Tibial Lengthening Over an Intramedullary Nail with Use of the Ilizarov External Fixator for Idiopathic Short Stature

Park, Hui Wan; Yang, Kyu Hyun; Lee, Ki Seok; Joo, Sun Young; Kwak, Yoon Hae; Kim, Hyun Woo

doi:10.2106/jbjs.g.00897

Cited by 60 publications

(38 citation statements)

References 15 publications

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“…However, the concomitant use of an intramedullary nail, such as with tibial LON, can act as a strong resistance to the deforming forces, minimizing axial deviations compared with the classic Ilizarov method. Some studies [2,3,15,20,21] compared the classic Ilizarov method with the LON technique and showed that axial deviation occurred in 4% to 13% of tibias with the classic Ilizarov method, whereas it was 0% to 2% with the LON technique. However, Kim et al [8] reported that they observed 20 segments (14%) that showed valgus angulation with a mean of 10°using the LON technique.…”

Section: Discussionmentioning

confidence: 99%

“…It can act as a guide such that the bone is lengthened along the longitudinal axis of the nail with no axial deviations. It was reported that the secondary deformity induced during distraction could be substantively negated with the intramedullary nail in the LON technique of the tibia [3,15,20,21]. However, Kim et al [8] reported that a valgus deviation was the most common complication in 20 segments (25%) in their series of the LON technique of the tibia.…”

Section: Introductionmentioning

confidence: 99%

“…Another potential advantage of this technique is that it prevents the secondary deformity that can occur during distraction [3,15,20,21]. In contrast to the classic Ilizarov method, the intramedullary nail in the LON technique is thought to resist distraction-resisting deforming forces [14,20].…”

Section: Introductionmentioning

confidence: 99%

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Is there an Increase in Valgus Deviation in Tibial Distraction Using the Lengthening Over Nail Technique?

Park

Ryu

Kim

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background During tibial lengthening, the soft tissues of the posterolateral compartment produce distraction-resisting forces causing valgus angulation. Although this occurs with the classic Ilizarov method, whether a valgus deformity develops with the lengthening over nail (LON) technique is questioned, because the intramedullary nail is thought to resist deforming forces and adequately maintain alignment of the distracted bone. Questions/purposes The purposes of this study were to (1) determine the amount of valgus deviation during tibial lengthening with the LON technique; and (2) analyze the factors that may be associated with valgus deviation with the LON technique. Methods Between June 2009 and September 2013, we performed 346 tibial lengthenings using the LON technique, lengthening and then nail technique, or lengthening with an intramedullary lengthening device. Sixty patients (120 tibias) who underwent bilateral lower leg lengthening with the LON technique were enrolled in this retrospective study. To limit the number of variables, we analyzed only the right tibia in all patients (60 tibias). The mean followup was 42 months (range, 26-71 months). The mean age of the patients was 25 years (range, 18-40 years). There were 36 male and 24 female patients. The mean final length gain was 67 ± 9 mm. The mean time for distraction was 100 ± 25 days. The overall valgus deviation was assessed by measuring the change in the medial proximal tibial angle and mechanical femorotibial angle on radiographs obtained before and after surgery and after completion of lengthening. Several demographic, surgical, and distraction-related variables were considered possible factors to prevent valgus deviation: proximal fixation method; presence of a blocking screw; diameter and length of the intramedullary nail; degree of nail insertion; length of the nail in the distal segment after completion of distraction; final length gain; and patient's BMI. During the period studied, the blocking screw was to maintain the mechanical axis in patients who had neutral or valgus alignment preoperatively, or to prevent more valgus change in patients who underwent acute correction of varus deformity intraoperatively. Uni-and multivariate analyses were conducted. Results Valgus deviation occurred during the tibial LON. The medial proximal tibial angle increased from 86°(95% CI, 85°-86°) to 90°(95% CI, 89°-91°) (p \ 0.001). The mechanical femorotibial angle changed from 2.2°varus (95% CI, 3°-1.4°varus) to 2.6°valgus (95% CI, 1.8°-3.4°E

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is there an Increase in Valgus Deviation in Tibial Distraction Using the Lengthening Over Nail Technique?

Park

Ryu

Kim

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…The same technique is being used to increase the height of somatically normal persons who report negative feelings regarding their short stature [2,6,11,20] deriving from cosmetic, social, and occupational concerns.…”

Section: Introductionmentioning

confidence: 99%

Cosmetic Lower Limb Lengthening by Ilizarov Apparatus: What are the Risks?

