Fracture following lower limb lengthening in children: A series of 58 patients

Launay, Franck; Younsi, R.; Pithioux, Martine; Chabrand, Patrick; Bollini, G.; Jouve, Jean-Luc

doi:10.1016/j.otsr.2012.08.005

Cited by 37 publications

(48 citation statements)

References 25 publications

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“…In a literature report that examined the frequency of fracture after performing 111 leg lengthening surgeries in 58 patients, the age at which leg lengthening was begun was reported as 10.1 years (range: 2.1 to 20.3 yr) (76) .…”

Section: Cq11: At What Age Is Limb Lengthening Appropriate?mentioning

confidence: 99%

Clinical Practice Guidelines for Achondroplasia*

Kubota

Adachi

Kitaoka

et al. 2020

Clin Pediatr Endocrinol

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Achondroplasia (ACH) is a skeletal dysplasia that presents with limb shortening, short stature, and characteristic facial configuration. ACH is caused by mutations of the FGFR3 gene, leading to constantly activated FGFR3 and activation of its downstream intracellular signaling pathway. This results in the suppression of chondrocyte differentiation and proliferation, which in turn impairs endochondral ossification and causes short-limb short stature. ACH also causes characteristic clinical symptoms, including foramen magnum narrowing, ventricular enlargement, sleep apnea, upper airway stenosis, otitis media, a narrow thorax, spinal canal stenosis, spinal kyphosis, and deformities of the lower extremities. Although outside Japan, papers on health supervision are available, they are based on reports and questionnaire survey results. Considering the scarcity of high levels of evidence and clinical guidelines for patients with ACH, clinical practical guidelines have been developed to assist both healthcare professionals and patients in making appropriate decisions in specific clinical situations. Eleven clinical questions were established and a systematic literature search was conducted using PubMed/MEDLINE. Evidence-based recommendations were developed, and the guidelines describe the recommendations related to the clinical management of ACH. We anticipate that these clinical practice guidelines for ACH will be useful for healthcare professionals and patients alike.

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Section: Cq11: At What Age Is Limb Lengthening Appropriate?mentioning

confidence: 99%

Clinical Practice Guidelines for Achondroplasia*

Kubota

Adachi

Kitaoka

et al. 2020

Clin Pediatr Endocrinol

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“…The fracture risk was higher in these patients when lengthening was >15% of initial segment length (except for patients with achondroplasia), and when the latency period was less than 7 days [25]. Bone fragility is present in more than 100 different genetic disorders including skeletal dysplasias [26].…”

Section: Treatment Of Deficient Bone Formationmentioning

confidence: 99%

The biology of bone lengthening

Hvid

Horn

Huhnstock

et al. 2016

Journal of Children's Orthopaedics

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Distraction osteogenesis biologically resembles fracture healing with distinctive characteristics notably in the distraction phase of osteogenesis. In the latency phase of bone lengthening, like in the inflammatory phase of fracture repair, interleukines are released and act with growth factors released from platelets in the local haematoma, leading to attraction, proliferation and differentiation of mesenchymal stem cells into osteoblasts and other differentiated mesenchymal cells. These in turn produce matrix, collagen fibers and growth factors. A callus containing cells, collagen fibers, osteoid and cartilage matrix is formed. Provided stable fixation, distraction will trigger intramembranous bone formation. As distraction proceeds, the distraction gap develops five distinctive zones with unmineralized bone in the middle, remodelling bone peripherally, and mineralizing bone in between. During consolidation, the high concentration of anabolic growth factors in the regenerate diminishes with time as remodelling takes over to form mature cortical and cancellous bone. Systemic disease, congenital bone deficiencies, medications and substance abuse can influence the quality and quantity of regenerate bone, usually in a negative way. The regenerate bone can be manipulated when needed by using injection of mesenchymal stem cells and platelets, growth factors (BMP-2 and -7), and systemic medications (bisphosphonates and parathyroid hormone). Growth factors and systemic anabolic and antiresorptive drugs are prescribed on special indications, while distraction osteogenesis is not an authorized indication. To some extent, however, these compounds can be used off-label. Use in children presents special problems since growth factors and specific anabolic medications may involve a risk of inducing cancer.

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“…В литературе мы не нашли сведений о последовательном использовании чрескостного остеосинтеза и управляемого роста. Как следует из многочисленных данных, применение метода чрескостного остеосинтеза при лечении врожденных деформаций бедра и голени сопряжено с крайне высоким риском осложнений -от 50 до 150 % [7,8,[17][18][19][20]. В целом наше исследование подтверждает эти данные.…”

Section: Discussionunclassified

Treatment of congenital long-bone deformities in children using the consequtive application of guided growth and external fixation: preliminary report

Vilensky

Александрович²,

Zakharjan

et al. 2018

Pediatr Traum Orthop Reconstr Surg

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Aim. This study aimed to estimate the results of congenital long bone deformities using the consecutive application of guided growth and external fixation. Materials and methods. We performed a retrospective analysis of the treatment results of 38 children with congenital deformities of long bones. Group 1 consisted of 17 children who underwent consecutive application of two methods: guided growth and external fixation. Group 2 (control group) consisted of 21 children who underwent isolated lengthening and deformity correction by external fixation. Results. There were 14 complications in group 1 and 25 complications in group 2. Moreover, only seven cases in group 1 had complications requiring surgical treatment, whereas 17 cases in group 2 required operative treatment for complications. There was a relatively low level of refractures: zero cases in group 1 and three cases in group 2. The most common complication was a recurrence of deformity associated with the continuous growth of children: seven cases in group 1 and eight cases in group 2. However, no recurrence of the torsion component of deformity was observed in any group 1 cases, and repeated guided growth could be performed in the six cases of growing children. Conclusion. The consecutive use of external fixation and guided growth to treat congenital deformities of the lower limbs is a promising direction for pediatric orthopedics because it reduces the incidence of complications. The repeated use of guided growth, because of its minimal invasiveness, is the most effective solution for the recurrence of deformity in a growing child.

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Fracture following lower limb lengthening in children: A series of 58 patients

Abstract: Level IV.

Cited by 37 publications

References 25 publications

Clinical Practice Guidelines for Achondroplasia*

Clinical Practice Guidelines for Achondroplasia*

The biology of bone lengthening

Treatment of congenital long-bone deformities in children using the consequtive application of guided growth and external fixation: preliminary report

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