Simultaneous Ipsilateral Femoral and Tibial Lengthening with the Ilizarov Method

Curran, Andrew R.; Kuo, Ken N.; Lubicky, John P.

doi:10.1097/01241398-199905000-00019

Cited by 16 publications

(11 citation statements)

References 12 publications

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“…However, the risk associated with simultaneous femoral and tibial lengthening was substantially higher than that associated with isolated single-level femoral lengthening (2%); four of 214 or tibial lengthening (4%); fourteen of 351. Previous studies [19][20][21][22] did not demonstrate a higher prevalence of nerve compromise with double-level lengthening of the femur or tibia compared with that associated with isolated femoral or tibial lengthening. Double-level lengthening greatly decreases the distraction and consolidation times 23 ; since peroneal nerve decompression is a relatively minor procedure, it is worth performing double-level lengthening even if decompression will become necessary.…”

Section: Discussionmentioning

confidence: 84%

Nerve Lesions Associated With Limb-Lengthening

Nogueira

Paley

Bhave

et al. 2003

The Journal of Bone and Joint Surgery-American Volume

104

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Background: Nerve injury is one of the most serious complications associated with limb-lengthening. We examined the risk, assessment, and treatment of nerve lesions associated with limb-lengthening. Methods: We retrospectively studied the records on 814 limb-lengthening procedures. Nerve lesions were defined by clinical signs and symptoms of motor function impairment, sensory alterations, referred pain in the distribution of an affected nerve, and/or positive results of quantitative sensory testing with use of a pressure specified sensory device. Results: Seventy-six (9.3%) of the limbs had a nerve lesion. Eighty-four percent of the nerve lesions occurred during gradual distraction, and 16% occurred immediately following surgery. The pressure specified sensory device showed 100% sensitivity and 86% specificity in the detection of nerve injuries. The patients in whom the lesion was diagnosed with this method, or with this method as well as with nerve conduction studies, had significantly faster recovery than did those diagnosed on the basis of clinical symptoms or nerve conduction studies alone (p = 0.02). Patients undergoing double-level tibial lengthening and those with skeletal dysplasia were at higher risk for nerve lesions (77% and 48%, respectively). Nerve decompression was performed in fifty-three cases (70%). The time between the diagnosis and the surgical decompression was strongly associated with the time to recovery (p = 0.0005). Complete clinical recovery was achieved in seventy-four of the seventy-six cases. Conclusions: Early detection based on signs and symptoms or testing with a pressure specified sensory device improves the prognosis for nerve injury that occurs during limb-lengthening. Of the methods that we used to identify neurologic compromise, testing with the pressure specified sensory device was the most sensitive. Aggressive early treatment (slowing the rate of lengthening and/or performing decompression) allows continued lengthening without incurring permanent nerve injury. When indicated, decompression of the affected nerve should be performed as soon as possible, thereby improving the chances of and shortening the time to complete recovery.

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Section: Discussionmentioning

confidence: 84%

Nerve Lesions Associated With Limb-Lengthening

Nogueira

Paley

Bhave

et al. 2003

The Journal of Bone and Joint Surgery-American Volume

104

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“…Healing indices (time in fixator/length gained) for limb‐lengthening range from 28 to 36 days per centimeter. (2–4) Variable techniques have been pursued to reduce the impact of the prolonged healing time on the patient, including lengthening with a fixator over an intramedullary nail and distraction using a lengthening nail (5–7) . These methods, while promising, lend their own array of complications to the procedure and cannot be applied to many patients because of the need for deformity correction.…”

Section: Introductionmentioning

confidence: 99%

Zoledronic Acid Prevents Osteopenia and Increases Bone Strength in a Rabbit Model of Distraction Osteogenesis

