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At least 19 recordsLinked to original sources
PubMed1994

Complications of bone lengthening.

Bone lengthening is a surgical method which requires meticulous technique, continuous attention, and satisfactory cooperation on the part of the patient. The absence of common criteria makes it difficult both to classify the complications which arise, and to compare them with those of other authors. We report the complications in a group of 61 patients who were studied prospectively. Disorders of the lengthening callus accounted for 45% of all complications, and a further 33% arose in the joints. The remainder occurred in the bone, the apparatus and the soft tissues, of which the most common were stiffness of the joints, axial deviations and loosening of the pins, while articular subluxation, fractures with angulation and delayed consolidation occurred less frequently. In our study, the overall number of complications per lengthening process was 2.1. In bilateral lengthening, the rate was 1 per segment, while in unilateral cases the mean was 2.7. Problems which we defined as severe, requiring that the lengthening had to be halted, occurred in 1.8% of the total complications. The aetiology of the length discrepancy has an important role in the complications which occur in each segment. Over twice as many problems occur in asymmetrical lengthening procedures as in patients where lengthening is symmetrical.

Bone Lengthening↗
PubMed1999

Relationship between radiologic morphology of the bone lengthening formation and its complications.

The objective was to study the different types of lengthened bone regeneration and their development during the various phases of the process to correlate them with patient factors and the surgical technique used, and to establish a possible relation between the development of the bone lengthening formation and the problems or complications. The authors studied the radiographs of a random group of 55 patients taken at three points during the course of treatment. The callus was classified with regard to its transverse diameter and the presence or absence of hypodense areas. The overall callus type was significantly influenced by the etiology, the osteotomy site, and the percentage lengthened. The percentage by which the limb was lengthened at the beginning of the process influences the overall morphology of the callus. Poor callus had been lengthened the most, atrophic callus the least. There was a correlation between the morphology of the overall callus at the end of treatment and the percentage lengthened, and between the percentage lengthened and the presence of bands at the end of treatment. The authors also found a significant correlation between age and the appearance of bands at the end of distraction. A central band was found among younger patients. The type of osteotomy affected the overall callus at the end of distraction and at the end of treatment and also influenced the transverse diameter. All the elongations with poor bone formation at the end of treatment were found to have undergone a diaphyseal osteotomy. The most common complication at the first follow-up and at the end of distraction was angulation. The diameter of the callus and the presence of bands at the end of treatment were significantly related to the complications. Fracture occurred in the first 2 weeks after removal of the external fixator in 88% of cases and in the third and fourth week in the rest. However, the segment had no significant influence on the appearance of complications. Lengthened callus with incomplete trabecular formations and hypodense areas at the end of the treatment has a high risk of fracture at the end of treatment. Callus with axial deviation, hypodense areas, or an insufficient transverse diameter during the lengthening procedure must be manipulated so that it reaches the maturing phase in better condition.

Adolescent↗
PubMed2006

The effect of latency on bone lengthening force and bone mineralization: an investigation using strain gauge mounted on internal distractor device.

BACKGROUND: The purpose of this study was to investigate the effect of latency on the development of bone lengthening force and bone mineralization during mandible distraction osteogenesis. METHODS: Distraction tensions were investigated at different latency period in 36 rabbits using internal unilateral distractor. Strain gauges were prepared and attached to the distractor to directly assess the level of distraction tension during mandible lengthening. The tensile force environment of the mandible of rabbit during distraction was evaluated through in vivo experiments using two gauges. The animals were divided into 3 groups each containing 12 rabbits. Latency periods of 0, 4 and 7 days respectively were observed prior to beginning distraction. The distraction protocol consisted of a lengthening rate of 1 mm once daily for 8 days, followed by a consolidation phase of 2 weeks after which the animals were killed. Biopsies specimens were taken from the distracted area at the end of the distraction period. A non-distracted area of the mandible bone served as control. The specimens were analyzed by scanning electron microscopy to assess the ultrastructural pattern, and the bone mineralization. RESULTS: The resting tension acting on the distraction gap increases through distraction. The 7-day latency groups exhibit higher tension then those of 0-day and 4-days latency groups. Quantitative energy dispersive spectral analysis confirmed that immediate distractions were associated with lower calcium and phosphate atomic weight ratio. CONCLUSION: the latency periods could affect the bone lengthening tension and the bone mineralization process.

