PURPOSE: To evaluate the clinical results of radical necrotic bone resection and distraction osteogenesis for the treatment of infected nonunion of tibia using the Ilizarov technique. MATERIALS AND METHODS: 32 patients who were followed up at least 1 year after the treatment of infected nonunion of tibia from March 1995 to March 2001 were evaluated. Their mean age was 43 years and mean duration of follow-up was 37 months. The results were divided into bone results and functional results and analyzed by grading to excellent, good, fair, and poor. RESULTS: The average amount of bone lengthening was 5.3 cm (range, 2~10 cm) and the average healing index was 61.5 days/cm (range, 52.7~70.4 days/cm). Bony union was obtained at average 10.3 months in all cases. The bone result was excellent in 9 cases, good 18, and fair 5. The functional result was excellent in 8 cases, good 16, fair 7, and poor 1 case. CONCLUSION: Ilizarov technique is an effective method in the treatment of infected nonunion of tibia for early range of motion exercise, weight bearing and correction of limb shortening.
Bone Lengthening ; Extremities ; Follow-Up Studies ; Humans ; Ilizarov Technique* ; Osteogenesis, Distraction ; Range of Motion, Articular ; Tibia* ; Weight-Bearing

We investigated the effect of tibial lengthening by means of callotasis on enchondral growth of the tibia, Ninety-nine 5-week-old immature rabbits were separated into five groups according to the percentage of lengthening : GroupI(10% lengthening), Group II (20% lengthening), Group III (30% lengthening), Group IV (40% lengthening), Group V (sham operation without lengthening). Osteotomy of the tibia and fibula was made at the proximal metaphysiodiaphyseal junction. Distraction was started at the rate of 0.25mm twice a day from the third postoperative day to simulate the currently accepted callotasis. In Group I, II, and V, there two were no statistically significant differences in the growth rates between the left operated and the right normal tibiae. In contrast, the ratios of left over right tibial length decreased significantly in Group III (4.8%), and Group IV (8.6%) at the completion of lengthening(p < 0.0001), and remained decreased until near skeletal maturity. Histomorphometric study revealed that, in Group III and IV, there were statistically significant decreases in the ratios of the thickness of left over night tibiae at both proximal and distal growth plate(p < 0.0001). Immunohistochemical study also revealed that, in Group III and Group IV, the ratios of left over right bromodeoxyuridine(BrdUrd) labeling percentage decreased significantly (p < 0.0001). In summary, when the tiba was lengthened 30% or more, retardation of enchondral growth was evident, which persisted from the time of completion of lengthening to near skeletal maturity. It is postulated that unphysiologically increased pressure on the growth plate due to excessive bone lengthening may be closely related with the inhibition of enchondral growth.
Bone Lengthening ; Fibula ; Growth Plate ; Osteogenesis, Distraction ; Osteotomy ; Rabbits ; Tibia

We investigate the serial change of the bone density of the lengthening sites in distraction osteogenesis in long bone lengthening of the lower extremity by measuring the pixel value of the PACS(Picture Archiving Communication System). The purpose of this study was to find the clinical implication of the pixel value in PACS in the distraction osteogenesis. The number of the distraction sites were 22 in tibia and 16 in femur. The average distraction length was 4.5cm ranged between 2.1cm and 7.0cm in femur, 4.1cm ranged hetween 1.9cm and 6.8cm in tibia. When the image were sent to the PACS workstations, they were directly interfaced to the workstation without any processing. The absolute and the relati ve pixel values of cortical bones of the original and the lengthening sites repr sented in workstation of PACS were obtained by average value measuring 3 times by 3 different persons. The average absoiute pixel value of the original cortical bone near distraction site was not significantly changed, maintaining 575+/-6 in femur, and 570+/-7 in tibia. The absolute pixel vaIues in AP and lateral view were not significantly changed until 6 week/cm, but rapidly increased after 7 week/cm hoth in the tibia and the femur. The relative pixel value of the lengthening sites were more than 95% in three of the four cortices at the time of the removal of the external fixators. in conclusion, the pixel value of the PACS can be a rapid, simple and easy method for detection of the change of the bone density in distraction osteogenesis.
Bone Density* ; Bone Lengthening* ; External Fixators ; Femur ; Humans ; Lower Extremity* ; Osteogenesis, Distraction* ; Tibia

Distraction osteogenesis is a technique of bone lengthening by gradual movement and subsequent remodeling. Distraction forces applied to bone also create tension in the surrounding soft tissues, distraction histiogenesis. Distraction osteogenesis is used to correct facial asymmetry, such as patients with hemifacial microsomia, maxillary or mandibular retrusion, cleft lip and palate, alveolar defect and craniofacial deficiency. Hemifacial microsomia is characterized by unilateral facial hypoplasia, often with unilateral shortening of the mandible and subsequent malocclusion. This report describes two cases of hemifacial microsomia(type IIB). In these two cases, distraction osteogenesis was used to correct a facial asymmetry. Two patients underwent unilateral mandibular distraction osteogenesis of ascending ramus of the mandible with extraoral devices. Successful distraction osteogenesis was achieved in the patients with hemifacial microsomia.
Bone Lengthening ; Cleft Lip ; Facial Asymmetry ; Goldenhar Syndrome* ; Humans ; Malocclusion ; Mandible ; Osteogenesis, Distraction* ; Palate ; Retrognathia

