Humeral lengthening and deformity correction

Abstract

IntroductionIlizarov principles and hybrid fixation have improved the results of humeral lengthening. We reviewed the literature on humeral lengthening using different fixators with regard to indications, operative technique, results and complications. We also retrospectively reviewed 56 segments in 46 patients treated with humeral lengthening and deformity correction using Ilizarov external fixation. The etiology was achondroplasia (10 patients), epiphyseal injury (8 cases), infection (11 cases) and Erb’s palsy (17 cases). The average age at surgery was 14 years (range 8–20 years). The patients were assessed clinically and radiographically and DASH score was available for 36 segments. Follow-up ranged from 1−11 years. The magnitude of lengthening achieved ranged from 5−15.5 cm with an average of 9 cm. The average healing index was 29.5 cm (range 26–37 days). The percentage of area of lengthening to the original length ranged from 25 to 100% with an average of 55%. The average DASH (available for 36 segments only) score ranged from 15−40 preoperatively to 7−16 (P = 0.04) at last follow-up. Functionally, all the patients returned to their preoperative jobs and daily activities including sports.ComplicationsComplications included pin track infection in 46 segments, radial nerve palsy which recovered completely in 2 patients, fracture of the regenerate in 7 cases and premature consolidation of the regenerate in one case.ConclusionHumeral lengthening, whether unilateral or bilateral, is a valid method that improves the outcome following arm shortening and deformity correction, including angulation and rotation. Extensive lengthening up to 100% of the original length could be achieved without increasing the risk of complications.Level of evidenceIV, retrospective cohort.

Limb lengthening history, evolution, complications and current concepts

“…There are few indications for upper extremity lengthening, but they include achondroplasia, hereditary multiple exostosis with shortening of the forearm bones, physeal growth arrest, amputation, infection and shortening from trauma. The reason upper extremity operations are not attempted as often as lower extremity operations might be due to reports of a high rate of complications and the possibility of functional deterioration [59,60]. However, with developing experience we think that bone lengthening has no harmful effect on the upper extremity.…”

Evaluation of clinical efficacy and safety of the Ilizarov apparatus for external fixation (literature review)

“…Along with the accumulation of experience in the use of the external fixation apparatus, a number of problems were identified such as risks of developing joint contractures, vascular and neurological complications; "ischemic" regenerates; penetration of infectious agents along the structural elements of the external fixation apparatus that pass into the bone [11][12][13][14][15][16][17][18][19][20][21][22].…”

Adjustable bone plate: state of art

“…ABP is a user-friendly device that protects the axial alignment of the bone during distraction. We believe that there is a gap in the literature in the optimal implant for the upper extremity distraction osteogenesis and paediatric bone lengthening [18][19][20]. ABP can fill this gap in upper extremity with its extramedullary design and eliminating the neurovascular complications of external fixators.…”