Animals↗
PubMed1999

Stimulation of bone formation by recombinant fibroblast growth factor-2 in callotasis bone lengthening of rabbits.

Bone lengthening by callotasis is one of the most useful methods not only for the treatment of short extremities but also for extensive bone defects; however, the procedure takes a long time especially for the consolidation of the distracted callus. In this study, effects of a single local injection of recombinant human fibroblast growth factor-2 (FGF-2 or basic FGF) on callotasis bone lengthening were examined in rabbits. Ten days after the osteotomy at the middle of the tibia and the installment of an external fixator, the osteotomized site was distracted at a rate of 1.4 mm/day for 7 days, resulting in 9.8 mm lengthening. On the final day of distraction, 200 microg of FGF-2 in 150 microl of saline solution or vehicle alone was injected into the center of the distracted callus. Injection of FGF-2 increased bone formation at the distracted callus radiologically and histologically. A significant effect on bone mineral content (BMC) at the callus was observed as early as 2 weeks, and FGF-2 increased the BMC about twofold at 5 weeks after a normal remodeling process. We conclude that the callotasis method in combination with FGF-2 injection at the consolidation step could be clinically beneficial to shorten the bone lengthening period.

Absorptiometry, Photon↗
PubMed1999

[Primary shortening followed by bone lengthening in situ for the treatment of gunshot bone defect].

OBJECTIVE: To study the treatment of gunshot bone defect and the biological basis of primary shortening followed by callus distraction in situ. METHODS: The canine with gunshot bone defect were treated by two methods, primary shortening followed by callus distraction or delayed bone graft. The local blood flow and pathomorphological change were observed and compared with each other. RESULTS: In the experiment, the bone lengthening was stopped at the 56th day with (2.82 +/-e 0.94) cm (19.3%) gain in the group of bone lengthening, and the time of bone healing was much shorter in the group of bone lengthening than in the group of delayed graft. There was no significant difference between the groups in the time of soft tissue healing and local blood flow. CONCLUSIONS: The technique of primary bone lengthening is simple and has no side effect on tissue healing and local blood flow.

Animals↗
PubMed1992

Membranous bone lengthening: a serial histological study.

Bone lengthening using the process of corticotomy and gradual distraction of callus is applicable to the membranous bone of the canine mandible. In this study the precursors to bone formation, in the area between the distracted bone edges, are analyzed in an attempt to determine the mechanism of bone formation. Ten mongrel dogs 5 months of age were studied. A unilateral, periosteal-preserving angular corticotomy was performed, and an external bone-lengthening device was fixed to the mandible. After 10 days of external fixation, the mandible was lengthened 1 ml per day for 20 days and then held in external fixation for 8 weeks. The dogs were killed for histological and microradiographic study at 10 and 20 days of distraction, and at 14, 28, and 56 days after the completion of distraction. It was observed that the gap between the distracted bone edges is first occupied by fibrous tissue. As distraction proceeds, the fibrous tissue becomes longitudinally oriented in the direction of distraction. Early bone formation advances along the fibrous tissue, starting from the cut bone ends. Eventually the area is converted to mature cortical bone. Bone is formed predominantly by intramembranous ossification. This mechanism is similar to that of bone formation during long bone lengthening.

Animals↗
PubMed2006

[Polarized microscopic observation of the collagen change in bone healing during bone lengthening].

