Variables Affecting Time to Bone Healing During Limb Lengthening

Fischgrund, Jeffrey S.; Paley, Dror; Suter, Charles M.

doi:10.1097/00003086-199404000-00006

Cited by 266 publications

(230 citation statements)

References 5 publications

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“…The recommended latency time between surgery and the start of distraction is 3-10 days [8,10,13,28,92]. After detailed oral and written instructions are given to the patient, distraction is usually effected with classic 1 mm/ day (rate) [26] divided into 4 increments/day (rhythm) [8,28].…”

Section: Osteotomy Techniques and Biology Of Callotasismentioning

confidence: 99%

“…More than a typical central 4-6-mm-thick radiolucent zone corresponds to an exaggerated rate of distraction and vice versa [38,92,[108][109][110][111]. The assessment of the shape, type and quality of regenerate bone may be helpful to predict the stability [112].…”

Section: Osteotomy Techniques and Biology Of Callotasismentioning

confidence: 99%

“…The assessment of the shape, type and quality of regenerate bone may be helpful to predict the stability [112]. In daily clinical use, the most common definition of consolidation and stability to allow for the removal of hardware is tricortical radiographic consolidation on two orthogonal radiographs [92]. For more specific requirements, quantitative CT and finite element modelling offer predictions of bone stiffness [106].…”

Section: Osteotomy Techniques and Biology Of Callotasismentioning

confidence: 99%

“…Numeric parameters-distraction-consolidation time (DCT) and healing index (HI)-aim at quantifying the quality and speed of bone formation. The consolidation time (end of distraction to bone stability which allows hardware removal) is about twice as long as the distraction time in children, but may be three to four times longer in adults [22,92]. The consolidation index quantifies the time to consolidation per centimetre of distraction gap [59].…”

Section: Osteotomy Techniques and Biology Of Callotasismentioning

confidence: 99%

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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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Section: Osteotomy Techniques and Biology Of Callotasismentioning

confidence: 99%

Section: Osteotomy Techniques and Biology Of Callotasismentioning

confidence: 99%

Section: Osteotomy Techniques and Biology Of Callotasismentioning

confidence: 99%

Section: Osteotomy Techniques and Biology Of Callotasismentioning

confidence: 99%

See 2 more Smart Citations

Current concepts of leg lengthening

Hasler

Krieg

2012

Journal of Children's Orthopaedics

102

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“…However, published studies [4,8,10,12,13,23,24,31,38,44] on the TSF have been in the form of case reports, have included small numbers of patients, and have combined various bones and etiologies. In addition, the methods of reporting deformity correction and alignment have been variable.…”

Section: Introductionmentioning

confidence: 99%

Does the Taylor Spatial Frame Accurately Correct Tibial Deformities?

Rozbruch¹,

Segal²,

Ilizarov³

et al. 2010

Clinical Orthopaedics &Amp; Related Research

103

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Histochemical and molecular analyses of distraction osteogenesis in a mouse model

Tay

Gould

et al. 1998

Journal Orthopaedic Research

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A tibial lengthening scheme in the mouse was used to study the molecular and cellular events regulating tissue regeneration during distraction osteogenesis. Here, we report on the surgical technique and frame design and describe the histochemical and molecular aspects of distraction during different phases of treatment. A total of 26 mice were used in this study. The treatment protocol was divided into a latency period of 7 days, a phase of active distraction that lasted 10 days with a distraction rate of 0.42 mm/day, and a maturation phase of 9 days. During latency, the distraction site resembled a stabilized fracture callus on both a histochemical and a molecular level. During active distraction, the gap was characterized by a central fibrous interzone bordered by primary matrix fronts, regenerate bone aligned with the distraction force, parallel columns of vascular sinusoids, and a medullary cavity. Alkaline phosphatase activity was detected in the endosteal and periosteal surfaces of the bone ends. Tartrate resistant acid phosphatase staining revealed that osteoclasts remodeled the bone regenerate as it formed. Collagen type I was expressed in the periosteum and the primary matrix front during distraction, whereas collagen type-II transcripts were localized to discrete regions on the periosteal surfaces, immediately adjacent to the osteotomy ends. Collagen type-II transcripts were not detected in the fibrous interzone. During the maturation phase, cells within the fibrous interzone expressed collagen type I and exhibited abundant alkaline phosphatase activity, suggesting that they had begun to terminally differentiate. Collectively, these data demonstrate the utility of a mouse model to study the molecular and cellular bases for the regeneration and remodeling of tissue.

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Variables Affecting Time to Bone Healing During Limb Lengthening

Cited by 266 publications

References 5 publications

Current concepts of leg lengthening

Current concepts of leg lengthening

Does the Taylor Spatial Frame Accurately Correct Tibial Deformities?

Histochemical and molecular analyses of distraction osteogenesis in a mouse model

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