Regenerate bone fracture rate following femoral lengthening in paediatric patients

Abstract

PurposeFemoral lengthening using a circular or mono-lateral frame is a commonly used technique. Fracture at the site of the regenerate bone is a major concern especially following removal of the external fixator. This aim of this study was to assess the rate of fracture of the regenerate bone in this single surgeon series of paediatric patients and determine potential risk factors.MethodsRetrospective review of all the femoral lengthening performed by the senior author was performed. The medical and physiotherapy notes were reviewed. The gender, age at time of surgery, disease aetiology, total days in the external fixator and length of the new regenerate bone were recorded. Patients who sustained a regenerate fracture were identified.ResultsA total of 176 femoral lengthening procedures were performed on 108 patients. Eight regenerate fractures occurred in seven patients (4.5%). The mechanism of injury was a fall in five cases and during physiotherapy in three cases. The regenerate fracture occurred a median number of nine days following removal of frame. There was no significant difference between gender, age at time of surgery, total time in external fixator between those who sustained a regenerate fracture and those patients who did not. A significant difference was noted between the amount of lengthening between the ‘regenerate fracture group’ and the ‘no fracture group’ (50 mm vs 38 mm, respectively; p = 0.029). There was no association between disease aetiology and risk of regenerate fracture.ConclusionsFemoral lengthening of more than 50 mm increases the risk of a fracture at the regenerate site regardless of the disease aetiology. We recommend avoidance of aggressive physiotherapy for the initial four weeks following external fixator removal.

Does Retrograde Femoral Nailing through a Normal Physis Impair Growth? An Experimental Porcine Model

“…Furthermore, after frame removal, there is a risk of developing a deformity in an immature regenerate in addition to fracture through the regenerate or a pin site. 8 – 11 Internal bone lengthening by intramedullary lengthening nails has been introduced to avoid the external frame and the associated complications. 12 , 13 However, in the growing child, the physis needs to be injured for the intramedullary nail to be inserted.…”

Femoral lengthening using limb reconstruction system augmented with only one antegrade flexible nail in children: early results

“…Nevertheless, there was a comparable incidence of fracture to the combined methods using two nails (0-27.5%) [4,10,11,[19][20][21].…”

“…Also, both patients who encountered fracture of the regenerate had underlying CFD, and as we know, the diameter of the bone is smaller than normal in CFD. Nevertheless, there was a comparable incidence of fracture to the combined methods using two nails (0–27.5%) [4,10,11,19–21].…”

Comparison of methods for assigning the material properties of the distraction callus in computational models

“…For example, it is critical for clinicians to decide the moment when the fixator must be removed without stiffness measurements. In fact, a premature fixator removal is usually a source of complications …”