OBJECTIVETo study the two-axis parallel method in bone lengthening.

METHODSAmong 54 patients (male 28, female 26, mean age 22) who performed tibial lengthening by metaphyseal osteotomy using two-axis parallel method, 26 patients were poliomyelitis sequelae, 13 patients were inequality in limb length after trauma, 4 patients were achondroplasia, 6 patients were genetic short stature, 1 patient was maculatum disease complicated with leg length discrepancy, 4 patients were pituitary dwarfism.

RESULTSAll the patients were followed up and the duration ranged from 18 months to 45 months, with an average of 24.5 months. All patients had bone lengthened. The maximum increase of limb length was 12 cm and the minimum increase was 5 cm, averaged 6.2 cm. One patient had foot drop, 2 patients had foot drop complicated with strephexopodia, 1 patient had serious pinhole infection, and 1 patient had delayed union of the bone.

CONCLUSIONThe two-axis parallel method tibial lengthening by metaphyseal osteotomy can reduce postoperative complications and simplify the operative procedure, which is an ideal method for bone lengthening.

Adult ; Bone Lengthening ; methods ; Female ; Humans ; Male ; Middle Aged ; Osteotomy ; methods ; Tibia ; surgery

We, at Department of Orthopedic Surgery, College of Medicine, Pusan National University, applied epiphyseal distraction as a method of limb lengthening, using unilateral one-plane pin fixator(ORTHOFIX) and bilateral multi-plane ring fixator(SEQUOIA) to three children with limb length discrepancies and angulation deformity due to injury of epiphyseal plate, and obtained following results. l. At first case, on whose distal femoral physis, bone bridge occupied about 20% of total epiphyseal plate and distributed mainly on the lateral side. At 10 days of distraction, epiphysiolysis occurred from the lateral side at first and angulation deformity was corrected. Epiphysiolysis on the medial side of physis appeared apparently after 60mm distraction. Bone lengthening of 4.2cm and correction of 25 valgus deformity were achieved after 72mm distraction for about 10 weeks. The percentage of increase in the initial length achieved was 11.67% and healing index was 27.86. 7 months later, loss of lengthening of 2.7cm was observed and it was considered that this was due to relatively short corticalization phase. 2. At second case, on whose distal tibial physis, bone bridge occupied about 40% of total epiphyseal plate and distributed on the medial side. At 10 days of distraction, epiphysiolysis occurred on the medial side of the epiphyseal plate, but not on the lateral side and instead of further lengthening, valgus deformity of the ankle appeared. It was thought that asymmetric distraction was attributed to the difference between the force applied on the medial side and that applied on the lateral side of the epiphyseal plate by unilateral one-plane pin fixation. 3. At third case, on whose distal tibial physis, bone bridge occupied about 75% of total epiphyseal plate. No epiphysiolysis occurred. there was a difficulty in observation of epiphysiolysis because ring fixator was overlapped with the epiphyseal plate on radiographs.
Ankle ; Bone Lengthening ; Busan ; Child ; Congenital Abnormalities ; Epiphyses, Slipped ; Extremities ; Growth Plate ; Humans ; Methods ; Orthopedics

