronically dislocated and painful hips. A subtrochanteric valgus osteotomy with a monolateral fixator was performed in all patients. Patients were analyzed clinicoradiologically, and caregivers were asked about ease of handling, transfers, and perineal care. At an average follow-up of 37 months (range, 14-72 months), all caregivers were satisfied with the surgery and felt that their child was more comfortable and could sit with support for a longer time period and that perineal care, wheelchair mobilization, and transfers were much easier. A total of 11 complications in 7 patients were observed, including pin-tract infections, delayed consolidation, abduction deformity, and hypostatic pneumonia. The complication rate of subtrochanteric valgus osteotomy was comparable with other methods, and this method had the advantage of shorter surgical time, ease of application, no internal implant with lesser chance of infection or heterotopic calcification, and less intraoperative blood loss with less morbidity.

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Serial bone mineral density ratio measurement for fixator removal in tibia distraction osteogenesis and need of a supportive method using the pixel value ratio

Cited by 21 publications

References 20 publications

Radiomorphological Manifestations of Femoral and Tibial Cortical Bones at Different Stages of Limb Lengthening

Radiomorphological Manifestations of Femoral and Tibial Cortical Bones at Different Stages of Limb Lengthening

Early and late fracture following extensive limb lengthening in patients with achondroplasia and hypochondroplasia

Subtrochanteric Valgus Osteotomy With Monolateral External Fixator in Hips for Patients With Severe Cerebral Palsy

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