Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Osteogenesis, Distraction”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,657 records · Page 92Linked to original sources
PubMed2006

Gradual distraction fronto-orbital advancement with 'floating forehead' for patients with syndromic craniosynostosis.

Eleven patients with syndromic craniosynostosis were treated with gradual distraction fronto-orbital advancement using "floating forehead." The frontal and supraorbital area was cut and remolded. Bony orbits were widened in three patients. Frontal bone was let floating on the dura and fixed loosely with absorbable threads to remolded supraorbital bone. A pair of distracters with hinge plates (A.V.D. system, Bear Medic Corp, Tokyo, Japan) was fixed between the temporal area and supraorbital bone. Distraction was begun 5 to 7 days after the surgery, and 1.8 to 3.2 cm advancement was obtained. Distracters were taken off after 3 to 7 weeks of consolidation periods. Although no major complication was encountered, some minor complications related to the devices were experienced.

Absorbable Implants↗
PubMed1998

Presurgical finite element analysis from routine computed tomography studies for craniofacial distraction: II. An engineering prediction model for gradual correction of asymmetric skull deformities.

Finite element analysis from routine computed tomography studies (CT/FEA) allows clinicians to predict the mechanical and anatomic consequences of specific distraction systems before human application. A realistic three-dimensional CT/FEA engineering model of an actual plagiocephalic infant with unicoronal synostosis was developed using 4215 parabolic triangular shell elements and intracranial pressure conditions ranging from 10 to 20 mmHg. The completed finite element analysis model was used to predict the anatomic outcome of multiaxial distraction delivered by hypothetical patterns of rod and node distraction units. The predictions for the various patterns of distraction units were also compared quantitatively with respect to force, stress, strain, and intracranial volume. Best anatomic corrections were achieved with bilateral patterns of distraction units that simultaneously elongated the ipsilateral cranium and shortened the contralateral cranium. Greatest strain levels were experienced within the osteotomy callus, greatest stress levels at the appliance anchorage sites, and the greatest rod force at the ipsilateral lower coronal position.

Biomechanical Phenomena↗
PubMed2001

Response of the physis to leg lengthening.

UNLABELLED: The physeal response to limb lengthening by callotasis was investigated in an animal model by measuring 1) the growth rate using an oxytetracycline labelling technique, 2) histomorphological changes, and 3) proliferative cellular activity using bromodeoxyuridine. An osteotomy without lengthening stimulated growth at the physis. At 20% lengthening, regardless of the rate of distraction, no significant changes were detected. However, the growth rate was drastically reduced after 30% or more of lengthening and in 50% of cases there was evidence of premature closure of the distal growth plate. CLINICAL RELEVANCE: Caution should be exercised in carrying out high percentages of lengthening of children's bones.

Animals↗
PubMed1999

The effect of sagittal orientation of the distractor on the biomechanics of mandibular lengthening.

PURPOSE: It has been previously demonstrated that distractors placed parallel to the mandible in the transverse plane, without regard to the vector of distraction create lateral displacement tendencies at the appliance-bone interface, leading to potential clinical problems and complications. The purpose of this study was to evaluate the biomechanical effects of linear distractor orientation in the sagittal plane relative to the anatomic axis of the mandible (mandibular plane) and the maxillary occlusal plane. MATERIALS AND METHODS: A 2-dimensional model of the human mandible was generated for computer simulation of osteodistraction. Positional changes of the distal mandibular segment were then analyzed during 10 mm of incremental lengthening based on distractor orientation relative to the maxillary occlusal plane. RESULTS: Distractors placed parallel to the inferior border of the mandible without regard to the maxillary occlusal plane created a vertical translation of the distal bone segment resulting in an anterior open bite. The magnitude of the anterior open bite was proportional to the angle between the vector of distraction and the maxillary occlusal plane, and to the amount of distraction. Placement of the distractors parallel to the maxillary occlusal plane eliminated the tendency for an anterior open bite. CONCLUSIONS: The orientation of the distractors relative to the maxillary occlusal plane is one of the important biomechanical parameters that must be included in preoperative planning for mandibular osteodistraction.

Biomechanical Phenomena↗
PubMed2001

Bimaxillary osteodistraction for the treatment of facial asymmetry in adults.

