Skip to main content
SpringerLink
Log in

Tibial Lengthening: Extraarticular Calcaneotibial Screw to Prevent Ankle Equinus

  • Symposium: Advances in Limb Lengthening and Reconstruction
  • Published:
Clinical Orthopaedics and Related Research

Abstract

Between 2003 and 2006, we used an extraarticular, cannulated, fully threaded posterior calcaneotibial screw to prevent equinus contracture in 10 patients (four male and six female patients, 14 limbs) undergoing tibial lengthening with the intramedullary skeletal kinetic distractor. Diagnoses were fibular hemimelia (two), mesomelic dwarfism (two), posteromedial bow (one), hemihypertrophy (one), poliomyelitis (one), achondroplasia (one), posttraumatic limb-length discrepancy (one), and hypochondroplasia (one). Average age was 24.5 years (range, 15–54 years). The screw (length, typically 125 mm; diameter, 7 mm) was inserted with the ankle in 10° dorsiflexion. Gastrocnemius soleus recession was performed in two patients to achieve 10° dorsiflexion. Average lengthening was 4.9 cm (range, 3–7 cm). Screws were removed after a mean 3.3 months (range, 2–6 months). Preoperative ankle range of motion was regained within 6 months of screw removal. No neurovascular complications were encountered, and no patients experienced equinus contracture. We also conducted a cadaveric study in which one surgeon inserted screws in eight cadaveric legs under image intensifier control. The flexor hallucis longus muscle belly was the closest anatomic structure noted during dissection. The screw should be inserted obliquely from upper lateral edge of the calcaneus and aimed lateral in the tibia to avoid the flexor hallucis longus muscle.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–B
Fig. 2A–B
Fig. 3A–B
Fig. 4A–E

Similar content being viewed by others

References

  1. Ahmadi B, Akbarnia BA, Ghobadi F, Ganjavian MS, Nasseri D. Experience with 141 tibial lengthenings in poliomyelitis and comparison of 3 different methods. Clin Orthop Relat Res. 1979;145:150–153.

    PubMed  Google Scholar 

  2. Aldegheri R. Distraction osteogenesis for lengthening of the tibia in patients who have limb-length discrepancy or short stature. J Bone Joint Surg Am. 1999;81:624–634.

    PubMed  CAS  Google Scholar 

  3. Baumgart R, Betz A, Schweiberer L. A fully implantable motorized intramedullary nail for limb lengthening and bone transport. Clin Orthop Relat Res. 1997;343:135–143.

    Article  PubMed  Google Scholar 

  4. Campbell WC. An operation for the induction of osseous fusion in the ankle joint. Am J Surg. 1929;6:588.

    Article  Google Scholar 

  5. Cole JD, Justin D, Kasparis T, DeVlught D, Knobloch C. The intramedullary skeletal kinetic distractor (ISKD): first clinical results of a new intramedullary nail for lengthening of the femur and tibia. Injury. 2001;32(Suppl 4):SD129–SD139.

    Article  Google Scholar 

  6. Coleman SS, Stevens PM. Tibial lengthening. Clin Orthop Relat Res. 1978;136:92–104.

    PubMed  Google Scholar 

  7. Dal Monte A, Donzelli O. Tibial lengthening according to Ilizarov in congenital hypoplasia of the leg. J Pediatr Orthop. 1987;7:135–138.

    PubMed  CAS  Google Scholar 

  8. De Deyne PG, Meyer R, Paley D, Herzenberg JE. The adaptation of perimuscular connective tissue during distraction osteogenesis. Clin Orthop Relat Res. 2000;379:259–269.

    Article  PubMed  Google Scholar 

  9. Eldridge JC, Bell DF. Problems with substantial limb lengthening. Orthop Clin North Am. 1991;22:625–631.

    PubMed  CAS  Google Scholar 

  10. Faber FW, Keessen W, van Roermund PM. Complications of leg lengthening: 46 procedures in 28 patients. Acta Orthop Scand. 1991;62:327–332.

    PubMed  CAS  Google Scholar 

  11. Green SA. Postoperative management during limb lengthening. Orthop Clin of North Am. 1991;22:723–734.

    CAS  Google Scholar 

  12. Guichet JM, Casar RS. Mechanical characterization of a totally intramedullary gradual elongation nail. Clin Orthop Relat Res. 1997;337:281–290.

    Article  PubMed  Google Scholar 

  13. Guichet JM, Deromedis B, Donnan LT, Peretti G, Lascombes P, Bado F. Gradual femoral lengthening with the Albizzia intramedullary nail. J Bone Joint Surg Am. 2003;85:838–848.

    PubMed  Google Scholar 

  14. Hankemeier S, Gösling T, Pape HC, Wiebking U, Krettek C. Limb lengthening with the Intramedullary Skeletal Kinetic Distractor (ISKD). Oper Orthop Traumatol. 2005;17:79–101.

