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Clinical Outcomes of Lower Extremity Lenghtening Osteotomies

Year 2018, , 138 - 141, 13.11.2018
https://doi.org/10.30565/medalanya.386818

Abstract

Aim: In this
study; We aimed to evaluate the outcomes of distraction cases with distraction
osteogenesis technique using monolateral and annular external fixator in
patients who suffer from lower extremity shortness.

Patients and
Methods:
In our study, we tried to explain the results of the lower extremity
osteotomy operations using
  distraction
osteogenesis technique in the 16 lower extremities of 12 patients. Seven of the
patients were female and 5 of them were male. The mean age of the patients was
11.8 (4-26) years. Four of the patients' femurs, 4 of the patients' tibias, and
4 of the patients' both femurs and tibias were extended. A monolateral external
fixator (orthoFix) was used in the distraction of 15 patients, and Ilizarov's
ringed external fixator was used in the extension of one patient.

Results: The average
length of extension was 3.5 cm (2-7), the waiting period before extension was
13.2 days (9-20), the healing index was approximately 52 (31-90), the ratio of
gained lenght to the extended bone segment was approximately 13,6%
(5%-19%)
  and the average duration of
stay of fixators was 182 days (140-270). Twenty complications were observed in
the 16 lower extremity lengthening procedures. The most common complication (in
9 patients) was angulation.


























Conclusion: In the
extensions depending one Ilizarov's extension principles, the extensions are
successful;but
  it should not be forgotten
that the number of complications might be excessive and operation experience is
also important.

References

  • 1. Moseley CF. Leg lengthening. The historical perspective. Orthop Clin North Am 1991;22:555-61.
  • 2. Ilizarov G. A.The Tension-Stress Effect on the Genesis and Growth of Tissues: Part I. The Influence of the Rate and Frequency of Distraction. Clin Orthop Relat Res 1989;238:249-81.
  • 3. Ilizarov G. A.The Tension-Stress Effect on the Genesis and Growth of Tissues: Part II. The Influence of the Rate and Frequency of Distraction. Clin Orthop Relat Res 1989;239:263-85.
  • 4. Aldegheri R, Renzi-Brivio L, Agostini S. The Callotasis Method of Limb Lengthening. Clin Orthop Relat Res 1989;241:137-145.
  • 5. Birch JG. A Brief History of Limb Lengthening. J pediatr Orthop 2017; Suppl 2: S1-S8
  • 6. Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res.1990;(250):81-104.
  • 7. Price CT, Mann JW. Experience with the Orthofix device for limb lengthening. Orthop Clin North Am 1991;22:651-61
  • 8. De Bastiani G, Aldegheri R, Renzi-Brivio L, Trivella G :Limb lengthening by callus distraction(callotasis).J Pediatr Orthop 1987;7:129-134.
  • 9. Ilizarov GA:Transosseous Osteosynthesis.Green SA (Ed) Springer-Verlag Berlin,Heidelberg,1992; p 137-139.
  • 10. Chao EYS, Aro HT, Lewallen DG, Kelly PI. The Effect of Rigidity on Fracture Healing in External Fixation. Clinical Orthopaedics and Related Research. 1989;241:24-35.
  • 11. Wasserstein I. Twenty-Five Years' Experience With Lengthening of Shortened Lower Extremities Using Cylindrical Allografts. Clinical Orthopaedics and Related Research1990;250:150-153.
  • 12. Chilbule SK, Dutt V, Madhuri V.Limb lengthening in achondroplasia. Indian J Orthop. 2016;50(4):397-405.
  • 13. Ilizarov GA Clinical application of the tension-stress effect for limb lengthening. Clin Orthop Relat Res. 1990;(250):8-26.
  • 14. Liantis P(1), Mavrogenis AF, Stavropoulos NA, Kanellopoulos AD, Papagelopoulos PJ, Soucacos PN, Babis GC. Risk factors for and complications of distraction osteogenesis . Eur J Orthop Surg Traumatol. 2014 ;24(5):693-8.
  • 15. Aronson J, Harp JH. Mechanical Forces as Predictors of Healing During Tibia1 Lengthening by Distraction Osteogenesis Clin Orthopaedics and Related Research. 1994;301:73-79.
  • 16. Herzenberg JE, Scheufele LL, Paley D, Bechtel R, Tepper S. Knee Range of Motion in Isolated Femoral Lengthening. Clin Orthopaedics and Related Research. 1994;301:49-54.
  • 17. Paley D. Current techniques of limb lengthening. J Pediatr Orthop. 1988 ;8(1):73-92.
  • 18. Guidera KJ, Hess WF, Highhouse KP, Ogden JA:Extremity lengthening.Results and Complications with the Orthofix system.J Pediatr Orthop 1991;11:90-4
  • 19. Subaşı, M., Aliyev A.F., Can, Ö.: Lengthening of Congenital Lower Limb Shortness with The Methods of Ilizarov. Acta Orthop Traumatol Turc 1995; 29: 139-41.
  • 20. Erdal OA, İnan M. İskelet displazilerinde alt ekstremite deformitelerinin değerlendirilmesi. TOTBİD Dergisi 2016; 15:279–287.
  • 21. Hankemeier S, Bastian L, Gosling T, Krettek C. Principles of callus distraction. Unfallchirurg. 2004;107(10):945-58.
  • 22. Hantes ME(1), Malizos KN, Xenakis TA, Beris AE, Mavrodontidis AN, Soucacos PN. Complications in limb- lengthening procedures: a review of 49 cases. Am J Orthop (Belle Mead NJ). 2001;30(6):479-83. 23. Castelein S,Docquier PL:Complications associated with bone lengthening of the lower limb by callotasis. Acta Orthop Belg. 2016;82(4):806-813.
  • 24. Krieg AH,Speth BM,Foster BK:Leg lengthening with a motorized nail in adolescents:an alternative to external fixators? Clin Orthop Relat Res 2008; 466:189-97.
  • 25. Dinçyürek H,Kocaoğlu M,Eralp İL,Bilen FE,Dikmen G,Eren I:Functional results of lower extremity lengthening by motorized intramedullary nails. Acta Orthop Traumatol Turc. 2012;46(1):42-9.
  • 26. Al-Sayyad MJ:Lower limggggb lengthening and deformity correction using the Fitbone motorized nail system in the adolescent patient. J Pediatr Orthop B 2012;21:131–6.
  • 27. Xu WG: Comparison of Intramedullery Nail Versus Convantional Ilizarov Method for Lower Limb Lengthening. A Systematic Review and Meta-Analysis. Orthop Surg 2017;9(2):159-166

