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At least 217 records · Page 12Linked to original sources
PubMed1982

Tibial and femoral lengthening: a report of 54 cases.

Forty-eight patients have undergone 54 leg-lengthening procedures (30 femoral and 24 tibial). The average age at the time of lengthening was 12.3 years. The average follow-up was 5 years. Six different methods have been used for lengthening: Wagner (38 procedures), Anderson (12 procedures), Abbott-Bost, one-stage step-cut, Barnes plate, and Steinmann pin with turnbuckles (1 procedure each). The average preoperative limb-length discrepancy was 7.6 cm; the average lengthening achieved was 6 cm, or 21% of the lengthened bone. Seventy-five percent of our patients had good results, 12.5% had fair results, and 12.5% had poor results; of those with fair and poor results, 75% had congenital limb deficiencies.

Bone Lengthening↗
PubMed2003

Hydroxyapatite coating of external fixation pins to decrease axial deformity during tibial lengthening for short stature.

BACKGROUND: Tibial valgus, a known complication of leg lengthening with external fixation techniques, has been related to the stability of the bone-fixator system and, in particular, to pin loosening. A hydroxyapatite coating has been reported to enhance the quality of the bone-pin interface. The aim of this study was to compare the prevalence of axial deformity after tibial lengthening with hydroxyapatite-coated external fixation pins with the prevalence after tibial lengthening with uncoated pins. METHODS: We conducted a prospective study of thirty-four symmetrical tibial lengthening procedures in seventeen pathologically short patients. One limb of each patient was lengthened with use of hydroxyapatite-coated pins and the other, with standard uncoated pins; the sides of the operations were randomly selected. The bone angle in the frontal plane was measured before the operation and at the end of the fixation period, and the difference between these measurements was compared between the lengthening procedures performed with coated pins and those performed with uncoated pins. RESULTS: The mean valgus deviation of the tibia was 6.5 degrees in the group treated with hydroxyapatite-coated pins and 12.5 degrees in the group treated with uncoated pins (p = 0.023). With the numbers available, other factors previously related to the development of valgus deformity did not differ significantly between the two groups. CONCLUSION: Tibiae that are lengthened with the use of hydroxyapatite-coated external fixation pins are less prone to axial deviation in the frontal plane than are those treated with uncoated pins. LEVEL OF EVIDENCE: Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.

Adolescent↗
PubMed1991

The importance of delay in distraction of osteotomies.

The factor of timing of the commencement of distraction of an osteotomy is evaluated. Experimental osteotomies subjected to immediate distraction result in the production of a small volume of callus with deficient vascularity. Delay alters this response, and there is a more cellular osteogenic reaction with proliferative vascularization during lengthening. A delay is advocated in all gradual leg lengthening procedures, in progressive correction of deformity controlled by external skeletal fixation following osteotomy, and in bone transport procedures. The period of delay should be carefully determined according to each individual case.

Animals↗
PubMed2001

Fracture stiffness in callotasis determined by dual-energy X-ray absorptiometry scanning.

Assessing healing after distraction limb lengthening is essential to manage patients undergoing callotasis for leg lengthening or bone transport. Direct measurement of fracture stiffness can assess healing but the equipment may not be available. In addition, it requires removal of the fixator, which may be complicated for ring fixators. The present study investigates whether an equivalent measure of healing can be based on the mineral density pattern from dual-energy X-ray absorptiometry (DXA) scans. Nine consecutive patients undergoing callotasis were studied. Bending stiffness of the distraction segment was measured and DXA scans were performed regularly starting 6 weeks after completing distraction. In all, 23 simultaneous readings of bending stiffness and DXA scans were obtained. All density patterns showed a distinct minimum value of bone mineral density. We found a high and significant correlation between fracture bending stiffness and the square of the total mineral content at the location of minimum bone density (r2 = 0.77, P < 0.001). We conclude that DXA scans can be used reliably and effectively to determine fracture bending stiffness, valuable for determining both time of frame removal and delay in union.

Absorptiometry, Photon↗
PubMed1989

Epiphyseal distraction monitored by strain gauges. Results in seven children.

