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Tibial lengthening with a submuscular plate in adolescents

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

Lengthening over an intramedullary nail has become a common technique for reducing the period of external fixation. However, the technique presents difficulties in patients with an open physis or a small marrow canal. Lengthening using a submuscular plate offers a new substitute in such situations, but few studies have been undertaken to determine its efficacy in teenagers.

Patients and methods

A retrospective review was performed on 20 consecutive tibiae of 16 patients who underwent tibial lengthening with the aid of external fixator and submuscular plate. Charts and radiographs were reviewed for demographics, surgical details, and complications related to the technique.

Results

The average age of the 16 patients was 14.3 years (range 10–17), and the amount of lengthening averaged 4.1 cm (range 3.0–5.0 cm), which represented 12.7 % of preoperative bone length (range 9.1–15.8 %). Mean time in the fixator was 60.3 days, mean external fixation index was 14.8 days/cm (range 13.2–22.5 days/cm), and mean healing index was 49.1 days/cm (range 37–59.3 days/cm). Twenty-seven complications occurred giving an overall complication rate of 1.35. Twenty of the 27 were minor complications, but 7 were major. These major complications were resolved surgically or by a resolution period exceeding 3 months. There were 3 cases of transient angular deformity of distraction callus, 2 cases of transient peroneal nerve palsy, 1 case of clamp loosening, and 1 case of plate failure. Functional results were good or excellent with an average score of 95.6 according to modified Paley’s criteria.

Conclusions

Although complications were not uncommon, tibial lengthening with a submuscular plate proved to be a reliable technique for treating limb length discrepancy in adolescents with reduced external fixation duration.

Level of evidence

Level IV, case series.

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References

  1. Ilizarov GA. The principles of the Ilizarov method. Bull Hosp Jt Dis Orthop Inst. 1988;48:1–11.

    CAS  PubMed  Google Scholar 

  2. Paley D, Herzenberg JE, Paremain G, Bhave A. Femoral lengthening over an intramedullary nail. A matched-case comparison with Ilizarov femoral lengthening. J Bone Jt Surg Am. 1997;79:1464–80.

    CAS  Google Scholar 

  3. Song HR, Oh CW, Mattoo R, Park BC, Kim SJ, Park IH, Jeon IH, Ihn JC. Femoral lengthening over an intramedullary nail using the external fixator: risk of infection and knee problems in 22 patients with a follow-up of 2 years or more. Acta Orthop. 2005;76:245–52.

    Article  PubMed  Google Scholar 

  4. Kim SJ, Mandar A, Song SH, Song HR. Pitfalls of lengthening over an intramedullary nail in tibia: a consecutive case series. Arch Orthop Trauma Surg. 2012;132:185–91.

    Article  PubMed  Google Scholar 

  5. Kristiansen LP, Steen H. Lengthening of the tibia over an intramedullary nail, using the Ilizarov external fixator. Major complications and slow consolidation in 9 lengthenings. Acta Orthop Scand. 1999;70:271–4.

    Article  CAS  PubMed  Google Scholar 

  6. Burghardt RD, Herzenberg JE, Specht SC, Paley D. Mechanical failure of the intramedullary skeletal kinetic distractor in limb lengthening. J Bone Jt Surg Br. 2011;93(5):639–43.

    Article  CAS  Google Scholar 

  7. García-Cimbrelo E, Curto de la Mano A, García-Rey E, Cordero J, Marti-Ciruelos R. The intramedullary elongation nail for femoral lengthening. J Bone Jt Surg Br. 2002;84:971–7.

    Article  Google Scholar 

  8. Iobst CA, Dahl MT. Limb lengthening with submuscular plate stabilization: a case series and description of the technique. J Pediatr Orthop. 2007;27:504–9.