Nine patients with hemifacial microsomia or facial asymmetry were treated between April 1998 and November 1999. The ages of the patients ranged from 21 years to 45 years (mean: 24.6 years); six were female and three were male. The follow-up period ranged from 6 months to 24 months (mean: 15.3 months). The operative procedure was based on Ortiz Monasterio's simultaneous mandibular and maxillary distraction technique. This technique frees only the pterygo-maxillary junction of the affected side, thereby leaving the nasal septum and the pterygo-maxillary junction of the unaffected side intact. It also uses an external corticotomy on the mandible. In contrast, we modified Ortiz Monasterio's method by using a complete LeFort I osteotomy with both a complete separation of the pterygo-maxillary junction and a mandibular osteotomy to avoid any resistance during distraction. In one patient with scleroderma and severe atrophy of the mandible and soft tissue on the right side of the face, a free scapular osteocutaneous flap was used; 1 month later we performed simultaneous distraction of the maxilla and transfer of the scapula bone to the mandible. In one patient with hypoplasia of the zygoma, zygoma expansion was also performed simultaneously. Bidirectional distraction was performed in one patient and intraoral devices were applied in three patients. After a latent period of 5 days, distraction was performed at a rate of 1 mm per day. After a consolidation period of 6-8 weeks, the intermaxillary fixation and distraction devices were removed. Preoperatively, the deviation of the occlusal plane ranged from 8degrees to 13 degrees (mean: 10.5 degrees); the distraction distance ranged from 7 mm to 17 mm (mean: 13 mm). In two patients there was radiologic evidence of relapse 6 months after distraction, but no significant change in facial appearance was observed. Seven patients maintained a stable preoperative occlusal relationship and the preoperative lateral open bite was improved postoperatively in two patients. The postoperative occlusal plane was between 0 degrees and 1 degree in every case.

Adolescent↗
PubMed2005

Treatment of segmental tibial defects using acute bone shortening followed by gradual lengthening with circular external fixator.

The aim of this study was to clinically and radiographically evaluate acute bone shortening followed by gradual lengthening in the treatment of large segmental tibia defects induced in seven clinically normal dogs. A circular external fixator was assembled with one proximal 5/8-circle ring, one middle ring and one distal ring connected with three rods. Thirty per cent of the tibia and fibula were removed in the middle and distal parts of the diaphyses, between the middle and distal rings. Acute bone shortening with compression of proximal and distal segments was performed. A subperiosteal osteotomy was performed between the half-ring and middle ring. Bone distraction started 7 days after surgery; after lengthening, the apparatus was left in place for 14 weeks for consolidation of regenerated bone. The frame was removed at the end of this period, and the dogs observed for four more weeks. Functional results were considered excellent in two, good in three and fair in the other two dogs. Bone regeneration within the distraction gap was obtained 14 weeks after neutral fixation period. We concluded that acute bone shortening followed by gradual lengthening by Ilizarov method can be used to treat extensive tibial defects in dogs, although it presents limb temporary abnormal limb shape and unequal length as early disadvantages.

Animals↗
PubMed2005

Reduction of high dislocation of the hip using a distraction nail before arthroplasty.

We report the case of a 22-year-old woman who underwent plate and screw fixation for a traumatic left acetabular fracture and fixation with cancellous screws for an associated femoral neck fracture. Two months later, the internal fixation became infected and was removed. This resulted in a painful high dislocation of the hip. We solved the problem with continuous soft-tissue distraction using a fully implantable motorised distraction nail in order to reduce the proximal femur prior to total hip arthroplasty. To our knowledge, this is the first time that reduction of a high dislocation of the hip has been performed using such a system.

Acetabulum↗
PubMedDate not supplied

Long-term results of lower limb lengthening by the Wagner method.

Methods of limb lengthening have been continuously modified. The construction of an apparatus for gradual bone distraction was a great improvement. The aim of this study was to evaluate the long-term results of lower limb elongation using the Wagner technique. Between 1983 and 1989, 45 patients underwent surgery in the authors' institution. There were 31 femoral and 15 tibial lengthenings. The operation and lengthening procedure were performed according to the rules published by the method's author. The intended amount of lengthening was achieved in 80% of patients during tibial elongation and in only 52% during femoral elongation because of many problems, obstacles, and complications during treatment. A significant percentage of improper (deficient or irregular) new bone formation led to femoral malunion in three patients and to tibial and femoral delayed bone consolidation in six patients. Fast distraction produced great forces on the surrounding joint surfaces, resulting in a limited range of motion and joint stiffness. The Wagner technique does not seem to be effective and is associated with a long duration of treatment and some complications impairing the function of the limb.