Ten epiphyses in seven children underwent fixed-rate distraction of 0.25 mm twice daily in an attempt to achieve percutaneous leg lengthening by chondrodiatasis. The forces generated across the growth plate were recorded by means of strain gauges incorporated into the distractors. All epiphyses fractured before 33 days of lengthening. An average gain of 6.75 cm was achieved. Epiphyseal distraction at the lower femur produced many complications, but at the upper tibial epiphysis planned lengthening was achieved, with excellent bone production and few complications.

Adolescent↗
PubMed2000

Electromyographically evident changes in skeletal muscles during tibial lengthening in dogs using the Ilizarov method.

Twenty-four beagle dogs underwent a lower leg lengthening on the right side of 2.5 cm at a distraction rate of 2 times 0.5 mm per day using a circular fixator system. After a latency phase of 5 days and a distraction phase of 25 days, 12 dogs (30-day dogs) underwent electromyography (EMG) of the gastrocnemius muscle on the lengthened and on the control side. The remaining half of the dogs underwent EMG after a consolidation phase of 25 days following the end of distraction (55-day dogs). During every EMG, at least 20 different muscle potentials were analyzed, and the duration, amplitude, and number of phases were determined of each individual potential. The 30-day dogs had significantly longer potential phases on the lengthened side and insignificantly smaller amplitudes compared with the control side. Furthermore, we observed a slightly larger number of polyphasic potentials on the distraction side. In the 55-day dogs, no significant differences were observed in the various parameters between the lengthened and the control side. Comparing 30- and 55-day dogs, the duration of the potentials on the distraction side was not significantly shorter in the 55-day dogs, and the amplitude significantly higher. These findings could indicate combined neurogenous and myopathic alterations of the muscles during the early distraction phase which will be compensated during the later distraction period and the consolidation phase by reparative and reinnervation processes, leaving no lasting functional damage.

Action Potentials↗
PubMedDate not supplied

[Nerve injuries in total hip arthroplasty--prophylactic strategies--quality assurance and risk management in orthopaedic and trauma surgery].

AIM: Nerve lesions are a serious complication of total hip arthroplasty. The incidence of lesions of large nerves exceeds those of luxation and septic loosening. An analysis of damage causes should lead to prophylactic strategies and improvement of operative technique. Patients are more aware of this complication and malpractice cases are increasing. Between 1977 and 2001 the medical association of North Rhine dealt with 126 cases of nerve lesions. METHOD: All potential intraoperative causes for nerve damage are investigated. RESULTS: Incorrectly placed Hohmann retractors offer the largest damage potential. Electro surgery and self-cutting screws have a hazardous potential. Sharp injuries, retractor damage and leg lengthening are infrequent causes for nerve lesions. Positioning devices such as leg holders used for robotic hip surgery might damage the peroneal nerve. CONCLUSION: Risk management is necessary for medico-legal quality control and gives protection for patient and surgeon. Risk management may prevent damage in advance. The head of the department is in charge of internal quality control. Systematic evaluations of operative techniques and damage possibilities are necessary to avoid future malpractice. Guidelines give a good support, but cannot replace teaching on the patient. Operation reports offer the surgeon the chance to document cautious and nerve protecting techniques.

Arthroplasty, Replacement, Hip↗
PubMed1988

Bone lengthening in rabbits by callus distraction. The role of periosteum and endosteum.

The histology and mechanics of leg lengthening by callus distraction were studied in 27 growing rabbits. Tibial diaphyses were subjected to subperiosteal osteotomy, held in a neutral position for 10 days and then slowly distracted at 0.25 mm/12 hours, using a dynamic external fixator. Radiographs showed that the gap became filled with callus having three distinct zones. Elongation appeared to occur in a central radiolucent zone; this was bounded by two sclerotic zones. Histologically, the radiolucent zone consisted of longitudinally arranged cartilage and fibrous tissue while the sclerotic zones were formed by fine cancellous bone. New bone occasionally contained islands of cartilage, suggesting it had been formed by endochondral ossification. After completion of distraction, the two sclerotic zones fused, shrank and were eventually absorbed, leaving tubular bone with a new cortex. When the periosteum had been removed at the operation, callus formation was markedly disturbed and there was failure of bone lengthening. Scraping of endosteum, in contrast, did not have a pronounced effect. These results suggest that the preservation of periosteum is essential if bone lengthening by callus distraction is to succeed, and that preservation of the periosteum is more important than careful corticotomy.

