Limb Lengthening by Callus Distraction (Callotasis)

G, De Bastiani; Aldegheri, Roberto; Renzi-Brivio, L.; Trivella, Giampaolo

doi:10.1097/01241398-198703000-00002

Cited by 573 publications

(278 citation statements)

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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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“…The technique is to lengthen the osteotomied bone by callus distraction. There are various published techniques and experiences [18][19][20][21][22][23]. The procedure is often performed with a circular or a monolateral external fixator, but also over an intramedullary nail [24].…”

Section: Discussionmentioning

confidence: 99%

Metabolic and orthopedic management of X-linked vitamin D-resistant hypophosphatemic rickets

Fucentese

Neuhaus

Ramseier

et al. 2008

Journal of Children's Orthopaedics

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Purpose Therapy of vitamin D-resistant hypophosphatemic rickets (VDXLR) consists of oral phosphate and vitamin D supplements. Bone deformities, pain, and small stature can occur even in children with good compliance, requiring surgical correction and bone lengthening. However, only few surgical reports are available. Methods Twelve patients (three males) with VDXLR were followed at our institution. Median age at diagnosis was 3 9/12 years (range, birth to 11 10/12) with a follow-up period of 7 8/12 years (1 9/12-30) and age at last follow-up of 13 6/12 years (2-30). Eight patients underwent surgical correction, three of them in combination with bone lengthening. The corrections were performed at the end of growth in three patients. Clinical endpoints were height, leg axis, and pain. Results Single bilateral surgical correction was performed in six patients; one patient each had three and five corrections. Bone lengthening was performed in three patients. At last follow-up, the height of seven operated patients was within normal range. In addition, leg axis was normalized in six patients with mild genua vara in two. Only one patient complained of intermittent pain. Bone healing was excellent; surgical complications were rare. There was no radiological evidence of degenerative arthropathy.Conclusions Medical treatment remains the main pillar of therapy in children with VDXLR. In case of bone deformity, surgery can safely be performed, independent of age or bone maturation. All patients were satisfied with the results of axial corrective surgery and bone lengthening, and in the majority only one corrective intervention was needed.

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“…The healing index (DCT/cm) [25,89] is the most widely used parameter. It amounts usually 1 month/cm in children and 2-3 months/cm in adults [8,77], plateaus for long distances and increases for very small gaps [92].…”

Section: Osteotomy Techniques and Biology Of Callotasismentioning

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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Limb Lengthening by Callus Distraction (Callotasis)

Cited by 573 publications

References 0 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

Metabolic and orthopedic management of X-linked vitamin D-resistant hypophosphatemic rickets

Current concepts of leg lengthening

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