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At least 343 records · Page 19Linked to original sources
PubMed2006

Difference in stretching of sarcomeres between medial gastrocnemius and tibialis anterior by tibial lengthening: an experiment in rabbits.

PURPOSE: To compare the degree of stretching of sarcomeres--in the medial gastrocnemius versus the tibialis anterior--acutely extended by tibial lengthening. METHODS: The right lower legs of 6 New Zealand White rabbits were acutely distracted by 6.3 mm using an external fixator, whereas the left lower legs served as controls. Immediately after distraction, the ankle was dorsiflexed at 50 degrees and the knee flexed at 140 degrees, with respect to the posture of resting on the ground. Both legs were immersed in 10% buffered formalin for fixation, and the medial gastrocnemius and tibialis anterior were removed. Length of the 2 sarcomeres was measured by a laser diffraction technique using isolated muscle fibre bundles. RESULTS: The mean lengths of sarcomeres in the medial gastrocnemius and tibialis anterior were 3.0 microm and 2.3 microm in the lengthened legs, and 2.4 microm and 2.1 microm in control legs, respectively. The degree of stretching of corresponding sarcomeres was therefore 25% and 10%, this difference being significant (p<0.01). CONCLUSION: Sarcomeres of the medial gastrocnemius are more stretchable than those of the tibialis anterior following tibial lengthening.

Animals↗
PubMed1990

[The fate of children undergoing bone lengthening in congenital hypoplasia of the legs].

This retrospective study was conducted on 26 patients, 14 women and 12 men whose average inequality prognosis was 8.5 cm. They have been reviewed after they were more than 20 years old (mean 23.8 y). Between 1962 and 1979 these 26 patients have had 38 lengthening procedures with various methods. The results were evaluated after clinical examination and X-rays. The average radiological discrepancy was 1.5 cm at the follow-up. On the X-rays, the deterioration was rare for the hip point, more frequent for the knee and very frequent for the ankle and the foot. If the socio-professional integration was satisfactory, many problems remained unsolved at the review. The matter was the aspect of the lengthened limb considered as unesthetic and ugly by 22 patients. 20 of the 26 patients had problems to put on shoes. On the other hand two patients out of three had a relative intolerance to effort, cutaneous troubles probably in conjunction with vascular and trophic insufficiency with many concern for the future.

Bone Diseases, Developmental↗
PubMed1982

Surgical equalisation of leg length: shortening of the long femur and lengthening of the short in one operation.

The Author suggests a technique for surgical equalisation of leg length. When the discrepancy is around 4 cm the Author obtains equalisation by simultaneous shortening and lengthening by removing from the long femur a cylinder of bone equal to half the discrepancy and grafting it into the short femur. Two Küntscher nails are used to obtain fixation. The technique has been successfully used on 4 cases.

Adolescent↗
PubMed2006

Concurrent surgeries are a factor in predicting success of rectus transfer outcomes.

Cerebral palsy (CP) patients exhibit a wide range of functional responses to specific surgical interventions. The variability associated with surgical outcomes within this patient population precipitates the need to determine the functional effects in advance of the surgery. Pilot studies have indicated that the application of statistical models towards predicting functional outcomes of surgery produces clinically meaningful results. The purpose of this study was to evaluate the influence of pre-operative kinematic parameters in conjunction with concurrent surgeries on rectus transfer (RT) outcomes. Gait analysis data were collected from 68 patients (94 legs) pre- and post-operatively within a year of surgery. Patients were divided into four groups. Group 1 (N=14) contained only legs experiencing a rectus transfer. Group 2 (N=30) contained legs experiencing RT and hamstring lengthening (HL). Group 3 (N=7) contained legs experiencing RT and lower leg surgeries: either Achilles lengthening (AL), or gastrocnemius lengthening (GL). Finally, Group 4 (N=43) contained legs which experienced all four surgeries (RT+HL+AL+GL) concurrently. Multivariate jackknifed linear regression was used to predict the change in knee range of motion, DeltaROM, due to surgery on a group-by-group basis. In each case, the sole significant pre-surgical variable was the range of motion. Group 1 legs had the best correlation (R=0.846) between pre-surgical ROM and DeltaROM whereas Group 4 legs had the worst correlation (R=0.661). Group 3 results were not significant. Group 1 DeltaROM were also significantly lower as a whole, than all other groups, due to a larger percentage of patients needing the surgery to change timing of flexion in swing phase. When compared to modeling without consideration of surgery, modeling by surgical group produced results with fewer outliers and better correlation coefficients. Regardless of surgical group, patients with a lower pre-surgical ROM (<40 degrees ) were more likely to experience an increase in ROM as a result of surgical intervention compared to their peers with an elevated pre-surgical ROM who were likely to see a decrease in ROM. Pre-surgical ROM therefore serves as a useful predictor of outcome in rectus transfer surgery.