Alt Ekstremite Uzatma Osteotomilerinin Klinik Sonuçları

Year 2018, , 138 - 141, 13.11.2018
https://doi.org/10.30565/medalanya.386818

Abstract

Amaç : Çalışmamızda; alt eksremite
kısalığı olan hastalarda, monolateral ve halkalı eksternal fiksatör
kullanılarak, distraksion osteogenezi tekniği ile yaptığımız uzatma
olgularımızın sonuçlarını değerlendirmeyi amaçladık.

Hastalar ve Yöntem: Çalışmamızda; 12 hastanın 16 alt
ekstremitesinde distraksion osteogenezi tekniği ile yapılan alt eksremite
uzatma osteotomilerinin sonuçlarını açıklamaya çalıştık. Hastaların 7'i kadın,
5'i erkek di. Ortalama yaş 11,8(4-26) dı. Hastaların 4'ünin femuru, 4'ünün
tibiası ve 4 hastanın da hem femuru hem de tibiası uzatılmıştır. 15 hastanın
uzatmasında monolateral eksternal fiksatör(orthofix), bir hastanın
uzatmasında
  İlizarov'un halkalı
eksternal fiksatörü kullanıldı.

Bulgular: Ortalama uzama miktarı 3,5 cm(2-7),
uzatma öncesi bekleme süresi ortalama 13,2 gün(9-20), iyileşme indeksi ortalama
52(31-90), kazanılan uzunluğun uzatılan kemik segmentine oranı ortalama
%13,6(%5-%19), fiksatörlerin kalış süresi ortalama 182 gün(140-270)dür. Yapılan
16 alt ekstremite uzatma isleminde
  20
komplikasyon görüldü. En sık görülen komplikasyon (9 hastada) Açılanmadır.


























Sonuç: İlizarov'un uzatma prensiplerine
bağlı olarak yapılan uzatmalarda ,uzatmalar başarılı şekilde gerçekleşmektedir;
ancak komplikasyon sayısının fazla olabileceği ve operasyon deneyimin önemli
olduğu unutulmamalıdır.