The purpose of this study is to investigate the effect of lengthening in long bones on the articular carilage by observing the changes in articular cartilage, Fifty-seven rabbits of growing period were divided into four lengthening groups; 5%, 10%, 20%, and 30%. Lengthening by callotasis that was done on the left tibiae and right tibiae were used as control. After lengthening histopathological, histochemical and autoradiographic studies were done on the proximal and distal tibial articular cartilages. That following observations were made. 1. As compared with controls, statistically significant degenerative changes were noted in proximal and distal articular cartilages when the tibiae were lengthened 10% or more. 2. In the proximal joints, the changes were significant between 10% and 20% lenghtening groups, but not between the 20% and 30% lengthening groups. 3. In the distal joints, the changes were significant. Not only were there between 10% and 20% lengtening groups but also there were between 20% and 30% lengtening groups. 4.Degenerative changes were frequently found in the intermediate zone between the periphery and the center, where most of the weight is borne.5. Decrease in matrix content of degenerated articular cartilage was noted by histochemical studies using safranin-0 and Alcian-blue.6. Autoradiography with S04 was done to quantitate matrix content of articular cartilage, and the mean uptake ratio of the articular cartilage was slightly higher than others in the 30% lengthening group. This esuggest decreased matrix synthesis, but no statistical significance was found. Following conclusion were drawn from above observations. 1. In rabbits, tibial lengthening tended to cause microscopic degenerative changes, and the changes begun to appear when the tibiae were lengthened 10% or more. 2. When lengthened over 20%, the changes became more pronounced in the distal joint than in the proximal joint.
Autoradiography ; Bone Lengthening ; Cartilage, Articular ; Joints ; Leg ; Osteogenesis, Distraction ; Rabbits ; Tibia

Thirteen cases of lengthening of short tubular bone by gradual axial distraction using an unilateral external fixator(Orthofix M-100, Orthofix CP0089) are reported. This study aims to prove effective- ness of gradual distraction for lengthening of short tubular bone and usefulness of the newly designed external fixator. Nine patients had brachymetatarsia and four brachymetacarpia. The etiology was consisted of post-traumatic physeal injury in two and congenital in eleven cases. The average amount of lengthening was 14.5mm(37.0%) in metacarpal bone, and 17.3mm(37.5%) in metatarsal. Complications were angular deformity in 3, pin loosening in 2 cases, and premature consolidation, nonunion and pin site infection in one case, respectively. Cosmetical and functional satisfactory results were obtained in all cases. We believe that callotasis is effective for short tubular bone lengthening. Also we confirmed the newly designed external fixa- tor(Orthofix CP0089) useful.
Bone Lengthening ; Congenital Abnormalities ; External Fixators ; Humans ; Metatarsal Bones ; Osteogenesis, Distraction

PURPOSE: Distraction osteogenesis is now a standard method for bone lengthening. However, little is known about the exact mechanism of new bone formation. This study was undertaken to investigate the temporal and spatial changes of angiogenesis during the periods of distraction osteogenesis; the three-dimensional microarchitecture of newly formed vessels and their origin; and the role of angiogenesis with reference to mineralization. MATERIALS AND METHODS: Sprague-Dawley rat's tibia was osteotomized subperiosteally and was distracted at a rate of 0.5 mm per day for two weeks after one week of latency period. Vascular corrosion casting using Mercox was done on the hindlimbs before osteotomy, and at the 1st, 2nd, 3rd, 4th, and 6th weeks postoperatively. Replicated microvascular structures and their distribution patterns at the distraction site and adjacent parent bone were observed temporally and spatially under scanning electron microscope. These findings were compared with radiographical and histological observations. RESULTS: 1. At postoperative first week and second week, proliferation of periosteal vessels were more pronounced than that of endosteal vessels, which corresponded to the early new bone formation in subperiosteal area on histologic sections. 2. At postoperative third week, arterial branches from the medulla of parent bone entered into the distraction gap. Multiple longitudinal vascular branches sprouted out from the newly formed vascular network, and ran towards the interzone. 3. At postoperative fourth week, there was vascular proliferation in the periosteal side of interzone, from which branches arose towards the parent bone. 4. At postoperative sixth week, vascular networks of both sides connected to each other, and few angiogenetic findings were observed. CONCLUSIONS: In distraction osteogenesis, angiogenesis occurred actively during the distraction period and then gradually decreased with time. Taken together with radiographical and histological findings, close temporal and spatial relationship between the angiogenesis and new bone formation at the distraction site was revealed.
Animals ; Bone Lengthening ; Corrosion Casting ; Hindlimb ; Humans ; Latency Period (Psychology) ; Osteogenesis ; Osteogenesis, Distraction* ; Osteotomy ; Parents ; Rats, Sprague-Dawley ; Tibia

