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ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2002, Number 2

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Acta Ortop Mex 2002; 16 (2)

An assessment of 120 cases of bone lengthening in different limbs. Inter-institutional trial

Márquez NJCC, Madinaveitia VJA, Hernández SIH, Alvarado SJC

Language: Spanish
References: 32
Page: 62-69
PDF size: 306.29 Kb.


ABSTRACT

Objective. This retrospective paper has been designed to evaluate our results in cases of dyaphyseal bone lengthening. Particular emphasis has been focused in the complications of the procedure. Material and methods. A whole 144 long bones were lengthened in 120 patients of both genders by an Orthofix external fixator, except for 37 metatarsals which were elongated by a mini-fixator (Instituto Nacional de Ortopedia, Mex. design). Age ranked 5 to 41 years. Causes of bone-shortening were: hemimelia, club foot, tibial pseudoarthrosis, trauma, tumor, achondroplasia or infection. Affected bones were: femur 67, tibia 38, metatarsals 37 and humerus 2. Patients were treated from 1992 through 1996 in three hospitals as outlined in headings of this paper. A bone growing of 1 mm daily was scheduled in all cases. Complimentary procedures such as iliotibial fasciotomy or heel cord lenghtening were carried out before starting on the bone elongation, aiming to avoid bone malalignment while in progress. A permanent rehabilitation program and periodical electromyography recordings were performed along the complete span of the bone growing. Results. Obtained lenght increasing was from 3.5 to 18 cm, however it seldom was needed to increase more than 10 cm. A whole 31 cm of body growing were obtained in one case of achondroplasia. Best results in children were produced when periodical elongation was repeatedly performed through the growth, thus preventing the necessity of a one-time major elongation which increase the complications risk. Complications ocurred in 34 cases, 19 major and 15 mild (23.6%) that were: pin trac infection in 10 cases, knee valgus of 6-20 degrees in 7, flexion knee contracture in 4, broken pins in 4, no bone formation in 3, fracture in the new formed bone in 2, toe retraction in 2, premature bone formation in 1 and broken of fixator in 1. All complications were resolved either by conservative measures or by a second surgical procedure. Conclusion. Objectives of bone lenghtening surgery can be accomplished by external fixation procedures, however most of the still common complications should be significantly reduced by clear explanation and a closer observation of patients.


REFERENCES

  1. A querreta JD, Forriol F, Cadadell J. Complications of bone lengthening. Int Orthop 1994; 18(5): 299-303.

  2. Aldegheri R, Renzi L. The callotaxis method of limb lengthening. Clin Orthop 1989; 13: 7-14.

  3. Anderson WV. Leg lengthening. J Bone Surg 1952; 34B: 150-1.

  4. Aronso J, Harrison BH. The histoloy of distraction osteogenesis using different external fixation. Clin Orthop Res 1989: 106-116.

  5. Berrens F. General theory and principles of external fixation. Clin Orthop Rel Res 1989: [S-23.

  6. Bonnard C, Favard L, Sollogoub L, Glorion B. Limb lengthening in children, using the Ilizarov method. Clin Orthop 1993; (293): 83-8.

  7. Cauchoix, j Rey, JC Heripret G. L’allongement du femur dans le traitement des inegalites de longueur des membres inferieurs. Descriplíon d’une technique d’allungeentextemporanec. Rev Chir Orthop 1963; 49: 192.

  8. Coleman SS, Stevens PM. Tibial lengthening. Clin Orthop 1978; 136: 92.

  9. Dahl MT, Gulli B, Berg T. Complications of limb lengthening. A learning curve. Clinic Orthop 1994; (301): 10-8.

  10. Danziger MB, Kumar A, De weese J. Fractures aper lengthening using the Ilizarov method. J Pediatric Orthop 1995; 15(2): 220-3.