OBJECTIVE: To investigate the feature and regularity of the collagen change in bone healing during bone lengthening. METHODS: Bone lengthening model was made in the middle segment of the rabbit tibia. Five days after the model was established, the bone was lengthened 1.5 mm per day for 14 days. The rabbits were put to death after elongation, 7, 14, 21, 30, 40, 50, 60 and 70 days after elongation. The distracted area of the bone was imbedded with paraffin. After being stained by the picric acid-sirius red staining, the slice was observed under polarized microscope. RESULTS: The features of the collagen change in the distracted bone were as follows: (1) In the fibrous tissue of the distracted area during lengthening period and the early stage after lengthening, there was not only collagen III but also much collagen I. (2) Collagen I , II and III were observed in the cartilage. (3) Collagen I, II and III were also observed in the pseudo-growth plate. (4) Collagen I took the dominance during lengthening period and the late stage after lengthening. CONCLUSION: New bone formation in bone lengthening is under the distracted force, so the collagen changes have different features compared with that in fracture healing. Collagen I, II and III can be identified by picric acid-sirius red staining and polarized microscope, so a new method for studying the collagen typing in bone repairing is provided.

Animals↗
PubMed1995

Biomechanical analysis of canine bone lengthened by the callotasis method.

The mechanical integrity of tibial bone treated by distraction osteogenesis (callotasis) using an Orthofix external fixator was evaluated in a group of 6 dogs. Diaphyseal corticotomies were performed on Day 0. Distraction was begun on Day 8, at a rate of 0.33 mm every 8 hours. On Day 34, the Orthofix frame was locked. On Day 56, the frames were removed and the dogs were euthanized. Radiographs were taken weekly to assess regenerate bone formation and extent of tibial bone lengthening, which averaged 12 mm (range, 5-20 mm). One dog showed incomplete bony union that was attributed to pin loosening. Torsional testing of lengthened and contralateral control tibiae resulted in spiral diaphyseal fractures. Five of 6 lengthened tibiae bones fractured within the diaphysis, but outside the regenerate area, suggesting that the strength of the lengthened segment exceeded that of the original diaphysis which was exposed to stress shielding by the external fixator. These observations have led to a method to test and evaluate lengthened bone at the time of frame removal and to monitor the effectiveness of this type of technique.

Animals↗
PubMed2004

[Elastic stable intramedullary nailing in Ilizarov bone lengthening].

PURPOSE OF THE STUDY: Bone lengthening with the Ilizarov technique gives good results but certain disadvantages are common: possible axial deviation during lengthening, long time to bone union, risk of fracture after removal of the external fixator. Associating the Ilizarov technique with elastic stable intramedullary nailing (ESIN) commonly used in traumatology has to be evaluated. We conducted an experimental study and report results of the first clinical application. MATERIAL AND METHODS: Eleven lengthenings of the tibia were conducted in dogs aged 1 to 4 years using an Ilizarov external fixator associated with ESIN. Lengthening started on day 1 and continued for 28 days. X-rays were obtained every week during lengthening, then at 15 and 30 days during the fixation period and 30 days after removal of the fixator. In two cases, arteriography was performed. In a pilot clinical trial, fourteen patients (8 males, 6 females) were treated with this method (1 humerus, 1 forearm, 7 femurs, 5 tibias). Mean patient age was 14 years. RESULTS: In the experimental study, the x-rays showed rapid ossification of the regenerate which led to increased tibia length in 7 cases from 1.25 to 2 mm/day. Total bone union was observed in four dogs during the lengthening period. At day 15 of the fixation period, all tibia had fused with a good quality cortical bone and healing of the growth part of the regenerate. In three dogs, the external fixator was removed at day 15 of fixation and weight-bearing was total with the ESIN in place. No axial deviation and no skin problems were observed. The medullary artery was seen on the two arteriograms. In the clinical trial, bone union of the regenerate appeared earlier than in the Ilizarov series. The regenerate always displayed good density on the x-rays, proving intense bone activity. In three patients, the lengthening rate was increased to avoid premature bone fusion. The endosteal bone regenerate was obvious. Mean healing index was 18.6 days/cm (SD=6.2). Weight-bearing was allowed at six weeks. The desired correction was achieved in all patients and no complications were related to ESIN. DISCUSSION: Bone lengthening may be obtained with an intramedullary locking nail which avoids the use of an external fixator but also destroys the endomedullary circulation. Our experimental and clinical study shows that use of an ESIN does not inhibit the endosteal regenerate and seems to improve new bone formation. In many patients, the lengthening rate had to be increased to avoid premature bone fusion. When used in optimal conditions, ESIN can stimulate new endosteal and periosteal bone formation. In addition, ESIN increases shaft stability avoiding the risk of axial deviation. ESIN plays an additional role of stabilization after early removal of the external fixation.