Adolescent↗
PubMed2005

[Posttraumatic elbow stiffness: planning and technical aspects of arthrolysis].

Posttraumatic limitation of range of motion in the elbow joint may be of extraarticular, intraarticular or mixed origin. If conservative management fails to improve elbow motion, arthroscopic arthrolysis, open arthrolysis and distraction arthroplasty are available as therapeutic options. Joint distraction for gradual lengthening of shortened ligaments and capsules is used to disimpact the humero-ulnar articular surface. Under distraction fixator controlled mobilization is carried out. The use of transarticular external fixation is particularly helpful in cases of subluxation in order to restore joint congruity and facilitate postoperative physiotherapy. The postoperative management plays an important role in achieving the therapeutic goal.

Ankylosis↗
PubMed1998

Foraminal pressure changes during intervertebral distraction simulating anterior cervical discectomy.

Distraction of the disc space over baseline height has been shown to increase foraminal size. The purpose of this procedure is to determine pressure changes, with disc space distraction simulating an anterior cervical discectomy and fusion (ACDF). An analysis of pressure changes during disc space distraction at C5-C6 was performed. Data were analyzed for maximal pressure observed and for pressure change with prolonged distraction. Five cadaveric specimens underwent a discectomy at the C5-C6 level. Distraction of the disc space was performed and pressure measurements were obtained from within the foramen. Measurements were made for maximal pressure with an intact posterior longitudinal ligament (PLL), divided PLL, and with the nerve root removed from within the foramen. Pressures were also recorded with prolonged distraction until a steady state was achieved. Incremental distraction of +2, +4, and +6 mm resulted in pressure increases within the foramen. Sectioning of the PLL did not affect these increases. Removal of the nerve root from the foramen resulted in pressure increases; however, these were not significantly different from baseline. Prolonged distraction produced an initial increase and a gradual return toward baseline. Final pressures still differed significantly from baseline. Increase intraforaminal pressures can be seen with increasing disc space distraction such as occurs during an ACDF. This suggests that either the foramen narrows in at least one dimension and/or soft-tissue attachments to the nerve produce a tensile force in the nerve as they tighten. The pressure increases relax over time.

Aged↗
PubMed2006

Meniscus transplantation using the femoral distractor.

Accurate tunnel placement, graft passage, and secure suture fixation are key elements in meniscus allograft transplantation. We describe the use of a femoral distractor in meniscus transplantation. Joint distraction on the side of the transplantation by the femoral distractor can dramatically improve visibility and joint access. The distractor is applied after all necessary preparatory work. The distal femoral pin is placed in the supracondylar region on the side corresponding to the side to be transplanted. To avoid injury to the peroneal nerve, the proximal tibial pin is placed medial to lateral for both medial and lateral transplantations. The tibial pin is placed at a level approximately 1 to 2 cm below the tibial tubercle. The knee is then held in the flexion angle that affords the best visualization arthroscopically (typically between 60 degrees and 90 degrees of flexion). Gradual distraction is then applied with the distraction rod until adequate visualization is obtained. The case then proceeds with tunnel or trough creation, graft delivery, and peripheral repair. The improved visualization and access provided by the femoral distractor markedly simplifies the more challenging aspects of meniscus transplantation, helping to ensure precise tunnel placement, facilitate graft passage, and aid in accurate suturing.

Femur↗
PubMed2006

Adult acquired flexible flatfoot, treated by calcaneocuboid distraction arthrodesis, posterior tibial tendon augmentation, and percutaneous Achilles tendon lengthening: a prospective outcome study of 20 patients.