References

  • 1. Moseley CF. Leg lengthening. The historical perspective. Orthop Clin North Am 1991;22:555-61.
  • 2. Ilizarov G. A.The Tension-Stress Effect on the Genesis and Growth of Tissues: Part I. The Influence of the Rate and Frequency of Distraction. Clin Orthop Relat Res 1989;238:249-81.
  • 3. Ilizarov G. A.The Tension-Stress Effect on the Genesis and Growth of Tissues: Part II. The Influence of the Rate and Frequency of Distraction. Clin Orthop Relat Res 1989;239:263-85.
  • 4. Aldegheri R, Renzi-Brivio L, Agostini S. The Callotasis Method of Limb Lengthening. Clin Orthop Relat Res 1989;241:137-145.
  • 5. Birch JG. A Brief History of Limb Lengthening. J pediatr Orthop 2017; Suppl 2: S1-S8
  • 6. Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res.1990;(250):81-104.
  • 7. Price CT, Mann JW. Experience with the Orthofix device for limb lengthening. Orthop Clin North Am 1991;22:651-61
  • 8. De Bastiani G, Aldegheri R, Renzi-Brivio L, Trivella G :Limb lengthening by callus distraction(callotasis).J Pediatr Orthop 1987;7:129-134.
  • 9. Ilizarov GA:Transosseous Osteosynthesis.Green SA (Ed) Springer-Verlag Berlin,Heidelberg,1992; p 137-139.
  • 10. Chao EYS, Aro HT, Lewallen DG, Kelly PI. The Effect of Rigidity on Fracture Healing in External Fixation. Clinical Orthopaedics and Related Research. 1989;241:24-35.
  • 11. Wasserstein I. Twenty-Five Years' Experience With Lengthening of Shortened Lower Extremities Using Cylindrical Allografts. Clinical Orthopaedics and Related Research1990;250:150-153.
  • 12. Chilbule SK, Dutt V, Madhuri V.Limb lengthening in achondroplasia. Indian J Orthop. 2016;50(4):397-405.
  • 13. Ilizarov GA Clinical application of the tension-stress effect for limb lengthening. Clin Orthop Relat Res. 1990;(250):8-26.
  • 14. Liantis P(1), Mavrogenis AF, Stavropoulos NA, Kanellopoulos AD, Papagelopoulos PJ, Soucacos PN, Babis GC. Risk factors for and complications of distraction osteogenesis . Eur J Orthop Surg Traumatol. 2014 ;24(5):693-8.
  • 15. Aronson J, Harp JH. Mechanical Forces as Predictors of Healing During Tibia1 Lengthening by Distraction Osteogenesis Clin Orthopaedics and Related Research. 1994;301:73-79.
  • 16. Herzenberg JE, Scheufele LL, Paley D, Bechtel R, Tepper S. Knee Range of Motion in Isolated Femoral Lengthening. Clin Orthopaedics and Related Research. 1994;301:49-54.
  • 17. Paley D. Current techniques of limb lengthening. J Pediatr Orthop. 1988 ;8(1):73-92.
  • 18. Guidera KJ, Hess WF, Highhouse KP, Ogden JA:Extremity lengthening.Results and Complications with the Orthofix system.J Pediatr Orthop 1991;11:90-4
  • 19. Subaşı, M., Aliyev A.F., Can, Ö.: Lengthening of Congenital Lower Limb Shortness with The Methods of Ilizarov. Acta Orthop Traumatol Turc 1995; 29: 139-41.
  • 20. Erdal OA, İnan M. İskelet displazilerinde alt ekstremite deformitelerinin değerlendirilmesi. TOTBİD Dergisi 2016; 15:279–287.
  • 21. Hankemeier S, Bastian L, Gosling T, Krettek C. Principles of callus distraction. Unfallchirurg. 2004;107(10):945-58.
  • 22. Hantes ME(1), Malizos KN, Xenakis TA, Beris AE, Mavrodontidis AN, Soucacos PN. Complications in limb- lengthening procedures: a review of 49 cases. Am J Orthop (Belle Mead NJ). 2001;30(6):479-83. 23. Castelein S,Docquier PL:Complications associated with bone lengthening of the lower limb by callotasis. Acta Orthop Belg. 2016;82(4):806-813.
  • 24. Krieg AH,Speth BM,Foster BK:Leg lengthening with a motorized nail in adolescents:an alternative to external fixators? Clin Orthop Relat Res 2008; 466:189-97.
  • 25. Dinçyürek H,Kocaoğlu M,Eralp İL,Bilen FE,Dikmen G,Eren I:Functional results of lower extremity lengthening by motorized intramedullary nails. Acta Orthop Traumatol Turc. 2012;46(1):42-9.
  • 26. Al-Sayyad MJ:Lower limggggb lengthening and deformity correction using the Fitbone motorized nail system in the adolescent patient. J Pediatr Orthop B 2012;21:131–6.
  • 27. Xu WG: Comparison of Intramedullery Nail Versus Convantional Ilizarov Method for Lower Limb Lengthening. A Systematic Review and Meta-Analysis. Orthop Surg 2017;9(2):159-166
There are 26 citations in total.

Details

Primary Language Turkish
Subjects Surgery
Journal Section Research Article
Authors

Devrim Özer This is me

Yavuz Arikan 0000-0001-7108-9864

Publication Date November 13, 2018
Submission Date January 30, 2018
Acceptance Date March 30, 2018
Published in Issue Year 2018

Cite

Vancouver Özer D, Arikan Y. Alt Ekstremite Uzatma Osteotomilerinin Klinik Sonuçları. Acta Med. Alanya. 2018;2(3):138-41.

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