Adolescent↗
PubMed1994

Biomechanical and physical properties of lengthened bone in a canine model.

Reports on the mechanical and physical properties of lengthened bone after completion of the lengthening process remain scarce. Varied results of torsional testing of lengthened bone have been reported. Furthermore, torsional testing provides information on the shear properties of the tissue but does not reflect the elastic properties obtained from tensile, compressive, or bending tests. The present study evaluated the mechanical properties of lengthened bone at various time points, using a uniaxial tension test. Physical properties (density and ash weight) were determined as well. Results indicate that the tensile properties of the lengthened bone increase with time after the completion of lengthening, but they remain significantly weaker than controls (50%) even after 12 weeks. Density and ash weight measurements also increased with time, correlating with the increase in the tensile mechanical properties.

Analysis of Variance↗
PubMed1994

Bone lengthening in malformed upper limbs: a four year experience.

Bone lengthening by corticotomy, gradual distraction and stabilization with an external frame has proved to be effective in the repair of osseous defects in lower extremities. More recently this technique has been introduced also in the treatment of post-traumatic deformities and malformations of the upper limbs. From 1989 to 1992 we treated 38 patients (46 upper limbs) with bone lengthening of which 12 (16 upper limbs) affected by post-traumatic deformities and 26 (30 upper limbs) by malformations. We present herein our four year experience with malformed cases only. The results suggest that bone lengthening is a simple and reliable procedure to obtain good function, to correct angular deviations and, also, to give a better esthetic appearance. Satisfying results, low complication rates and simple execution recommend its use in the treatment of many congenital malformations of the upper limbs, usually in association with traditional techniques. However, we are now strongly selecting the indications in order to improve our future results. We stress in particular that the treatment of some malformations, as ulnar or radial club hands, could be radically modified by introduction of bone lengthening.

Arm↗
PubMed1990

Bone lengthening in the craniofacial skeleton.

The process of bone lengthening by cortical fracture and gradual distraction of callus has become well established in the enchondral bones of the extremities. In this study the principles of bone lengthening were applied to the membranous bone of the craniofacial skeleton using the growing dog mandible as a model. Six mongrel dogs five months of age were studied. A unilateral, periosteal-preserving angular corticotomy was performed, and an external minilengthening device was fixed to the mandible perpendicular to the corticotomy. After 10 days of external fixation, the mandible was lengthened 1 mm/day for 20 days and then held in external fixation for 56 days (8 weeks) after which all dogs were killed. Anthropometric measurements and histological analysis of the specimens confirmed that bone lengthening had occurred and that new cortical bone was formed in the expanded areas.

Animals↗
PubMed1998

[Experimental study on the effect of Chinese traditional medicine "bone growth fluid" in the change of trace elements in bone lengthening area].

In order to study the effect of Chinese traditional medicine, "Bone Growth Fluid", on bone formation in bone lengthening, the limb lengthening model was made on goat to observe bone formation in the distracted area, and the content of the trace elements was determined. The bone-lengthening operation was carried out on the upper metaphysis of left tibia. The animals were divided into two groups following operation. From 2nd day afteroperation, "Bone Growth Fluid", 10 ml per kilogram body weight, was given daily to goats in the experimental group, and same amount of normal saline was given to goats in another group as control. The results showed-that new bone formation and bone remodeling in the experimental group appeared earlier than that in the control group, and the content of the trace elements was also improved. So Chinese Traditional medicine, "Bone Growth Fluid", could accelerate the accumulation of the trace elements in callus on the distracted sites and it might play some role in the promotion of osteogenesis and bone remodeling in bone lengthening.

