Distraction Osteogenesis of the Lower Extremity with Use of Monolateral External Fixation. A Study of Two Hundred and Sixty-one Femora and Tibiae*

Noonan, Kenneth J.; Leyes, Manuel; Forriol, F.; Cañadell, J.

doi:10.2106/00004623-199806000-00003

Cited by 144 publications

(130 citation statements)

References 29 publications

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“…These findings are similar to those in developmental growth. We therefore believe that peripheral nerve elongation with therapeutic leg lengthening [5,23,24] is compensated for by elongation of internodes when no neuropathic symptoms occur. On the other hand, repair of paranodal demyelinaton, caused by improper leg lengthening, must involve both elongation of internodes and segment intercalation [ 11.…”

Section: Discussionmentioning

confidence: 97%

“…Leg lengthening procedure has become a popular method for treating dwarfism in conditions such as achondroplasia, as well as leg length discrepancy from a variety of causes [5,12,13,23,24]. An external fixator is lengthened very gradually such as at 1 m d d a y ; such rates are considered to minimize injury [5,12,13,23,24].…”

Section: Introductionmentioning

confidence: 99%

“…An external fixator is lengthened very gradually such as at 1 m d d a y ; such rates are considered to minimize injury [5,12,13,23,24]. In several reports a leg was lengthened more than 15 cm or 100% of the original bone length [23,24].…”

Section: Introductionmentioning

confidence: 99%

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Internodes can nearly double in length with gradual elongation of the adult rat sciatic nerve

Abe

Ochiai

Ichimura

et al. 2004

Journal Orthopaedic Research

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Leg lengthening procedure is used increasingly to treat leg length discrepancy and some forms of dwarfism. We investigated adaptation in rat sciatic nerve to the gradual nerve elongation that occurs with leg lengthening. Indirect nerve elongation was produced by leg lengthening by a total of 15, 30, 45, or 70 mm at a rate of 1 m d d a y . One day after leg lengthening completion, transverse semithin sections of sciatic nerve were prepared and examined; a teased-fiber study also was performed. Elongation decreased axon diameter, but not significantly. In teased-fiber preparations, internodal length was increased by 93%, and the longest internode measured 3000 pm after leg lengthening by 70 mm. Slopes of fiber diameter-internodal length regression lines increased with increasing elongation. Paranodal demyelination caused by nerve elongation worsened as elongation increased, stimulating remyelination (i.e., intercalation of a segment). Only 0.8% of axons showed degeneration in the group with 70 mm of elongation. We concluded that adult rat sciatic nerve can adapt itself to leg lengthening procedure with even doubling internodal length.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Internodes can nearly double in length with gradual elongation of the adult rat sciatic nerve

Abe

Ochiai

Ichimura

et al. 2004

Journal Orthopaedic Research

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“…During the distraction phase, mindful regular radiographic observation of the adjacent joints is recommended, since the prevalence of decentration is around 3-7 % [21,156]. Halt of distraction, soft tissue release or protective secondary bridging of the affected joint should be considered.…”

Section: Outcomes and Complicationsmentioning

confidence: 99%

Current concepts of leg lengthening

Hasler

Krieg

2012

Journal of Children's Orthopaedics

101

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Any lower limb discrepancy may be equalised by conservative means (insoles, prosthesis and orthosis). However, their long-term acceptance is low in regard to function, costs, expenditure and appearance. Timely epiphysiodesis is the best option in uniplanar deformities with adequate remaining growth and for patients whose predicted final body height is above the 50th percentile. However, many patients present late or with multi-planar deformities, which warrant more sophisticated operative approaches. The history of surgical bone lengthening comprises 100 exciting years of struggling, development and ongoing learning. The initial strategy of acute or rapid incremental distraction had lasted almost half a century until Ilizarov recognised the benefits of biological periosteum-preserving osteotomies and incremental lengthening at slow rates (1 mm/day) at a 4 × 0.25-mm daily rhythm, well appreciated as callotasis. In parallel, ring and wire constructs made complex three-dimensional axial, translational and rotational bone moulding possible. Taylor Spatial Frames—built on hexapod strut-linked platform technology as known from flight simulators—took limb correction to a more reliable, more precise and aesthetical level, all the more that the whole process became web-based. It represents state-of-the-art methodology and technology for complex, multi-plane deformities. Due to the significant risk of secondary malalignment, indications for lengthening by unilateral fixation have shrunken to moderate amounts of length disparity and uni- to bi-planar deformities in patients with still open physes. Mechanical or motorised, minimally invasively placed nails prevent muscle fixation and, therefore, ease rehabilitation, increase patient comfort and potentially shorten the overall time of sick leave and refrain from sports activities. Hence, they offer a valuable alternative for low-grade complexity situations. It remains to be proved if the significantly higher implant costs are compensated by lower treatment costs. Overall, limb lengthening, particularly in combination with multi-planar deformity correction, can still be an arduous endeavour. In any case, wise judgement of the patient’s deformity, medical and biological situation, psychosocial environment, selection of the appropriate method and hardware, as well as meticulous operating technique by an experienced surgeon are the cornerstones of successful outcomes.

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“…The use of intramedullary lengthening nails has gained popularity, as they reduce common complications associated with external fixators, including infection, joint stiffness, bone regenerate deformity, scarring, late fracture, and patient implant acceptance [10,17,25,27]. For the past 10 years, the only FDA-approved intramedullary lengthening device has been the Intramedullary Skeletal Kinetic Distractor (ISKD) (Orthofix Inc, Lewisville, TX, USA).…”

Section: Introductionmentioning

confidence: 99%

Internal Lengthening Device for Congenital Femoral Deficiency and Fibular Hemimelia

Shabtai

Specht

Standard

et al. 2014

Clin Orthop Relat Res

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Background Patients with congenital limb shortening can present with joint instability, soft tissue contractures, and significant leg length discrepancy. Classically, lengthening is done with external fixation, which can result in scarring, pin site infection, loss of motion, and pain. We therefore developed an alternative to this approach, a new, controllable, internal lengthening device for patients with congenital limb shortening.

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Distraction Osteogenesis of the Lower Extremity with Use of Monolateral External Fixation. A Study of Two Hundred and Sixty-one Femora and Tibiae*

Cited by 144 publications

References 29 publications

Internodes can nearly double in length with gradual elongation of the adult rat sciatic nerve

Internodes can nearly double in length with gradual elongation of the adult rat sciatic nerve

Current concepts of leg lengthening

Internal Lengthening Device for Congenital Femoral Deficiency and Fibular Hemimelia

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