BACKGROUND: Several methods for the treatment of acquired flexible flatfoot have been described. PATIENTS AND METHODS: We followed the outcome of calcaneocuboid distraction arthrodesis with lengthening of the lateral column prospectively in 20 patients (20 feet). The mean age of the patients was 55 (30-66) years and 16 were women. The lateral column lengthening was combined with percutaneous lengthening of the Achilles tendon and augmentation of the posterior tibial tendon in all patients. Fixed forefoot supination, hallux valgus, and/or symptomatic arthrosis, were corrected with arthrodesis of the first cuneiform-metatarsal joint (n = 8) and arthrodesis of the naviculocuneiform joint (n = 2). The Foot Function Index (FFI) and American Orthopedic Foot and Ankle Society (AOFAS) Clinical Rating Index hindfoot score (CRI) were completed preoperatively and at follow-up. Follow-up time was 25 (13-39) months. All patients were physically examined at follow-up at the outpatient clinic, and the overall satisfaction rate was registered. Standardized weight-bearing radiographs were taken preoperatively and at follow-up. The lateral and dorsoplantar talometatarsal angle was measured, together with the ground-navicular distance. RESULTS: At follow-up, 17/20 feet had complete relief of pain or only minor symptoms. The overall patient satisfaction rate was excellent or good in 15 patients and 17 patients reported an increase in daily and/or recreational activities. 3 patients complained of pain at the distraction site and/or cuboid-MT5 joint, without signs of arthrosis. All but 1 patient would have chosen to undergo the same procedure given the same circumstances. The improvement in both the FFI and CRI was statistically significant. On radiographic examination, the lateral and dorsoplantar talometatarsal angle and the ground-navicular distance improved significantly. Nonunion developed in 2 patients and united after bone grafting. 3 patients had either paresthesia or anesthesia in the distribution area of the sural nerve. INTERPRETATION: We found good short-term results after calcaneocuboid distraction arthrodesis, percutaneous tendon Achilles lengthening, and medial soft tissue augmentation for the treatment of degenerative/acquired flexible flatfoot. Pain or discomfort along the lateral aspect of the foot is the most common and worrying postoperative complaint.

Achilles Tendon↗
PubMed2004

Occlusal difficulties after simultaneous mandibular and maxillary distraction in an adult case of hemifacial microsomia.

A 23-year-old woman with hemifacial microsomia type IIB was treated by simultaneous mandibular and maxillary distraction. During the course of the distraction, cephalometric analysis showed that the maxilla was not moving downward and that the upper edge of the mandibular condyle was moving upward into the space between the condyle and the glenoid fossa. This phenomenon could lead to early consolidation of the osteotomized maxilla, resulting in malposition and occlusal difficulties. This is thought to be a problem unique to bimaxillary distraction of hemifacial microsomia type IIB with severe hypoplasia of the mandibular ramus and space between the condyle and the glenoid fossa. Surgeons should be alerted to this risk and prepared to address it when performing this procedure.

Adult↗
PubMed2004

Morphological evaluation of changes in velopharyngeal function following maxillary distraction in patients with repaired cleft palate during mixed dentition.

OBJECTIVE: To describe the morphological changes of nasopharyngeal components after maxillary distraction and clarify whether the morphological characteristics are related to velopharyngeal function (VPF). DESIGN: Perceptual judgments of hypernasality and nasendoscopy were performed before and after treatment. Lateral cephalograms were obtained to describe the morphological changes. SETTING: Department of Oral and Maxillofacial Surgery, Miyazaki Medical College, Miyazaki, Japan. PARTICIPANTS: Nine patients with repaired cleft palate in the mixed dentition stage underwent maxillary distraction using a face mask and an intraoral fixed appliance system. OUTCOME MEASURES: The severity of hypernasality, velopharyngeal insufficiency, and measurements such as pharyngeal depth, velar length, and the rotation of the palatal plane were evaluated. RESULTS: Increase in pharyngeal depth was not always proportional to the amount of advancement. It depended on the posture of the posterior pharyngeal wall and the rotation of palatal plane. CONCLUSION: Cephalometric measurements of the nasopharynx before and after surgery confirmed subsequent changes in VPF. These were suggested to be useful in predicting future VPF. When performing maxillary distraction in patients with cleft palate in the mixed dentition stage, and when velopharyngeal closure is found to occur by velar contact against the hypertrophied adenoid, patients should be counseled about risks of subsequent deterioration in their speech before surgery.

Adenoids↗
PubMedDate not supplied

The Ilizarov method in the treatment of malignant neoplasms of the tibia.