Animals↗
PubMed2002

Value of measuring bone density serial changes on a picture archiving and communication systems (PACS) monitor in distraction osteogenesis.

Serial changes of bone density in 26 femora and 22 tibiae that underwent leg lengthening by distraction osteogenesis were investigated by measuring the pixel value shown on a picture archiving and communication systems (PACS) monitor. The pixel value of the original cortex did not change significantly until the external fixator was removed. The pixel value of the distraction sites did not change significantly for the first 5-6 weeks/cm, but rapidly increased after 7 weeks/cm in the femur and tibia, then slowly increased after 8 weeks/cm. The serial changes of the pixel value of the distracted bone showed a sigmoid curve, rather than a straight increasing line. The relative pixel values of the lengthening sites were >95% in three of the four cortices at external fixator removal. Thus, the pixel value of PACS is a rapid and easy method for the detection of bone density changes in distraction osteogenesis.

Absorptiometry, Photon↗
PubMed1995

Bone mineral density changes in distracted callus stimulated by pulsed direct electrical current.

To evaluate the effect of application of pulsed direct current electrical stimulation to callus tissue, a 1-cm bone-lengthening model using an external lengthener was applied to rabbit tibia. Twenty-microampere pulsed direct current was applied 12 hours daily from the day of osteotomy until 40 days after the completion of lengthening. The area, bone mineral content, and bone mineral density of the distracted callus and of the proximal and distal segments of the tibia were evaluated using dual-energy xray absorptiometry. The absolute and relative values of bone mineral density of the electrically stimulated callus were significantly increased as compared with those in the control group. Pulsed direct current electrical stimulation may be indicated in bone lengthening to stimulate the poorly mineralized callus, and may shorten the overall time course of leg lengthening.

Absorptiometry, Photon↗
PubMed1976

[Fibula aplasia and associated malformations. 62 cases].

The authors have studied 62 cases of aplasia of hypoplasia of the fibula. They note that developmental abnormalities affect the whole of the lower limb. They describe the evolution of the bony deformities and of anomalies of the soft tissues. They conclude that discrepancy in limb length is the major factor in the prognosis and that it increases uniformally. Surgery is indicated even when a definitive prosthesis is planned. The possibility of leg lengthening must be approached with caution.

Adolescent↗
PubMedDate not supplied

Ilizarov lengthening in centralized fibula.

Tibial hemimelia often produces major limb length problems (1,6,9,15) as well as foot deformity. The decision to perform reconstructive surgery depends on the expected leg-length discrepancy, the anomalies of the foot, and the status of the knee (4,6,8,15). Congenital bone deficiencies usually have a constant rate of growth inhibition (8), and leg lengthening is often associated with more complications (5,13). The complication rate is also increased with the increased leg-length discrepancy (5). In tibial hemimelia with functioning quadriceps (types I and II) and a functional foot, centralization of the fibula onto the talus and synostosis with the proximal tibia is an accepted reconstructive procedure (1,4,6,7,9,15). However, when the transplanted fibula produces a functional limb for the patient, the correction of leg-length inequality would be a challenge. This is a report of such a case.

Child↗
PubMed1993

One-stage lengthening for femoral shortening with associated deformity.

One-stage femoral lengthening is thought to have an unacceptably high complication rate and is not widely practised. We reviewed 17 patients after one-stage lengthening for femoral shortening with associated angular or rotational deformities. Minimal dissection of the bone ends was undertaken. The mean length gain was 4 cm (2 to 7), and the average time to union was 6 months (3 to 10). There were no neurovascular complications. Four patients had delayed or nonunion, but union was achieved after bone grafting. We conclude that with minimal dissection, and with iliac crest cancellous bone grafting, one-stage leg lengthening for correction of deformity and leg-length inequality of up to 7 cm, in selected patients, can be effected safely with a relatively short rehabilitation.

Adolescent↗
PubMed1990

Leg length equalization during total hip replacement.

