- See:
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Limb Lengthening Fixators
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Distraction Histiogenesis
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Post Op Care in the Ilizarov Method: (by
Dr. Mangal Parihar)
- Discussion:
-
growth deformities of the limbs
- it is important to distinguish between limbs with good potential for lengthening (such as limbs prematurely shortened due to physeal injury) vs those w/ poor
potential for lengthening (such as the congenitally short limb that was never "programmed" to be long);
- some pediatric orthopaedists will be extremely reluctant to attempt lengthenings of the congentially short limb (such as PFFD) due to the high complication rate;
- in adults, obtaining more than a 15% increase in limb length is difficult;
- bone density measurements can be helpful in determining whether it is safe to remove the fixator (during regenerative phase);
- Limb Lengthening in Children:
- lengthening of the pediatric diaphysis:
- when projected discrepancy is > 5.1 cm, consider limb lengthening;
- femur can be lengthened in a single stage, upto 3 to 4 cm, or lengthening can be performed gradually over several weeks;
- references: Epiphyseal distraction-chrondrodiatasis. R. Aldegheri et al. CORR. Vol 241. 1989. 117-127.
- transphyseal lengthening
- distraction device is placed across the growth plate & lengthens the limb by causing separation at plate;
- procedure is generally performed just before skeletal maturity;
- congenitally short leg:
- limbs that were never "programmed" to achieve normal length will be at especially high risk for major complications from limb lengthening;
- this is in contrast to limbs that are short as a consequence of growth plate trauma, in which case, limb lengthening is a more reasonable treatment option;
- references:
- Complications of limb lengthening in children who have an underlying bone disorder. D. Naudie MD et al. JBJS. Vol 80-A. No 1. Jan 1998. p 18.
- Limb Lengthening of the Femur:
- Lengthening of the Tibia:
- Specific Lengthening Methods:
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Wagner Method:
- distraction apparatus is applied following a mid-diaphyseal osteotomy;
- following completion of lengthening, the lengthening apparatus is removed, & metal side plate is applied along w/ bone grafting to diaphyseal defect;
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Ilizarov Technique;
- bone is lengthened at a rate of 1.0 to 1.5 mm per day.
- gradual distraction allows the neurovascular bundle and muscles to lengthen safely;
- osteotomy is performed at lower metaphyseal level for enhanced bone healing;
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Lengthening over an IM Nail:
- in report by AS Simpson (JBJS-B 1999), authors followed 20 patients who underwent leg lengthening with a combination of ex fix and IM nailing;
- mean gain in length was 4.7 cm (2 to 8.6);
- mean time of external fixation was 20 days per cm gain in length;
- all distracted segments healed spontaneously without refracture or malalignment;
- there were 3 cases of deep infection, two of which occurred in patients who had had previous open frx of bone which was being lengthened (all
resolved with appropriate treatment)
- authors noted the following advantages:
- early rehabilitation, early return of knee ROM, low rate of complications, shorter period for using external rotation;
- Leg lengthening over an intramedullary nail. AS Simpson, and J Cole. J Bone Joint Surg [Br] 1999;81-B:1041-5
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Immediate Lengthening:
- references:
- Limb Lengthening and Correction of Angulation Deformity: Immediate Correction by Using a Unilateral Fixator. M. Kamegaya JPO Vol 16. 1996. p 477-479.
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One-stage lengthening for femoral shortening with associated deformity.
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Complications:
- adults will have a much higher complication rate than children;
- avoid simultaneous femoral and tibial lengthenings;
- contractures:
- occur from stretk
- neurovascular damage from stretching;
- if neurological damage develops, then lengthening must be stopped or reversed;
- consider decompression of the peroneal nerve over the fibular neck along with excision of the fascia lata and lateral intermuscular septum;
- fractures:
- lengthening should never be attempted through a previous fracture site;
Lengthening of congenital lower limb deficiencies.
One-stage lengthening for femoral shortening with associated deformity.
The effect of lengthening of the femur on the extensors of the knee. An electromyographic study.
Results of the Wagner and Ilizarov methods of limb-lengthening.
Limb Lengthening and Correction of Angulation Deformity: Immediate Correction by Using a Unilateral Fixator.
M. Kamegaya MD et al. Journal of Pediatric Orthopaedics. Vol 16. 1996. p 477-479.
Distraction osteogenesis of the lower extremity with use of monolateral external fixation. A study of 261femoral and tibia. KJ Noonan MD et al. JBJS. Vol 80-A. No 6. Jun 1998.
Nerve Lesions Associated with Limb-Lengthening.
Complications Encountered During Lengthening Over an Intramedullary Nail.