Limb lengthening is now an accepted form of correcting limb length inequality. It is, however, associated not infrequently with a variety of complications including pheripheral nerve palsies. Such nerve dysfunction is obviously dependent on the velocity and amount of bone lengtening. In this experiment, the author attempted to determine the safe limits of the velocity and amount of bone lengthening by measuring somatosensory evoked potential (SSEP). The tibiae of 96 rabbits, weighing from 1.5 to 1.6kg, were osteotomized; in Group I, the tibiae were lengthened 0.35mm per day once daily;in Group II, 0.7mm per day; in Group III, 1.05mm per day; and in Group IV, 1.4mm per day. Several rabbits were subjected to the study weekly until, six weeks postoperatively in Group I, five weeks postoperatively in Grup II, four weeks postoperatively in Group III, and three weeks postoperatively in Group IV. The following results were obtained: 1. Preliminarily, in order to verify the possible difference between the right and left tibiae, Pl latency and amplitude were measured in 18 rabbits. Paired t-test revealed no statistically significant difference between the two (p>0.05). The amplitude manifested more individual variation than the Pl latency. 2. As lengthening progressed, the Pl latency gradually increased, whereas the amplitude decreased. The higher the percentage of lengthening to the original tibial length, the more marked the changes in both the Pl latency and amplitude. 3. As lengthening progressed, significant changes were observed earlier in the amplitude than in the Pl laterncy. 4. Significant changes in the amplitude were observed when lengthening reached 12.2% of the original tibial length in Group I (0.35mm/day) and 10.5% in Group IV (1.4mm/day). Significant changes in the Pl laterncy were observed when lengthening reached 17.8% of the original length. It is concluded that somatosensory evoked potential is an effective method of detecting early and preventing neurological complications in bone lengthening. Somatosensory evoked potential is a clinically feasible technique. It is expected that the finding of study may serve as a useful guideline for detecting the safe limits of velocity and amount of bone lengthening.
Bone Lengthening ; Evoked Potentials, Somatosensory ; Extremities ; Methods ; Paralysis ; Rabbits ; Socioeconomic Factors ; Tibia

OBJECTIVETo study the role of the synchronized springy lengthening apparatus for the tibia and calcaneal tendon designed by the author in preventing the clubfoot of secondary to the Ilizarov tibia lengthening.

METHODSBased on the Ilizarov tibia lengthening apparatus, a special synchronized springy lengthening apparatus for the tibia and calcaneal tendon was designed. The tibial was made of distal and proximal 2 rings respectively and 4 threaded rods, and the calcaneal was made of a half ring, 2 hinges and a threaded rod with spring. The half ring was fixed to the calcaneus by 2 crossed wires. The fracture tibia and fibula, ankle joint, talocalcaneal joint were attached to the apparatus. At the same time of tibia lengthening, the soft tissue was simultaneously stretched, the ankle joint could move, and the leg could bear weight. If the clubfoot angle was larger, the percutaneous fasciotomy of calcaneal tendon was performed; if the angle was less than 20 degrees, the pes deformities were corrected only by the stretch of calcaneal tendon.

RESULTSSeventy-seven patients' tibia were lengthened averagely 4.6 cm, with an average speed of 0.7 mm/d. The healing made tibia lengthened, and the index was 1.35 months/cm. There were not the secondary varus and valgus deformities and clubfoot in all the patients. The clubfoot with 100-400 angle of the 16 patients were corrected after tibia lengthening.

CONCLUSIONSThe new apparatus coincides with the biomechanical principle and can effectively prevent the secondary deformities of foot such as clubfoot, talipes varus and valgus after tibia lengthening procedure.

Adolescent ; Adult ; Bone Lengthening ; instrumentation ; methods ; Child ; Equipment Design ; Female ; Humans ; Leg Length Inequality ; surgery ; Male ; Treatment Outcome

Indications for bone lengthening in the hand are less common than for the lower extremity. From 1991 to 1993 authors had performed nine hand bone lengthenings in the eight patients, based on callotasis and chondrodiastasis, Average age at the time of surgery was 18 years old(from 4 to 31 years old). Diagnoses included traumatic amputations in 7 cases and congenital syndactyly of both hand with hypoplastic digits in 2 cases. Sites of lengthening were metacarpal bone in 7 cases, phalangeal bone in 2 cases. Eight of 9 lengthening procedures resulted in complete consolidation of the bone gap after the single stage procedure. In one case secondary bone graft was required for the bone defect. Average consolidation period was 16 weeks(from 10 weeks to 22 weeks). Average gained length was 14.6mm (from 6 to 30mm) and average percent of gained digital bone length was 48%. There were minimal complications including marginal necrosis of skin, numbness and bone tip exposure and were responsed to conservative manage, but stump revision for bone tip exposure was performed in one case. In all cases followed to completion and for 1 to 3 years postoperatively, there was improvement of function with key pinch. The callotasis lengthening is one of the useful method of short hand bone lengthening to improve function of hand and cosmetic demand.
Amputation, Traumatic ; Bone Lengthening ; Diagnosis ; Fingers ; Hand ; Humans ; Hypesthesia ; Lower Extremity ; Methods ; Necrosis ; Osteogenesis, Distraction ; Skin ; Syndactyly ; Transplants