  11. Faber FW, Keesen W, Van Roermund FM. Complications of leg lengthening. Acta Orthop Scand 1991; 62(4): 327-32.

  12. Gabriel KR, Russelí JM, Crowford AH, Ray DR. Femoral lengthening in patients having abnormal ipsilateral hip or knee. Orthopaedies 1995; 18(S): 437-44.

  13. Harmanishi C, Tanaka S, Tamura K. Early physeal closure after femoral chondrodiastasis loss of length gain in 5 cases. Acta Orthop Scand 1991; 62(4): 327-32.

  14. Helm L, Steen H, Luduigsen P, Bjerkeim Y. Unchanged muscle function after bilateral femoral lengthening. Acta Orthop Scand 1995; 66(3): 258-60.

  15. Ilizarov GA, Deviatov. Surgical lengthening of the shortened lower extremities. Verta khir 1972; 107: 100.

  16. Kalumac U, Martson A, Haviko T, Hanninen O. The effect of lengthening of the femur of the extensors of the knee. J Bone Joint Surg Am 1995; 77(2): 247-50.

  17. Karger C, Guille JT, Bowem JR. Lengthening of congenital lower limbs deficiency. Clin Orthop 1993; (291): 236-45.

  18. Kawamura B, Hososno, et al. Limb lengthening by means of subcutaneous osteotomy. J Bone Joint Surg 1968; 50A: 851.

  19. Maffulli N, Fixen JA. Muscular strength after callotaxis limb lengthening. J Pediatric Orthop 1995; 15(2): 212-6.

  20. Magnan B, Bragantini A, Regis D, Bartolozzi P. Metatarsal lengthening by callotaxis during the growth phase. J Bone Joint Surg Br 1995; 77(4): 602-7.

  21. Márquez NJCC, Madinaveitia VJA, Rodríguez SE, Jug RSV. Hemimelia paraxial peronea. Tratamiento mediante elongación ósea con distractores Orthofix. (Comunicación preliminar). Rev Mex Ortop Traum 1999; 13(2): 130.

  22. Márquez NJCC, Madinaveitia VJA. Braquimetatarsalgia, tratamiento definitivo mediante elongación ósea. Rev Mex Ortop Traum 1996; 10(5): 224.

  23. Márquez NJCC. Uso de los fijadores externos en el tratamiento de las metatarsalgias por discrepancia de longitud. (Comunicación preliminar). Rev Mex Ortop Trauma 1994; 8(1): 23.

  24. Monticelli G, Spinelli R. L’osteogenesi riparativa in corso di distrazione. Giornale italiano ortop e traes 1986; 1212(45).

  25. Nakamura E, Mizuka H, Takagi K. Knee cartilage injury after tibial lengthening. Acta Orthop Scand 1995; 66(4): 313-6.

  26. Pablos J, Cañadell J. Elongación ósea, estado actual y controversias Departamento de Cirugía Ortopédica y Traumatológica Navarra, Pamplona, España 1990.

  27. Stanitski DF. The effect of limb lengthening on articular cartilage. An experimental study. Clin Orthop 1994; (301): 68-72.

  28. Stevens MA, De coster TA, García F, Sell JJ. Septic knee from Ilizarov transfixation tibial pin. Iowa Orthop Joint 1995; 15: 217-20.

  29. Tjernstrom B, Olerud S, Rehnberg L. Limb lengthening by callus distraction, complications in 53 cases operated 1980-1991. Acta Orthop Scand 1994; 65(4): 447-55.

  30. Tjernstrom B, Rohnberg L. Back pain and arthralgia before and after lengthening questioned after 6 (1-11) years. Acta Orthop Scand 1994; 85(3): 328-32.

  31. Vizkelety T, Marsehalko P. Limb lengthening with simultaneous correction of deformity. Acta Biomedic Ateneo Parmense 1992; 63 (1-2): 69- 77.

  32. Wagner H. Operative Beinverlangermug. Chir 1971; 42: 260.




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