Achilles Tendon↗
PubMed1992

Continuous monitoring of forces during tibial lengthening by distraction epiphysiolysis.

A leg length inequality of 5 cm was compensated by lengthening of the proximal tibia by distraction epiphysiolysis. During the first 7 weeks of lengthening the distraction force was monitored continuously by strain gauges attached to the extension bars of the external distraction device. The increase in length was 1.25 mm a day. The force registration showed a visco-elastic response of the tissue to distraction. In the first week the distraction force increased up to 791 N. Then lysis occurred, followed by a sudden decrease in force to an average level of 150 N. During subsequent distraction, pain and clinical symptoms could be associated with increasing tension and inadequate stress relaxation of soft tissues. Adjusting the distraction rate decreased the build-up of force in the tissue and ameliorated the clinical symptoms. These results show that force measurements can be clinically useful for appropriately adjusting the distraction rate.

Adolescent↗
PubMed1983

Femur lengthening using the Wagner technique.

Seventeen femoral lengthenings with an observation period of 1 year or more are reviewed. The mean leg length discrepancy was 6.9 cm, ranging from 3.8 to 14.8 cm. Mean lengthening was 5.8 cm, ranging from 3.6 to 10 cm. Osteosynthesis and bone grafting was done in all cases. Nonunion occurred in one lengthening, and five bones refractured. All failures, however, healed after reosteosynthesis. Transient peroneal paresis occurred in two cases, while in one case knee flexion was reduced to 55 degrees. In spite of minor pin-track drainage, no infections complicated the osteosynthesis. It is concluded that the Wagner procedure is an effective and fairly safe method for leg lengthening. Complications, however, are frequent and great caution is essential.

Adolescent↗
PubMed1986

[Osteomyelitic pseudarthrosis of the tibia with loss of substance treated with a graft of the opposite fibula].

Dragan Dj./Re. No. 2755/76, 5,5-year-old boy, referred to this hospital with signs of bipolar osteomyelitis, destruction and fistulisation of the left tibia and talocrural arthritis. Staphylococcus albus and streptococcus haemoliticus were isolated from the fistula. Osteomyelitis was treated with an adequate therapy including long usage of Lincocin. In Feb. and Oct. of 1977 a sequestrotomy of the mid portion of the tibia and transmedular fixation using Ratschmann's nail were performed. The process resulted in pseudarthrosis of the mid portion of the tibia with loss of bone substance in the length of 2.5 cm and talocrural arthrosis and deformed foot. The boy walking support. In July 1980, in the stage of "ripe" pseudarthrosis a complete resection of pseudoarthrosis with sclerotic portions of tibia to healthy bone was performed. The mid part of the right tibia was resected subperiostally and was grafted centromedularlly into the upper and lower medular channel of the left tibia. Two Kirschner's needles were implanted centromedularlly so as to strengthen the bone osteosynthesis. Complete union of the grafted fibula with treppassage of the medular channel occurred with its tibilisation and growth in length and width. In July 1982, the concave foot was corrected using Bertrand's method. The present difference in the length between the two legs is 4.5 cm which is corrected by the use of padded shoes. Lengthening of the leg is planned to be performed before he reaches the age of 14.

Child↗
PubMed1993

Primary shortening with secondary limb lengthening in severe injuries of the lower leg: a six year experience.

