Limb Lengthening Fixators

- Discussion of Limb Lengthening:

- Distraction Histiogenesis: (osteoclasis):
    - whether a ring or unilateral fixator is used, there is some evidence that a better regenerate is formed with the use of titanium half pins 
           rather than transfixation wires;
           - ref: Limb lengthening by callus distraction (callotasis).

- Uniplanar Fixators:
    - see: EBI fixator
    - osteotomy can be percutaneous using a Gigli saw which is passed percutaneously around the tibia (or femur), or can consist of a dome 
           shaped osteotomy for deformities greater than 20 deg;
    - angular deformities are completely corrected in the OR;
    - distraction is delayed in the usual manner (7-14 days), unless a sigificant angulatory deformity has been corrected, in which case a longer delay may be reqired (21 days);
    - for tibia lengthening, a segment of the distal fibula must be removed;
    - technical pearls:
           - it is essential that the lengthening procede down the correct axis (mechanical or anatomic);
           - place the most proximal and most distal pin first, and then place the middle pins;
           - tethering effect of skin:
                 - when the fixator has been placed for limb lengthening, consider incising the skin in front of the path that the pin will take during the lengthening;
                        - make a larger incision for the pins closer to the osteotomy site;
                        - the incision will create a weak spot (even after the incision has healed) which will allow the half pins to cut through the skin without creating excessive skin tension;
    - reference:
           - Limb Lengthening and Correction of Angulation Deformity: Immediate Correction by Using a Unilateral Fixator.

- Ring Fixator Technique (see: Ilizarov Menu)

Complications of limb lengthening. A learning curve.

Mechanical evaluation of external fixators used in limb lengthening.

Current Techniques of Limb Lengthening.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, May 29, 2012 2:05 pm