A method of equalization of leg lengths during total hip replacement surgery was developed which utilizes the concept of equalizing the vertical dimensions of the resected femoral head and neck segment and the remaining hip joint cartilage space, which are removed during the procedure, with the vertical dimensions of the femoral and acetabular prostheses, which are implanted into that void. This was accomplished by determining the dimensions of the prostheses from careful preoperative templating technique and by using a simple arithmetic formula to determine the level of the femoral neck osteotomy. The level of the osteotomy was made by a measurement from the top of the dislocated head of the femur to the medial femoral neck calcar. The radiologic postoperative leg length differences of a consecutive series of 84 patients undergoing primary total hip replacement using this method were determined. The average discrepancy was 2.8 mm. Seventy-five patients (89%) were found to have a postoperative leg length discrepancy of 6 mm (1/4 inch) or less. Six patients (7%) had a discrepancy of 7 to 13 mm, and only three patients (4%) had more than 13 mm (1/2 inch) leg length difference. Using this technique only two patients (2.5%) with unilateral hip replacements had leg lengthening of more than 6 mm.

Anthropometry↗
PubMed1991

Fibular hypoplasia with absent lateral rays of the foot.

We describe 11 children with fibular hypoplasia and three- or four-ray feet, two bilaterally. This deformity is a less severe form of the better known congenital short tibia with absent or dysplastic fibula. If the leg-length discrepancy is minor, no treatment or a simple orthosis are used. Epiphysiodesis or leg lengthening by callotasis is appropriate for mild to moderate discrepancy. If the foot is non-functional, or the projected leg-length discrepancy is too great, early amputation and a prosthesis are advised.

Child, Preschool↗
PubMed1999

Effect of lengthening rate on angiogenesis during distraction osteogenesis.

This study investigated the angiogenic response to four varying rates (0.3, 0.7, 1.3, and 2.7 mm/day) of distraction in a rabbit model of leg-lengthening. Immunostaining was performed with use of specific antibodies to type-IV collagen and endothelial cell antigen to examine semiquantitatively the presence of blood vessels in the developing tissues. With use of the Chalkley counting method, the greatest number of positive-staining blood vessel cells was found in the central fibrous zone of the groups that underwent lengthening at 0.7 and 1.3 mm/day compared with any other zone in any group (p < 0.05, t test). There were no statistical differences in the positive labeling indices in the mineralization front and the new bone zone adjacent to the mineralization front in any of the groups. However, the decrease in the number of positive-staining blood vessel cells in the new bone zone distant to the mineralization front compared with any other zone in any group was statistically significant. The results suggest that during distraction osteogenesis, the precursor cells of new capillaries were present in abundance within the fibrous interzone. These cells connected into the capillary network at the junction of the mineralization front and the fibrous zone. The angiogenic response was weaker in the more mature regions within the new bone zones. A slow rate of distraction (0.3 mm/day) did not maximally stimulate angiogenesis in the central fibrous zone, whereas high rates (2.7 mm/day) appeared to impair this response. In this model of distraction osteogenesis, the vascularization process in the central fibrous zone was maximally stimulated at distraction rates of 0.7 and 1.3 mm/day.

Animals↗
PubMed1992

Successful replantation of the lower leg after 42-hour ischemia: case report.

A case of right lower-leg replantation after 42-hr ischemia is presented. Revascularization of the other foot with circulatory decompensation after 36-hr ischemia was carried out simultaneously. The replanted lower leg survived. Following its shortening in replantation by 12 cm, right lower-leg lengthening by 8 cm was carried out 1.5 years after replantation with the aid of a distraction apparatus. The locomotor function in both lower extremities recovered.

Adult↗
PubMed1975

Visits abroad: the treatment of pseudarthrosis in the Soviet Union.

Three British surgeons on a visit to Russia were impressed with the Russian technique known as "compression distraction" used mainly in the treatment of infected pseudarthrosis of the tibia. Multiple thick Kirschner wires drilled through the tibia at a distance from the lesion were fixed in stirrups attached to steel rods and turnbuckles. By adjustment of the apparatus deformity was corrected at the time of application; shortening was overcome by gradual turnbuckling. The equipment was also used for leg lengthening and for complicated recent injuries.

Adolescent↗