The effects of limb lengthening on growth

McCarthy, James J.; Kim, Harry K.W.; Saluan, Paul; Karsky, Dawnne; Davidson, Richard S.

doi:10.1097/00009957-200309000-00007

Cited by 8 publications

(11 citation statements)

References 11 publications

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“…The stimulatory effect when lengthening was performed under optimal conditions was found to reach up to 5% of the final lengthened segment. Some authors have found no change in growth rate in older patients [17,21,24,46], although some authors have found stimulatory effects in young patients despite a higher mean percent lengthening [38]. In our study, using preoperative and postoperative measurements of developmental femoral and overall length discrepancies matched the findings of Popkov et al and others, showing no detrimental effect on femoral growth in young patients who underwent a relative femoral lengthening greater than 23.5% [17,21,45].…”

Section: Discussionsupporting

confidence: 84%

“…Some authors have found no change in growth rate in older patients [17,21,24,46], although some authors have found stimulatory effects in young patients despite a higher mean percent lengthening [38]. In our study, using preoperative and postoperative measurements of developmental femoral and overall length discrepancies matched the findings of Popkov et al and others, showing no detrimental effect on femoral growth in young patients who underwent a relative femoral lengthening greater than 23.5% [17,21,45]. However, our study could not support the hypothesis that femoral lengthening stimulates growth as has been previously postulated [34,38].…”

Section: Discussionmentioning

confidence: 99%

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Lengthening With External Fixation Is Effective in Congenital Femoral Deficiency

Prince

Herzenberg

Standard

et al. 2015

Clin Orthop Relat Res

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Background Treatment of congenital femoral deficiency is a complex, multistage protocol and a variety of strategies have been devised to address joint instability, limb length inequality, and deformities. Despite being an important part of the algorithmic approach to the overall treatment of patients with congenital femoral deficiency, a reproducible, safe, and functional treatment for femoral length discrepancy in patients with mild and moderate congenital femoral deficiency has not been reported. Questions/purposes (1) Does femoral lengthening by means of distraction osteogenesis, using a monolateral external fixator, result in effective lengthening without loss of hip or knee range of motion? (2) Does femoral lengthening cause an inhibition of femoral growth in patients with congenital femoral deficiency? (3) Do patients/families report satisfactory functional and emotional outcomes after undergoing femoral lengthening? (4) (Schaumburg, IL, USA), Pega Medical, and Springer (New York, NY, USA) outside the submitted work. The institution of one or more of the authors (JEH, SCS, DP) has received, during the study period, funding from Smith & Nephew, DePuy Synthes, Orthofix, Biomet, and OrthoPediatrics. One or more of the authors certifies that he (SCS), or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount less than USD 10,000 from Smith & Nephew, an amount less than USD 10,000 from Ellipse Technologies, and an amount less than USD 10,000 from Orthofix. One or more of the authors certifies that he (DP), or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of USD 100,001 to USD 1,000,000 from Orthofix, Inc during the period of this study. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. 123Clin Orthop Relat Res (2015) 473:3261-3271 DOI 10.1007 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® 1a, 1b, or 2a that had not previously undergone lengthening and had stable hip and knee joints. Of the 32 patients that completed treatment, 30 (94%) were available at a minimum of 2 years (mean, 3 years; range, 2-4.5 years) and were evaluated in this retrospective study. Preoperative and postoperative radiographic analysis, physiotherapy data, patient-based outcomes s...