Новиков

Subramanyam

Muradisinov

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Compelled by the psychosocial implications of short stature, patients with short stature are increasingly undergoing distraction osteogenesis for cosmetic limb lengthening. To the degree that this is true, evaluation of the risks and benefits of this treatment are very important, but to date, there are few studies reporting on using distraction osteogenesis for this indication. Questions/purposes We reviewed a group of patients undergoing cosmetic lower-extremity lengthening in terms of (1) soft tissue challenges, (2) bone-related complications, and (3) functional and subjective clinical outcomes. Methods The study was retrospective by reviewing data from medical records and radiographs. Between 1983 and 2006, we treated 138 somatically normal patients with bilateral lower-limb distraction osteogenesis for cosmetic purposes at our center using an Ilizarov external fixator, of whom 131 (95%; 65 males, 66 females) had complete clinical and radiographic data a minimum of 1 year after treatment (mean, 6 years; range, 1-14 years) and were reviewed for this report. The mean age of these patients was 25 years (range, 14-68 years) and their mean preoperative height was 159 cm (range, 130-174 cm). One hundred twenty-four (95%) patients had lengthening of the tibia alone, of which 66 (53%) were monofocal and 58 (47%) were bifocal. Six patients (4.58%) had crossed contralateral lengthening of the femur and tibia and one patient (0.76%) had bilateral lengthening of the femur. The mean height gained was 6.9 cm (range, 2-13 cm), 7.3 cm (range, 3.5-13 cm) in males and 6.5 cm (range, 2-13 cm) in females. The mean lengthening, maturation, and external fixator indexes were 12 days/cm (range, 4.3-24 days/cm), 19 days/cm (range, 5.2-63 days/cm), and 31 days/cm (range, 12-78 days/cm), respectively. Results Forty-eight patients (37%) had 59 complications related to treatment. Thirty-seven were soft tissue related (28%), of which 17 (46%) needed reinterventions, and 22 were bone related (17%), of which 16 (73%) needed reinterventions. At final followup, the outcome was excellent for 72 patients (55%), good for 52 (40%), satisfactory for six (4.58%), and poor for one (0.77%). One

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“…Some studies suggest making the decision [21,22] to increase weightbearing according to the number of matured cortices at the periphery of the newly formed bone seen on the radiographs: recommending patients remain partial weightbearing with two crutches until the newly formed bone has two mature cortices; full weightbearing without crutches was recommended when two intact cortices are seen on the radiographs, but this assessment is subjective and ill-defined. Previous studies report an increased screw or nail breakage rate of 10% [11] to 33% [13] when the tibia was lengthened with an interlocking nail; these complications require additional surgeries and would best be avoided.…”

Section: Introductionmentioning

confidence: 99%

Objective Guidelines for Removing an External Fixator after Tibial Lengthening Using Pixel Value Ratio: A Pilot Study

Zhao

Fan

Venkatesh

et al. 2009

Clin Orthop Relat Res

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During limb lengthening over an intramedullary nail, decisions regarding external fixator removal and weightbearing depend on the amount of callus seen at the lengthening area on radiographs. However, this method is subjective and objective evaluation of the amount of callus likely would minimize nail or interlocking screw breakage and refracture after fixator removal. We asked how many cortices with full corticalization of the newly formed bone at the lengthening area are needed to allow fixator removal and full weightbearing and how to radiographically determine the stage of corticalization. We retrospectively reviewed 17 patients (34 lengthenings) who underwent bilateral tibial lengthenings over an intramedullary nail. The average gain in length was 7.2 ± 3.4 cm. We determined the pixel value ratio (ratio of pixel value of regenerate versus the mean pixel value of adjacent bone) of the lengthened area on radiographs. There were no nail or screw breakage and refracture. Partial weightbearing with crutches was permitted when the pixel value ratio was 1 in two cortices and full weightbearing without crutches was permitted when the pixel value ratio was 1 in three cortices. The pixel value ratio on radiographs can be an objective parameter for callus measurement and may provide guidelines for the timing of external fixator removal. We cannot determine from our limited data the minimum pixel value in how many cortices would suggest safe removal, but we can say our criteria were not associated with subsequent refracture.

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Tibial Lengthening Over an Intramedullary Nail with Use of the Ilizarov External Fixator for Idiopathic Short Stature

Abstract: Tibial lengthening with use of the Ilizarov external fixator over an intramedullary nail results in new bone formation of a quality equal to that obtained with the conventional Ilizarov method; however, it reduces the duration of external fixation and the rate of complications.

Cited by 60 publications

References 15 publications

Is there an Increase in Valgus Deviation in Tibial Distraction Using the Lengthening Over Nail Technique?

Is there an Increase in Valgus Deviation in Tibial Distraction Using the Lengthening Over Nail Technique?

Cosmetic Lower Limb Lengthening by Ilizarov Apparatus: What are the Risks?

Objective Guidelines for Removing an External Fixator after Tibial Lengthening Using Pixel Value Ratio: A Pilot Study

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