OBJECTIVETo shorten the time of external skeletal fixation on legs, and enhance quality of limb lengthening, avoid complications of shortening, bending, twisting and etc.

METHODSInsert pin transcortical to attack external skeletal fixation simultaneously, put un-reaming locked intramedullary nail (do not insert distal locked screw) into endosteum of lengthening bone. After the legs achieved predetermined length, insert distal locked screw and then remove external skeletal fixation, locked intramedullary nail, then maintain consolidation of rehabilitation.

RESULTSThe group lengthened legs for 412 cases. The range of lengthening was 3 to 18 cm. Mean length was 7.6 cm. The mean time for needed external skeletal fixation was 20 d/cm. The mean time of osteogenesis was 56 d/cm. For complications, there were 3 tibias ununion cases and 1 varus ankle. All cases were treated undergoing twice.

CONCLUSIONSThe method reduces the time for needed external skeletal fixation visibly, enhances the quality of limb lengthening remarkably, prevents complications of shortening new bone, deformity, bending and re-fracture which do not effect the healing time. This is a new choice of limb lengthening.

Adult ; Bone Lengthening ; instrumentation ; methods ; Bone Nails ; Female ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; instrumentation ; Humans ; Ilizarov Technique ; instrumentation ; Male ; Middle Aged ; Tibia ; surgery ; Treatment Outcome

OBJECTIVETo investigate the safety and efficacy of minimally invasive achilles tendon lengthening and system rehabilitation for the treatment of contracture of achilles tendon.

METHODSFrom January 2002 to December 2010, 27 patients (31 feet) with contracture of achilles tendon were treated with minimally invasive achilles tendon lengthening and system rehabilitation. There were 11 males and 16 females with an average age of 35.5 years (ranged 3 to 65 years). Right foot was in 13 cases, left foot was in 10 cases, both feet were in 4 cases. Course of disease was from 1 to 5 years with an average of 2.3 years. The cause of contracture included postoperative complication of tibia fractures treated with intramedullary nailing in 7 feet, sequelae of lower leg compartment syndrome in 11 feet, congenital talipes equinovarus in 13 feet (both feet in 4). Before operation, all the patients walked with limping, plantar flexion anomaly was from 15 degrees to 50 degrees with an average of 35.5 degrees. The strength of quadriceps muscle of thigh was grade V in 27 feet, grade IV in 4 feet, the strength of musculus triceps surae was grade V in 24 feet, grade IV in 7 feet.

RESULTSAll the patients were followed-up for 6-24 months with an average of 11.3 months. According to standard of Arner-Lindholm to evaluate function of ankle joint, 29 feet obtained excellent results and 2 feet good. No infection, re-rupture or re-contracture was found.

CONCLUSIONMinimally invasive achilles tendon lengthening and system rehabilitation in treating contracture of achilles tendon has advantage such as simple operation, less complication, lower recurrence rate, which is favourable for thoroughly rehabilitation of patients. But, the case in which the strength of quadriceps muscle of thigh or musculus triceps surae still less than grade III after preoperative rehabilitation care should not choose the method.