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Lengthening With External Fixation Is Effective in Congenital Femoral Deficiency

Prince

Herzenberg

Standard

et al. 2015

Clin Orthop Relat Res

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“…So, the calculated average change of 4% in our children means between 8 and 20 mm. If we take into account that lengthening in many cases causes further growth retardation (Sharma et al 1996, Viehweger et al 1998, Sabharwal et al 2000, McCarthy et al 2003), we have observed a remarkable effect.…”

Section: Discussionmentioning

confidence: 80%

“…Growth stimulation has been reported in a limited number of patients after femoral lengthening in 2 studies (Shapiro 1987, Sabharwal et al 2000). Group effects have not been reported (Shapiro 1987, Hope et al 1994, Sabharwal et al 2000, McCarthy et al 2003). It is known that after a femoral fracture, growth in the length of the traumatized leg may increase temporarily, but this effect always lasts less than 2 years after the trauma (De Sanctis et al 1996, Stephens et al 1989).…”

Section: Discussionmentioning

confidence: 98%

Growth rate after limb deformity correction by the Ilizarov method with or without knee joint distraction

2009

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Background and purpose Growth inhibition and stimulation have both been reported after juvenile limb lengthening. Distraction of a joint usually suspends and unloads the growth plate and may stimulate growth. We investigated the influence of knee joint distraction on the speed of growth after limb lengthening.Methods In a retrospective study, growth patterns were analyzed in 30 children mean 61 (24–109) months after limb lengthening with the Ilizarov method, each child having more than 2 years of remaining growth. In 14 patients with knee joint instability, the knee was bridged over during lengthening for joint stabilization. Whether or not joint bridging and distraction would affect patterns of growth of the lengthened limb by unloading the growth plate was evaluated with a repeated measurements analysis of variance.Results After lengthening procedures, the proportionate leg-length discrepancy was found to decrease in 16 children, suggesting increased growth rate in the lengthened limbs. A statistically significantly faster growth rate was seen in 8 of 14 patients with knee distraction as compared to patients with single bone frame configurations.Interpretation Further research is required to investigate whether growth stimulation is due to the surgical technique and whether joint distraction should be recommended during limb lengthening in growing children.

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“…Growth rate (GR) was determined from the ratio of the difference of the actual length of the tibia (ALT) of 2 successive radiographs divided by the time span in years (McCarthy et al 2003): GR = (ALT current – ALT previous) / time span in years.…”

Section: Methodsmentioning

confidence: 99%

Physeal growth arrest after tibial lengthening in achondroplasia

Song¹,

Agashe²,

Huh³

et al. 2012

Acta Orthopaedica

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Background and purposeBilateral tibial lengthening has become one of the standard treatments for upper segment-lower segment disproportion and to improve quality of life in achondroplasia. We determined the effect of tibial lengthening on the tibial physis and compared tibial growth that occurred at the physis with that in non-operated patients with acondroplasia.MethodsWe performed a retrospective analysis of serial radiographs until skeletal maturity in 23 achondroplasia patients who underwent bilateral tibial lengthening before skeletal maturity (lengthening group L) and 12 achondroplasia patients of similar height and age who did not undergo tibial lengthening (control group C). The mean amount of lengthening of tibia in group L was 9.2 cm (lengthening percentage: 60%) and the mean age at the time of lengthening was 8.2 years. The mean duration of follow-up was 9.8 years.ResultsSkeletal maturity (fusion of physis) occurred at 15.2 years in group L and at 16.0 years in group C. The actual length of tibia (without distraction) at skeletal maturity was 238 mm in group L and 277 mm in group C (p = 0.03). The mean growth rates showed a decrease in group L relative to group C from about 2 years after surgery. Physeal closure was most pronounced on the anterolateral proximal tibial physis, with relative preservation of the distal physis.InterpretationOur findings indicate that physeal growth rate can be disturbed after tibial lengthening in achondroplasia, and a close watch should be kept for such an occurrence—especially when lengthening of more than 50% is attempted.

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The effects of limb lengthening on growth

Cited by 8 publications

References 11 publications

Lengthening With External Fixation Is Effective in Congenital Femoral Deficiency

Lengthening With External Fixation Is Effective in Congenital Femoral Deficiency

Growth rate after limb deformity correction by the Ilizarov method with or without knee joint distraction

Physeal growth arrest after tibial lengthening in achondroplasia

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