- 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;
- Limb Lengthening and Correction of Angulation Deformity: Immediate Correction by Using a Unilateral Fixator.
Complications of limb lengthening. A learning curve.