Tibial Lengthening: Extraarticular Calcaneotibial Screw to Prevent Ankle Equinus

Belthur, Mohan V.; Paley, Dror; Jindal, Gaurav; Burghardt, Rolf D.; Specht, Stacy C.; Herzenberg, John E.

doi:10.1007/s11999-008-0489-8

Cited by 27 publications

(11 citation statements)

References 31 publications

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“…We found a mean tibial lengthening of greater than 42 mm, a tibial lengthening of greater than 13% of original bone length, increased age, and a congenital etiology to be risk factors for equinus contracture and a consequent GSR. This is consistent with previous studies (Table 6), which found that equinus contracture is related to lengthening rate, etiology, amount of lengthening, and the condition of the gastrocsoleus-Achilles tendon complex [3,10]. Antoci et al [2] found that, in children, a percentage of limb lengthening of greater than 15% places the patient at an increased risk for joint contracture.…”

Section: Discussionsupporting

confidence: 91%

“…The exclusions left 95 patients, of whom 82 patients (83%) with 105 tibia lengthenings were available for followup at a minimum of 1 year. During the study period, we performed GSR for these patients during four time frames: (1) in patients who had a preoperative contracture of greater than 0°(mean, 2.5°) done to prevent increased equinus; (2) in patients while in the frame who had a recalcitrant contracture of greater than 10°(mean, 20°); (3) in patients at frame removal who had a recalcitrant contracture of greater than 0°(mean, 15°); and (4) in patients after frame removal who had a persistent contracture of greater than 0°(mean, 9°). The patients who underwent GSR at time of frame application had a preexisting equinus contracture before tibial lengthening and the surgery was performed to prevent severe contracture during tibial lengthening.…”

Section: Study Period and Algorithmmentioning

confidence: 99%

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What Risk Factors Predict Usage of Gastrocsoleus Recession During Tibial Lengthening?

Rozbruch

Zonshayn

Muthusamy

et al. 2014

Clin Orthop Relat Res

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Background Tibial lengthening is frequently associated with gastrocsoleus contracture and some patients are treated surgically. However, the risk factors associated with gastrocsoleus contracture severe enough to warrant surgery during tibial lengthening and the consistency with which gastrocsoleus recession (GSR) results in a plantigrade foot in this setting have not been well defined. Questions/purposes We compared patients treated with or without GSR during tibial lengthening with respect to (1) clinical risk factors triggering GSR use, (2) ROM gains and patient-reported outcomes, and (3) complications after GSR. Methods Between 2002 and 2011, 95 patients underwent tibial lengthenings excluding those associated with bone loss; 82 (83%) were available for a minimum followup of 1 year. According to our clinical algorithm, we performed GSR when patients had equinus contractures of greater than 10°while lengthening or greater than 0°before or after lengthening. Forty-one patients underwent GSR and 41 did not. Univariate analysis was performed to assess independent associations between surgical characteristics and likelihood of undergoing GSR. A multivariate regression model and receiver operating characteristic curves were generated to adjust for confounders and to establish risk factors and any threshold for undergoing GSR. Chart review determined ROM, patient-reported outcomes, and complications. Results Amount and percentage of lengthening, age, and etiology were risk factors for GSR. Patients with lengthening of greater than 42 mm (odds ratio [OR]: 4.13; 95% CI: 1.82, 9.40; p = 0.001), lengthening of greater than 13% of lengthening (OR: 3.88; 95% CI: 1.66, 9.11; p = 0.001), and congenital etiology (OR: 1.90; 95% CI: 0.86, 4.15; p = 0.109) were more likely to undergo GSR. Adjusting for all other variables, increased amount lengthened (adjusted OR: 1.05; 95% CI: 1.02, 1.07; p \ 0.001) and age (adjusted OR: 1.02; 95% CI: 0.99, 1.05; p = 0.131) were associated with undergoing GSR. Patients gained 24°of ankle dorsiflexion after GSR. Selfreported functional outcomes were similar between patients with or without GSR. Complications included stretch injury to the posterior tibial nerve leading to temporary and partial loss of plantar sensation in two patients.

