We lengthened 9 tibial segments over a nail to reduce the time in the external fixator in 5 patients with constitutional shortness. The median lengthening was 7 (5.5-7.3) cm and the external Ilizarov frame was removed after median 99 (63-125) days. In spite of a short time in the external fixator, consolidation was slow, with a median lengthening index of 4.4 (2.4-6.1) months/cm. The procedure resulted in 3 fatigue fractures of the intramedullary nail or interlocking screws that needed revision and bone grafting. In 1 patient, a deep intramedullary infection occurred. After the experience of these major complications we have returned to the traditional callotasis lengthening method described by Ilizarov.

The purpose of the current study was to evaluate the clinical results of the Ilizarov bone transport method in the treatment of congenital pseudarthrosis in the tibia. In seven patients operated on between 2.6 and 7.8 years of age, primary healing of the pseudarthrosis was achieved in all patients (after additional bone grafting in two patients). Within a followup of 6 to 8 years, major complications occurred in all patients. Five refractures occurred, and in one patient the refracture did not heal. At the last followup, axial deformities and an abnormal malalignment test with lateral mechanical axis deviation of 10 mm or greater was found in all patients. Three patients had leg length inequality of 20 mm or more. The Ilizarov bone transport method is useful in achieving primary healing in congenital pseudarthrosis of the tibia, but residual challenges with secondary reconstructive surgery caused by refracture and postoperative deformities must be expected.

Tibial torsion in children mainly develops during the first 4 years of life. After this the increase was of less clinical significance.

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Background Different methods and devices are used to perform lengthening and deformity reconstruction in the tibia. Recently, the Taylor spatial frame (TSF) has been introduced as a computer-assisted and versatile external ring fixator. Lengthening index (LI) and complications are important result parameters, and the aim of this study was to review our first 20 tibial segments operated with the TSF and to compare the results with our experience of using the traditional Ilizarov external fixator (IEF).Patients and methods We lengthened 20 tibial segments in 20 patients with the TSF. The results were compared with those of 27 tibial segments from 27 patients that were lengthened with the IEF. All segments were operated on with monofocal osteotomies.Results In the overlapping zone of comparable lengthening distances between 2.4 and 6.0 cm, the LI of 2.4 and 1.8 months/cm was not significantly different between the TSF and IEF groups, respectively (p = 0.17). This non-significant difference was confirmed after adjustment for age.Interpretation We found no difference between the TSF and IEF frames regarding LI and complication rate. However, rotational, translational, and residual deformity correction is easier to perform with the TSF.

The purpose of this investigation was to compare the tissue response during mono-and bifocal limb lengthening. The study includes four patients undergoing leg lengthening. All patients started out bifocally with a total diurnal distraction of 1.75 mm, but proceeded monofocally with a rate of 1 mm a day when the distal distraction was terminated due to contractures or pain. The tissue response was monitored by registration of axial force in the distraction rods. The force increased linearly during bifocal lengthening, but culminated or decreased in the period of monofocal lengthening. Average tissue stiffness, defined as the immediate force increase due to each 0.25 mm distraction increment, was significantly higher in the bifocal lengthening phase. The force decay between each distraction was significantly lower during bifocal lengthening, thus indicating decreased tissue accommodation. Details in the force registrations indicated that the soft tissue, not the regenerate, was the main contributor to the tensile force. Conclusively, the tissues at the two osteotomy sites do not lengthen independently. Bifocal lengthening exposes the entire soft tissue to large loads, resulting in increased tissue stiffness and reduced ability to adapt to the increased length. Accordingly, bifocal leg lengthening requires special attention to soft tissue adaptation.

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The present study investigates the effect of distraction frequency on the development of tensile force in the tissues during lengthening. Two patients with bilateral Ilizarov leg lengthening underwent distraction with high frequency in one leg and low frequency in the other. The clinical situation represented a unique model for investigating the effect of distraction frequency, as each individual served as its own control. Both patients had double level lengthening. Distraction frequency at the proximal lengthening zone was 0.25 mm x 4 in the first leg and 1/1440 mm once every minute in the other. Total diurnal distraction at the proximal metaphysis was 1 mm in both legs. In addition, a distal metaphyseal distraction of 0.25 mm x 3 daily was performed on each leg. The tissue's mechanical response was monitored by measuring the tensile force at the proximal osteotomy. Both patients experienced a significant lower level of force during the high frequency lengthening. The lower level of force was concluded to be due to improved soft tissue adaptation, rather than reduced bone regeneration. Accordingly, high distraction frequency was considered favouiabk to low frequency, and is recommended in large lengthenings where high force levels are expected.