Little

Smith

Williams

et al. 2003

Journal of Bone and Mineral Research

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Prolonged healing times and stress-shielding osteopenia remain problematic in distraction osteogenesis. In this study of 30 rabbits, zoledronic acid increased regenerate volume, mineralization, and tibial strength and prevented osteopenia over a 6-week period. Translation to the clinical setting, if safe, could improve outcomes in distraction osteogenesis in children.Introduction: Because the external fixators for limb lengthening and reconstruction are designed to control the positions of bone fragments accurately, they also produce stress-shielding effects on the forming regenerate and surrounding bone. Osteopenia, leading to refracture and limitations on rehabilitation, are common consequences, potentially increasing morbidity and detracting from final clinical outcome. Materials and Methods:We examined the effect of zoledronic acid on distraction osteogenesis in 42 immature male NZW rabbits. The model chosen results in reliable regenerate formation and stress-shielding osteopenia. Fourteen animals received either Saline, zoledronic acid 0.1 mg/kg at surgery (ZOL), or another dose 2 weeks postoperatively (Redosed ZOL). Rabbits underwent DXA for bone mineral content and bone mineral density in regenerate and surrounding segments of operated and contralateral tibias. After death at 6 weeks, 30 pairs of tibias underwent quantitative computerized tomography (QCT) and four-point bend testing, and 12 were examined by histomorphometry. The study was powered at 0.8 to show differences of 1.3 SDs for mineral and mechanical parameters. Results: Osteopenia observed in tibias of the Saline group was absent in ZOL and Redosed ZOL tibias, the latter exhibiting higher bone mineral density and bone mineral content over contralateral regions (p Ͻ 0.01). Regenerate bone mineral content was higher in ZOL and Redosed ZOL versus Saline groups at 4 and 6 weeks (p Ͻ 0.01). Cross-sectional area was 49% and 59% greater at 6 weeks in ZOL and Redosed ZOL regenerates compared with the Saline group (p Ͻ 0.01). ZOL and Redosed ZOL tibias were 29% and 89% stronger by four-point bending than the Saline group (p Ͻ 0.01). Histomorphometry in the regenerate of ZOL and Redosed ZOL groups revealed higher trabecular bone volume and trabecular number compared with the Saline group (p Ͻ 0.001). Conclusions: Zoledronic acid administration led to significantly greater bone area, mineral content, strength, and trabecular number with reduced stress-shielding osteopenia in this model of distraction osteogenesis. These data suggest that intraoperative and postoperative zoledronic acid administration could improve outcomes in children undergoing limb lengthening.

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“…It is reported to range between 28 days/cm and 36 days/cm. 4,5 There have been several studies which have investigated methods of accelerating this. 6,7 Bisphosphonates are stable pyrophosphate analogues which are distributed mainly to sites of exposed hydroxyapatite where they inhibit bone resorption.…”

mentioning

confidence: 99%

Locally administered low-dose alendronate increases bone mineral density during distraction osteogenesis in a rabbit model

Omi¹,

Kusumi

Kijima

et al. 2007

The Journal of Bone and Joint Surgery. British volume

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We investigated the effect of locally administered bisphosphonate on distraction osteogenesis in a rabbit model and evaluated its systemic effect. An osteotomy on the right tibia followed by distraction for four weeks was performed on 47 immature rabbits. They were divided into seven equal groups, with each group receiving a different treatment regime. Saline and three types of dosage of alendronate (low, 0.75 microg/kg; mid, 7.5 microg/kg and high 75 microg/kg) were given by systemic injection in four groups, and saline and two dosages (low and mild) were delivered by local injection to the distraction gap in the remaining three groups. The injections were performed five times weekly during the period of distraction. After nine weeks the animals were killed and image analysis and mechanical testing were performed on the distracted right tibiae and the left tibiae which served as a control group. The local low-dose alendronate group showed a mean increase in bone mineral density of 124.3 mg/cm(3) over the local saline group (analysis of variance, p < 0.05) without any adverse effect on the left control tibiae. The findings indicate that the administration of local low-dose alendronate could be an effective pharmacological means of improving bone formation in distraction osteogenesis.

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Simultaneous Ipsilateral Femoral and Tibial Lengthening with the Ilizarov Method

Cited by 16 publications

References 12 publications

Nerve Lesions Associated With Limb-Lengthening

Nerve Lesions Associated With Limb-Lengthening

Zoledronic Acid Prevents Osteopenia and Increases Bone Strength in a Rabbit Model of Distraction Osteogenesis

Locally administered low-dose alendronate increases bone mineral density during distraction osteogenesis in a rabbit model

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