Achilles Tendon ; surgery ; Adolescent ; Adult ; Aged ; Bone Lengthening ; methods ; Child ; Child, Preschool ; Contracture ; rehabilitation ; surgery ; Female ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods

PURPOSE: Although bilateral lower-limb lengthening has been performed on patients with achondroplasia, the outcomes for the tibia and femur in terms of radiographic parameters, clinical results, and complications have not been compared with each other. We proposed 1) to compare the radiological outcomes of femoral and tibial lengthening and 2) to investigate the differences of complications related to lengthening. MATERIALS AND METHODS: We retrospectively reviewed 28 patients (average age, 14 years 4 months) with achondroplasia who underwent bilateral limb lengthening between 2004 and 2012. All patients first underwent bilateral tibial lengthening, and at 9-48 months (average, 17.8 months) after this procedure, bilateral femoral lengthening was performed. We analyzed the pixel value ratio (PVR) and characteristics of the callus of the lengthened area on serial radiographs. The external fixation index (EFI) and healing index (HI) were computed to compare tibial and femoral lengthening. The complications related to lengthening were assessed. RESULTS: The average gain in length was 8.4 cm for the femur and 9.8 cm for the tibia. The PVR, EFI, and HI of the tibia were significantly better than those of the femur. Fewer complications were found during the lengthening of the tibia than during the lengthening of the femur. CONCLUSION: Tibial lengthening had a significantly lower complication rate and a higher callus formation rate than femoral lengthening. Our findings suggest that bilateral limb lengthening (tibia, followed by femur) remains a reasonable option; however, we should be more cautious when performing femoral lengthening in selected patients.
Achondroplasia/*surgery ; Adolescent ; Bone Lengthening/*methods ; Child ; Child, Preschool ; Female ; Femur/radiography/*surgery ; Humans ; Male ; Retrospective Studies ; Tibia/radiography/*surgery ; Treatment Outcome ; Young Adult

OBJECTIVE: To study the clinical efficacy of callotasis for pathological segmental defects in child femur. METHODS: Thirty-nine patients with segmental femoral defects suffered from suppurative osteomyelitis were treated with the bilateral, unilateral external fixation frame or intramedullary callotasis. The rolongational rate was from 2 to 2.5 cm per month after the operation. RESULTS: After a 13 to 57 month follow-up, all cases were healed according to clinical examination and radiological observation. The prolongational length ranged from 9 to 31 centimeters. Average ratio of prolongation reached 49%. The healing index was 30 d/cm, and the healing time of non-union was 134 days. No recurrent suppurative osteomyelitis or fracture was observed. CONCLUSION Callotasis is a reliable, simple and hyperadaptable method for femural segmental defects.
Adolescent ; Bone Lengthening ; methods ; Bony Callus ; surgery ; Child ; Child, Preschool ; Female ; Femur ; surgery ; Follow-Up Studies ; Humans ; Male ; Osteomyelitis ; surgery ; Suppuration

OBJECTIVETo examine the changes of osteocalcin and insulin-like growth factor I (IGF-I) during bone lengthening, and to clarify the mechanism of bone healing.

METHODSThirty-two shepherd dogs were divided into five groups randomly. Their tibiae were lengthened by Ilvzarov's external fixator at the rate of 1 mm/day. The lengthening area was the experimental side and the opposite side was the control. Samples were obtained on the 2nd, 4th, 6th, 8th, 12th weekend respectively. The samples were defatted, dried, powdered, centrifuged and measured by radioimmunoassay.

RESULTSThe osteocalcin concentration increased at the subsequent periods, but it was significantly lower in the experimental side than that of the control side, P<0.05 and the IGF-I concentration was not significantly lowered.

CONCLUSIONSDifferent noncollagenous bone growth factors may be different at different stage.

Analysis of Variance ; Animals ; Biomarkers ; analysis ; Bone Lengthening ; methods ; Disease Models, Animal ; Dogs ; Female ; Insulin-Like Growth Factor I ; analysis ; metabolism ; Male ; Osteocalcin ; analysis ; metabolism ; Probability ; Radioimmunoassay ; Random Allocation ; Sensitivity and Specificity ; Statistics, Nonparametric ; Tibia ; surgery