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Section: Discussionsupporting

confidence: 91%

Section: Study Period and Algorithmmentioning

confidence: 99%

What Risk Factors Predict Usage of Gastrocsoleus Recession During Tibial Lengthening?

Rozbruch

Zonshayn

Muthusamy

et al. 2014

Clin Orthop Relat Res

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“…This problem needs to be addressed in the future; whenever possible, surgical transfixing of the joints should be avoided through consistent physiotherapy and use of other aids—or if appropriate, early selective disassembly of the foot fixture after the end of distraction should be considered. The UAJ adjusting screws familiar from lengthening procedures using medullary nails might also play a role for fixator patients in the future (Belthur et al 2008). …”

Section: Discussionmentioning

confidence: 99%

Deformity correction and extremity lengthening in the lower leg: comparison of clinical outcomes with two external surgical procedures

et al. 2016

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Objective Distraction osteogenesis is a method of stimulating the growth of new bone tissue in order to lengthen the extremities or bridge resected bone defects. In addition to the now-established intramedullary procedures, two different fixator systems are in use. The present study investigated the classical Ilizarov ring fixator (IRF) and a hexapod to assess the precision of lower-leg lengthening and complications classified using the Paley criteria for problems, obstacles, and complications. The study also examined the follow-up results in functional tests to assess outcomes in terms of range of motion in adjacent joints, daily activities, and quality of life. Patients and methodsA total of 43 patients (53 segments) who were treated over a period of 16 years were re-assessed. In 33 segments, treatment was carried out with the hexapod Taylor Spatial Frame (TSF); the conventional IRF was used in 20 segments. The patients’ mean age was 13.5 years (range 2–54 years). The follow-up examinations were carried out 2–15 years postoperatively and comprised measurement of a current leg axis view with the patient standing, calculation of a knee score, activity scores, ankle joint scores, and assessment of motor function and sensory function using appropriate scores in the lower leg and foot. The post-treatment health-related quality of life was assessed using the Short-Form Health Survey-36 questionnaire. ResultsUsing the Paley criteria, far fewer problems occurred in the TSF group in comparison with the IRF (TSF 12.1%, IRF 50%). In the problems category, significant differences were observed with regard to axial deviation (TSF 0%, IRF 36.8%) and pin infections (TSF 9.1%, IRF 40%). Comparison of the obstacles and complications did not identify any significant differences between the two groups. Analysis of the scores for the knee, activity, and motor function/sensory function also did not show any marked discrepancies, apart from a major difference in mobility in the upper and lower ankle joints with poorer findings in the TSF group.ConclusionsDuring treatment, the TSF ring fixator leads to fewer problems, fewer secondary axial translations, and fewer pin infections. However, with temporary transfixation of the ankle joints, the TSF system is also associated with postoperative deterioration in mobility in the upper and lower ankle joint.

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“…The shortened toe region corresponds with the reduced range of motion we have described (Olabisi et al, 2007), suggesting that changes in tendon properties may contribute to loss in joint excursion. Current thinking holds that distraction induced contractures and range of motion losses are solely due to inadequate soft tissue length gains (Belthur et al, 2008). Yet our results suggest that joint stiffness may also be due in part to the changes in the biomechanical properties of the tendons themselves.…”

Section: Discussionmentioning

confidence: 99%

The biomechanical effects of limb lengthening and botulinum toxin type A on rabbit tendon

Olabisi

Best

Hurschler

et al. 2010

Journal of Biomechanics

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Tibial Lengthening: Extraarticular Calcaneotibial Screw to Prevent Ankle Equinus

Cited by 27 publications

References 31 publications

What Risk Factors Predict Usage of Gastrocsoleus Recession During Tibial Lengthening?

What Risk Factors Predict Usage of Gastrocsoleus Recession During Tibial Lengthening?

Deformity correction and extremity lengthening in the lower leg: comparison of clinical outcomes with two external surgical procedures

The biomechanical effects of limb lengthening and botulinum toxin type A on rabbit tendon

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