A total of 3 malignant neoplasms of the tibia are presented: 1 is a mesenchymal chondrosarcoma of the tibial pylon (male aged 14 years), and 2 are cases of squamous skin carcinoma of the leg with tibial infiltration (1 male and 1 female aged 32 and 64 years, respectively). The resections carried out (16.5 cm on the average) were treated by bone transport. Simple transport was used in the first patient, double in the other two. At the end of transport a second surgical stage involving astragalotibial arthrodesis was performed in the first case, and revision of the junction site of bone segments transported with application of autoplastic bone grafts was performed in the other two. The regenerate obtained was slowly corticalized in the first patient, submitted to various cycles of chemotherapy during the course of distraction. In the other two cases, which were not treated by chemotherapy during distraction, corticalization occurred over a shorter amount of time. Follow-up was obtained after 10 years in the first case, and after 2 years in the other 2 patients. There was no long-term recurrence.

Adolescent↗
PubMed2005

Ultrasound to stimulate early bone formation in a distraction gap: a double blind randomised clinical pilot trial in the edentulous mandible.

OBJECTIVE: In a double blind randomised clinical pilot trial, it was investigated whether low intensity pulsed ultrasound therapy stimulates early bone formation in a distraction gap created in a severely resorbed mandible. DESIGN: Eight patients underwent a mandibular vertical distraction over an average distance of 6.6+/-1.1mm. Ultrasound self-therapy or placebo therapy was started on the first day of distraction and continued daily until the implants were inserted. After 31+/-3.8 days of consolidation, the distraction device was removed, a transmandibular biopsy was taken, and two endosseous implants were inserted. RESULTS: All patients complied well with ultrasound therapy. During an average of 30.1+/-4.1 months follow-up, no complications did occur. Microradiographic examination of the biopsies revealed a comparable mean area of mineralised tissue in the distraction gap of 1.9+/-1.7mm(2) in the ultrasound treatment group and 1.9+/-1.3mm(2) in the placebo treatment group. Histological examination indicated that active woven bone was present within the distraction gap just adjacent to the osteotomy plane, with no apparent differences between the treatment groups. The lamellar bone formation outside the distraction gap appeared to have started as well. CONCLUSION: During a 31-day consolidation period, ultrasound treatment does not appear to stimulate bone formation in the severely resorbed vertical distracted mandible and it seems that this period is too short to evaluate properly if there is an effect. Therefore, a longer consolidation period has to be studied.

Aged↗
PubMed1999

Proximal segment position after distraction with the MD-DOS device.

We investigated cephalometrically the movement of the proximal segment in the sagittal plane in patients treated with distraction (MD-DOS device) for mandibular lengthening. The proximal segment was anteriorly rotated, whilst the distal segment was posteriorly rotated after the lengthening procedure. Thus the angle of the jaw was advanced half the distance of the advancement of the distal segment. One possible reason for the anterior rotation of 3.3 degrees on average is the repositioning of the proximal segment during application of the anterior fixation unit in the cases where mobilization was complete. Another more plausible reason is the anterior pull by the masticatory muscles and elastic bands being greater than the reactive distraction vector component in concert with a flexible telescopic distraction module and a single posterior screw anchorage. The positional movements of both distal and proximal segments were similar to those observed after mandibular advancement with bilateral sagittal split osteotomies.

Adolescent↗
PubMed1997

Vector of device placement and trajectory of mandibular distraction.

The role of preoperative planning, the geometric changes, and the long-term effects of mandibular distraction have not been previously reported. This study included 10 patients who underwent unilateral (5 patients) or bilateral (5 patients) mandibular distraction. Preoperative, postdistraction, and yearly radiographs (panoramic, posteroanterior, and lateral cephalograms) were reviewed. Postdistraction follow-up ranged from 12 to 70 months. Postdistraction, the mandibles showed evidence of anticipated growth without relapse. This growth rate was variable and dependent on the genetic program of the native bone. Previously reported improvement in temporomandibular joint morphology was maintained in the long term. The resulting shape of the neomandible was most influenced by the vector of placement of the distraction device. When placed vertically, ramal elongation was observed. When placed horizontally, anterior projection of the mandibular body occurred. When placed obliquely, ramal and body elongation occurred with preservation of the gonial angle. After 2 to 5 years of follow-up, continued growth of the neomandible was observed.

Cephalometry↗