Multiple secondary grafting procedures may be necessary in cases of complete or partial amputation of the lower limb if the aim is to preserve the initial limb length. The traditional concept of staged reconstruction often leads to a prolonged hospitalisation and a high complication rate, especially in cases with segmental nerve defects of more than one major nerve and severe skin loss. To minimize multiple secondary operations of soft tissue and bone, we have developed the concept of primary shortening with secondary limb lengthening. We perform a primary shortening of the amputation stump and the severed limb at the time of replantation, in order minimize the skin defect and to undertake a primary wound closure and/or primary nerve suture. Six to 12 months after replantation, secondary limb lengthening is started, using an external or internal distraction device. Since 1985, 7 patients presenting with complete or partial amputation of the lower leg had been treated using this concept. The indications, operative technique, complications and results are shown and discussed, comparing this new concept to the traditional concept with extensive free soft tissue transfer and secondary nerve grafting.

Adult↗
PubMedDate not supplied

Neuromuscular recovery after distraction osteogenesis at different frequencies in a rabbit model.

The muscle and nerve responses to stresses applied during distraction osteogenesis have not been clearly defined. This study hypothesized that distraction resulting in 30% lengthening decreases muscle force generation of the lengthened muscle and increasing the frequency of distraction attenuates the decrease of force generation accompanying lengthening. This study investigated the effects of different distraction frequencies on neuromuscular recovery in a rabbit model. Animals were assigned into group 1 (low-frequency distraction) and group 2 (high-frequency distraction). Distraction was continued until a 30% increase in the original tibial length was achieved. After consolidation of the osteotomy, knee and ankle range of motion, muscle force generation, and neuromuscular junction parameters were evaluated. Lengthening of 30% resulted in significantly decreased range of motion compared with the control leg (P < 0.05). Lengthening of 30% also substantially decreased force generation of the peroneus longus muscle. However, force generation of the peroneus longus muscle in the high-frequency group was 70.5% +/- 6.5% of the control side, significantly higher than that in the low-frequency distraction group (49.7% +/- 4.8% of the control side, P < 0.05). There was no statistical difference between the 2 groups in neuromuscular junction morphology, although an abnormal shape of the postsynaptic neuromuscular junction was observed after distraction. The use of a high-frequency distraction technique during limb lengthening may result in a reduction in impairment of knee and ankle range of motion and improved muscle function compared with that observed with the use of low-frequency distraction. Repeated microtrauma to the soft tissues associated with high-frequency distraction may facilitate the regenerative capacity of the soft tissues and result in an improved outcome of muscle and nerve function.

Animals↗
PubMed2005

Reconstruction with distraction osteogenesis for juxta-articular nonunions with bone loss.

BACKGROUND: Nonunions of a juxta-articular lesion with bone loss, which represent a challenging therapeutic problem, were treated using external fixation and distraction osteogenesis. METHODS: Seven juxta-articular nonunions (five septic and two aseptic) were treated. The location of the nonunion was the distal femur in four patients, the proximal tibia in one patient, and the distal tibia in two patients. All of them were located within 5 cm from the affected joints. Preoperative limb shortening was present in six cases, averaging 2.9 cm (range, 1-7 cm). The reconstructive procedure consisted of refreshment of the nonunion site, deformity correction, stabilization by external fixation, and lengthening to eliminate leg length discrepancy or to fill the defect. Shortening-distraction was applied to six patients and bone transport to one patient for reconstruction. Intramedullary nailing to reduce the duration of external fixation was simultaneously performed in two cases. All the patients had at least 1 year of follow-up evaluation. RESULTS: Osseous union without angular deformity or leg length discrepancy greater than 1 cm was achieved in all patients. The mean amount of lengthening was 5.8 cm (range, 2.2-10.0 cm). The mean external fixation period was 219 days (range, 98-317 days), and the mean external fixation index was 34.4 days/cm (range, 24.5-47.6 days/cm). All patients reported excellent pain reduction. There were no recurrences of infection in five patients with prior history of osteomyelitis. The functional results were categorized as excellent in two, good in three, and fair in two. CONCLUSION: Despite the length of postoperative external fixation, distraction osteogenesis can be a valuable alternative for the treatment of juxta-articular nonunions.

Adolescent↗