The purpose of our study was to analyze limb lengthening in fibular hemimelia type II. Ten patients underwent 16 tibia lengthenings. The mean tibia shortening was 5.8 cm. We used the Ilizarov technique in all cases. The mean follow-up time was 7.2 years. The mean lengthening was 23% of the former length. The healing index was 50.8 days/cm. In the final examination six patients were skeletally mature, equal limb length and functional foot positioning were achieved in four of them. Complications were observed during 14 lengthenings (87.5%). Although lengthening in fibular hemimelia is difficult, elongation with axis and foot correction may offer an alternative to amputation.
1. The addition of a dedicated physiotherapy programme to SpineCor dynamic bracing improves the chances of obtaining a positive outcome. 2. It is necessary to further analyse the course of the comprehensive treatment, also with regard to other types of braces and kinesiotherapy programmes.
Methods of limb lengthening have been continuously modified. The construction of an apparatus for gradual bone distraction was a great improvement. The aim of this study was to evaluate the long-term results of lower limb elongation using the Wagner technique. Between 1983 and 1989, 45 patients underwent surgery in the authors' institution. There were 31 femoral and 15 tibial lengthenings. The operation and lengthening procedure were performed according to the rules published by the method's author. The intended amount of lengthening was achieved in 80% of patients during tibial elongation and in only 52% during femoral elongation because of many problems, obstacles, and complications during treatment. A significant percentage of improper (deficient or irregular) new bone formation led to femoral malunion in three patients and to tibial and femoral delayed bone consolidation in six patients. Fast distraction produced great forces on the surrounding joint surfaces, resulting in a limited range of motion and joint stiffness. The Wagner technique does not seem to be effective and is associated with a long duration of treatment and some complications impairing the function of the limb.
Of the many methods of limb elongation, lengthening by physeal distraction is among the newest. The goal of this study was to estimate the long-term results of femoral and tibial lengthening by epiphyseal distraction. The authors examined 40 patients who underwent 24 femoral and 16 tibial lengthenings. The average follow-up period was 9.6 years. An average of 4.6 cm of femoral lengthening and 4.7 cm of tibial lengthening was achieved. The femoral healing index was 38.1 days/cm and the tibial healing index was 35.7 days/cm. After lengthening the epiphyseal cartilage started to function in all patients, and premature growth cartilage fusion was not observed during follow-up. Complications occurred in eight patients during femoral lengthening and in four during tibial lengthening. The authors suggest that physeal distraction is a good method for moderate and simple limb lengthening. Particular care should be applied to knee joint function, especially during femoral lengthening.
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