We investigated the effect of bone lengthening by callotasis, the gradual distraction lengthening, on the skin of tibia in rats. A pair of small external fixator were placed in the left tibiae of twenty Spraugue-Dawley rats. At two weeks and one year after 25% lengthening, skin flaps of both right and left tibia of each ten animals were removed and prepared for BrdU immunohistochemical study and H&E staining to observe any evidences of proliferative activity of skin. At 2 weeks, compared to the unlengthened skins, the number of BrdU labeled cells, which represents the DNA synthesis, increased 4.35 times(p < 0.001) in the lengthened skin, while that of one year samples did not show any differences. The H&E staining at 2 weeks failed to reveal any remarkable cell proliferation evidences such as mitosis, epidermal cell proliferation and hyperkeratosis except a marked thinning of skin, which became as thick as unlengthened skin at 1 year after lengthening. Though the physical properties of skin such as stretch and relaxation as well as migration can accomodate the lengthened bone, this study might suggest that distraction lengthening offers the gain of skin flap by way of synthesis an6 also support that the bone lengthening procedure stimulate soft tissue proliferation simultaneously.
Animals ; Bone Lengthening ; Bromodeoxyuridine* ; Cell Proliferation ; DNA ; External Fixators ; Immunohistochemistry* ; Mitosis ; Osteogenesis, Distraction* ; Rats* ; Relaxation ; Skin* ; Tibia*

OBJECTIVETo investigate the effect on intramuscular connective tissue and passive range of joint motion by the stress produced in limb lengthening.

METHODSAn animal model of limb lengthening was established in the tibia of rabbits. Distraction was initiated at a rate of 1 mm/d and 2 mm/d in two steps respectively, and both proceeded until 10% and 20% of the tibia length was achieved. Muscle samples were harvested at the time when distraction ended and at the 4th week of consolidation after the distraction. Scanning electron microscope was applied to observe the morphological changes of the perimysium. The goniometer, which we made for this study, was used to measure the passive range of joint motion.

RESULTSThe collagen fibers were partitioned in bundles, crimped and interconnected closely and orderly. In the regime of 1 mm/d distraction with 10% lengthening, no apparent changes of the collagen fiber and passive range of joint motion was demonstrated. When tibia was increased to 20%, the crimped fibers showed a tendency of being straightened while the passive range of joint motion was reduced. The findings remained the same at the 4th week of consolidation. In the regime of 2 mm/d distraction with 10% lengthening, the crimped structure of the collagen fibers in the perimysium disappeared and the fibers were almost straightened. Additionally, the interconnection of the collagen fibers became loosened and interstice was presented among the fibers. At the 4th week of consolidation, the restoration to the original crimped structure was not completed. When the lengthening ratio was increased to 20%, the collagen fibers were straightened completely. This condition remained unchanged throughout all 4 weeks. The passive range of joint motion was reduced dramatically in the regime of 2 mm/d distraction.

CONCLUSIONThe ultrastructure of perimysium and the passive range of joint motion in the regime of 1mm/d lengthening shows the condition closest to the normal ones. The regime of 2 mm/d lengthening may cause an apparent change in the ultrastructure of perimysium and passive range of joint motion.

Animals ; Bone Lengthening ; Collagen ; ultrastructure ; Connective Tissue ; injuries ; physiology ; ultrastructure ; Male ; Osteogenesis, Distraction ; Rabbits ; Range of Motion, Articular ; physiology ; Regeneration ; physiology

Uni- or bilateral mandibular hypoplasia can be associated with various syndromes or is acquired after early traumatic or inflammatory disease in the temporomandibular joint(TMJ). Early treatment is necessary to avoid consequent impairment of midfacial growth. The standard treatment of these malformations consists of the application of bone grafts which can lead to unpredictable growth, but the new procedure of bone lengthening which was presented by McCarthy et al. represents a limited surgical intervention and therefore open up a new perspective of treatment, especially in younger children with severe deformities. Patients with hemifacial microsomia and facial asymmetry have a vertically short maxilla, a tilted occlusal plane, and a short mandible. A 14-years-old boy with facial asymmetry, who was fractured on both condyle and mandibular symphysis before 8 years ago, was treated by mandibular ramus lengthening, symphysial widening and surgically assisted rapid palatal expansion with corticotomy. After allowing 1 week for the healing of the periosteum, the distraction was performed at the rate of 0.5-1.0mm per day for 7 days on maxilla and 14 days on mandible. The device was maintained on maxilla and mandible for 12 weeks following distraction. The difference in ramus and mandibular transverse deficiency were corrected and facial asymmetry was improved with complex distraction osteogenesis.
Bone Lengthening ; Child ; Congenital Abnormalities ; Dental Occlusion ; Facial Asymmetry ; Goldenhar Syndrome ; Humans ; Male ; Mandible ; Maxilla ; Osteogenesis, Distraction* ; Periosteum ; Transplants