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Staged upper and lower limb lengthening performing bilateral simultaneous surgery of the femur and tibia in achondroplastic patients

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Abstract

Introduction

Surgical lengthening and angular correction of the limbs are an option for treating the orthopedic clinical manifestations in patients with achondroplasia. This study assesses a staged limb lengthening protocol, performing simultaneous bilateral lengthening of the femur and tibia (stage I [S1]), and humeral lengthening (stage II [S2]).

Materials and methods

Twenty-one achondroplastic patients were included in this study, and 106 segments (34 femurs, 34 tibias and 38 humeri) were lengthened. Achondroplasia patients with a growth curve below the mean of the standard growth curves for achondroplasia were included in S1. The remaining patients were included directly in S2. Variables analyzed included anthropometric measurements, lengthening outcomes, difficulties, and functionality.

Results

Of the all patients included in the protocol, 15 patients completed S1 and S2, 4 only completed S2, and 2 only completed S1. Height and limb–trunk ratio before S1 were 107.65 ± 7.14 cm and 1.89 ± 0.10 and after S1 were 126.50 ± 9.19 cm and 1.64 ± 0.09, respectively. Limbs were lengthened 14.43 ± 1.41 cm (femurs and tibias) for S1 and 9.95 ± 0.60 cm for S2 (humeri), with a stage healing index of 18.23 ± 3.54 in S1 and 28.92 ± 4.42 in S2. Correction of lower angular deviations, functional improvement, and a controlled complications rate were achieved in all patients.

Conclusions

The limb lengthening protocol proposed in this study is a suitable treatment for achondroplasia patients to achieve the agreed-upon objectives (limb–trunk ratio, improved functionality, and lower limb alignment). The reproducibility of the procedure and patient safety were upheld.

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Acknowledgements

We thank the ALPE Achondroplasia Foundation (Gijón, Spain), especially to Carmen Alonso and Susana Noval, for its valuable collaboration on patient coordination and support activities throughout the standardized protocol. We thank Belén Pimentel from the AME Unit at IBIMA_FIMABIS for critical reading of the manuscript. We thank Biostatech Advice Training & Innovation in Biostatistics, S.L for statistical review.

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Correspondence to Antonio Leiva-Gea.

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Conflict of interest

No author has commercial associations that might pose a conflict of interest in connection with the submitted article. This was an independent study. The contracts of the clinicians and the public resources used in the study were funded by the Andalusian Public Health Service, Regional Ministry of Health in Andalucía, Spain, and by the corresponding Regional Ministry of Health for each patient from outside of Andalusia, supported by the National Public Health Service of Spain.

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Leiva-Gea, A., Delgado-Rufino, F.B., Queipo-de-Llano, A. et al. Staged upper and lower limb lengthening performing bilateral simultaneous surgery of the femur and tibia in achondroplastic patients. Arch Orthop Trauma Surg (2020). https://doi.org/10.1007/s00402-020-03360-3

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Keywords

  • Achondroplasia
  • Lower limb lengthening
  • Humeral lengthening
  • External fixator