    Article  PubMed  Google Scholar 

  15. Hankemeier S, Pape HC, Gosling T, Hufner T, Richter M, Krettek C. Improved comfort in lower limb lengthening with the intramedullary skeletal kinetic distractor: principles and preliminary clinical experiences. Arch Orthop Trauma Surg. 2004;124:129–133.

    Article  PubMed  Google Scholar 

  16. Hepburn GR. Case studies: contracture and stiff joint management with Dynasplint. J Orthop Sports Phys Ther. 1987;8:498–504.

    Google Scholar 

  17. Herzenberg JE, Paley D, Gillespie R. Limb deficiency. In: Staheli LT, ed. Pediatric Orthopaedic Secrets. 2nd ed. Philadelphia, PA: Hanley & Belfus, Inc.; 2003:406–416.

    Google Scholar 

  18. Lehman WB, Grant AD, Atar D. Preventing and overcoming equinus contractures during lengthening of the tibia. Orthop Clin North Am. 1991;22:633–641.

    PubMed  CAS  Google Scholar 

  19. Maffulli N, Lombari C, Matarazzo L, Nele U, Pagnotta G, Fixsen JA. A review of 240 patients undergoing distraction osteogenesis for congenital post-traumatic or postinfective lower limb length discrepancy. J Am Coll Surg. 1996;182:394–402.

    PubMed  CAS  Google Scholar 

  20. Paley D. Current techniques of limb lengthening. J Pediatr Orthop. 1988;8:73–92. Review.

    PubMed  CAS  Google Scholar 

  21. Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res. 1990;250:81–104. Review.

    PubMed  Google Scholar 

  22. Pouliquen JC, Glorion C, Ceolin JL, Langlais J, Pauthier F. Upper metaphyseal lengthening of the tibia: report of 57 cases in children and adolescents [in French]. Rev Chir Orthop Reparatrice Appar Mot. 1994;80:532–541.

    PubMed  CAS  Google Scholar 

  23. Singh S, Lahiri A, Igbal M. The results of limb lengthening by callus distraction using an extending intramedullary nail (Fitbone) in non-traumatic disorders. J Bone Joint Surg Br. 2006;88:938–942.

    Article  PubMed  CAS  Google Scholar 

  24. Song HR, Myrboh V, Oh CW, Lee ST, Lee SH. Tibial lengthening and concomitant foot deformity correction in 14 patients with permanent deformity after poliomyelitis. Acta Orthop. 2005;76:261–269.

    Article  PubMed  Google Scholar 

  25. Stanitski DF, Shahcheraghi H, Nicker DA, Armstrong PF. Results of tibial lengthening with the Ilizarov technique. J Pediatr Orthop. 1996;16:168–172.

    PubMed  CAS  Google Scholar 

  26. Stiell IG, McKnight RD, Greenberg GH, Nair RC, McDowell I, Wallace GJ. Interobserver agreement in the examination of acute ankle injury patients. Am J Emerg Med. 1992;10:14–17.

    Article  PubMed  CAS  Google Scholar 

  27. Tardieu C, Lespargot A, Tabary C, Bret MD. For how long must the soleus muscle be stretched each day to prevent contracture? Devel Med Child Neurol. 1988;30:3–10.

    Article  CAS  Google Scholar 

  28. Thonse R, Herzenberg JE, Standard SC, Paley D. Limb lengthening with a fully implantable, telescopic, intramedullary nail. Oper Tech Orthop. 2005;15:355–362.

    Article  Google Scholar 

  29. Tjernstroöm B, Olerud S, Rehnberg L. Limb lengthening by callus distraction: complications in 53 cases operated 1980–1991. Acta Orthop Scand. 1994;65:447–455.

    CAS  Google Scholar 

  30. Zarzycki D, Tesiorowski M, Zarzycka M, Kacki W, Jasiewicz B. Long-term results of lower limb lengthening by the Wagner method. J Pediatr Orthop. 2002;22:371–374.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Smith & Nephew, Inc., for donating the screws for the anatomic cadaveric study.

Author information

Authors and Affiliations

  1. SPARSH Hospital, Bangalore, India

    Mohan V. Belthur MD

  2. Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA

    Dror Paley MD, Stacy C. Specht MPA & John E. Herzenberg MD

  3. Children’s Healthcare of Atlanta at Scottish Rite, Atlanta, GA, USA

    Gaurav Jindal MD

  4. Department for Trauma Surgery, Klinikum Rechts der Isar der Technischen Universität München, München, Germany

    Rolf D. Burghardt MD

Authors
  1. Mohan V. Belthur MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dror Paley MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gaurav Jindal MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rolf D. Burghardt MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stacy C. Specht MPA
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. John E. Herzenberg MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John E. Herzenberg MD.

Additional information

One author (DP) is a consultant for Smith & Nephew, Inc., (Memphis, TN).

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

About this article

Cite this article

Belthur, M.V., Paley, D., Jindal, G. et al. Tibial Lengthening: Extraarticular Calcaneotibial Screw to Prevent Ankle Equinus. Clin Orthop Relat Res 466, 3003–3010 (2008). https://doi.org/10.1007/s11999-008-0489-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-008-0489-8

Keywords

Search

Navigation