    Article  PubMed  Google Scholar 

  9. Kulkarni R, Singh N, Kulkarni GS, Kulkarni M, Kulkarni S, Kulkarni V. Limb lengthening over plate. Indian J Orthop. 2012;46:339–45.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Oh CW, Song HR, Kim JW, Choi JW, Min WK, Park BC. Limb lengthening with a submuscular locking plate. J Bone Jt Surg Br. 2009;91:1394–9.

    Article  Google Scholar 

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

    PubMed  Google Scholar 

  12. Gordon JE, Goldfarb CA, Luhmann SJ, Lyons D, Schoenecker PL. Femoral lengthening over a humeral intramedullary nail in preadolescent children. J Bone Jt Surg Am. 2002;84-A:930–7.

    Google Scholar 

  13. Krieg AH, Speth BM, Foster BK. Leg lengthening with a motorized nail in adolescents: an alternative to external fixators? Clin Orthop. 2008;466:189–97.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Park HW, Yang KH, Lee KS, Joo SY, Kwak YH, Kim HW. Tibial lengthening over an intramedullary nail with use of the Ilizarov external fixator for idiopathic short stature. J Bone Jt Surg Am. 2008;90:1970–8.

    Article  Google Scholar 

  15. Herzenberg JE, Scheufele LL, Paley D, Bechtel R, Tepper S. Knee range of motion in isolated femoral lengthening. Clin Orthop. 1994;301:49–54.

    PubMed  Google Scholar 

  16. Kocaoglu M, Eralp L, Kilicoglu O, Burc H, Cakmak M. Complications encountered during lengthening over an intramedullary nail. J Bone Jt Surg Am. 2004;86-A:2406–11.

    Google Scholar 

  17. Simpson AH, Cole AS, Kenwright J. Leg lengthening over an intramedullary nail. J Bone Jt Surg Br. 1999;81:1041–5.

    Article  CAS  Google Scholar 

  18. Park HW, Kim HW, Kwak YH, Roh JY, Lee JJ, Lee KS. Ankle valgus deformity secondary to proximal migration of the fibula in tibial lengthening with use of the Ilizarov external fixator. J Bone Jt Surg Am. 2011;93:294–302.

    Article  Google Scholar 

  19. Sun XT, Easwar TR, Manesh S, Ryu JH, Song SH, Kim SJ, Song HR. Complications and outcome of tibial lengthening using the Ilizarov method with or without a supplementary intramedullary nail: a case-matched comparative study. J Bone Jt Surg Br. 2011;93:782–7.

    Article  Google Scholar 

  20. Kim H, Lee SK, Kim KJ, Ahn JH, Choy WS, Kim YI, Koo JY. Tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator. Int Orthop. 2009;33:835–41.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Catagni MA, Lovisetti L, Guerreschi F, Combi A, Ottaviani G. Cosmetic bilateral leg lengthening: experience of 54 cases. J Bone Jt Surg Br. 2005;87:1402–5.

    Article  CAS  Google Scholar 

  22. Simpson AH, Kenwright J. Fracture after distraction osteogenesis. J Bone Jt Surg Br. 2000;82:659–65.

    Article  CAS  Google Scholar 

  23. Nogueira MP, Paley D, Bhave A, Herbert A, Nocente C, Herzenberg JE. Nerve lesions associated with limb-lengthening. J Bone Jt Surg Am. 2003;85-A:1502–10.

    Google Scholar 

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Acknowledgments

This work was supported by Biomedical Research Institute grant, Kyungpook National University Hospital (2014).

Conflict of interest

None declared.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu, 700-721, Korea

    Chang-Wug Oh, Seung-Gil Baek, Joon-Woo Kim & Jeong-Woo Kim

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  1. Chang-Wug Oh
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  2. Seung-Gil Baek
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Correspondence to Chang-Wug Oh.

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Oh, CW., Baek, SG., Kim, JW. et al. Tibial lengthening with a submuscular plate in adolescents. J Orthop Sci 20, 101–109 (2015). https://doi.org/10.1007/s00776-014-0652-x

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  • DOI: https://doi.org/10.1007/s00776-014-0652-x

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