Animals↗
PubMedDate not supplied

Facial bone lengthening apparatus with expander and miniplates.

Since 1869, bone lengthening has been pursued; when Langenbeck tried growing a shortened bone extremity utilizing for this an arteriovenous fistula in the thigh. At the beginning of this century, codovilla (1905) introduced bone lengthening methods for lower limbs.

Bone Lengthening↗
PubMedDate not supplied

Correlation between ultrasound imaging and mechanical and physical properties of lengthened bone: an experimental study in a canine model.

The right tibias of 16 adult mongrel dogs were lengthened 2.5 cm using a uniplanar lengthening device (Orthofix). After the animals were killed in groups of 4 at 3, 6, 9, and 12 weeks postlengthening, ultrasound imaging and mechanical and physical testing was performed. There was a direct relationship between the percentage of intact cortices on ultrasound imaging and the mechanical and physical properties of lengthened bone. However, once 80-90% of all the cortices regained their continuity, the strength of the lengthened bone was only 50-60% that of the control. Ultrasound imaging, therefore, may be useful in predicting the mechanical and physical properties of lengthened bone in the early phases of limb lengthening. Once all the cortices become continuous, however, another method for assessment of the mechanical properties of lengthened bone should be used.

Animals↗
PubMed1999

[Bone lengthening. History of the development and field of applications].

Leg lengthening has been performed since early in this century. The first successful lengthening was reported in 1905. Leg lengthening evolved from forced lengthening of the bone during anaesthesia, through use of cortical bone grafts, plate and screws to callus distraction (callotasis). Development of external fixators and evolution of biological concepts of bone regeneration has been important. In 1951 Ilizarov developed his apparatus. Ilizarov pioneered the biology of bone and soft-tissue regeneration. He performs a percutaneous subperiosteal corticotomy and waits five to seven days prior to distraction with a rate of 0.25 mm of length four times each day. The method has increased the opportunities in reconstructive bone surgery. The technique is difficult with many problems and obstacles which can be overcome.

Bone Lengthening↗
PubMed2003

Effect of extracorporeal shock waves on callus formation during bone lengthening.

The effects of extracorporeal shock waves (ESWs) on callus formation during bone lengthening were studied in 25 female Japanese white rabbits. Bone lengthening of 9.8 mm was obtained over 2 weeks using the Orthofix M-100 bone fixator. ESWs were applied 3 weeks after surgery. Pins were removed 7 weeks after surgery, and specimens were prepared after the animals were killed at 9 and 24 weeks. The shock wave setting used was 0.42 mJ/mm(2) with a pulse interval of 2 Hz; 3000 shots each were applied to the central and peripheral areas. The specimens were evaluated using radiography, bone mineral density (BMD) measured by dual energy absorptiometry (DXA), and a three-point bending test to evaluate mechanical strength. Histological examination was performed on the lengthened portion. Radiographs and histological observations revealed no apparent fractures in nonlengthening tibias at the shock wave energy densities used. Radiographic observations revealed no apparent differences between the control group and the ESW group. BMD measurements by DXA revealed significantly increased bone mass in the ESW group 9 weeks after surgery. At 24 weeks after surgery the mean BMD had decreased to 25% and 15% of the values at 9 weeks in the control and ESW groups, respectively. The three-point bending test revealed no significant differences between the groups. Histological observations revealed significant capillary formation and osteoblasts and chondrocytes in the bone marrow as well as bridging of newly formed trabeculae 2 weeks after the bone was lengthened. At 4 weeks after treatment, observations included parts of the lengthened portion with no cortex or immature bone. At 9 weeks after surgery, cortex formation and a normal medullary cavity were clearly observed in the control group, whereas observations in the treated group included areas of the lengthened portion with no cortex and formation of immature trabecular structures and increased cancellous bone in the center of the lengthened portion. At 24 weeks after surgery, more prominent cortex formation and fatty marrow were observed in the ESW group than in the control group.

Animals↗