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Does Humeral Lengthening With a Monolateral Frame Improve Function?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Humeral lengthening by distraction osteogenesis historically has relied on bulky circular external fixators. Advances in fixator technology have allowed for the use of monolateral frames. However, it is unclear whether and to what degree function is improved after humeral lengthening.

Questions/Purposes

We asked: (1) Does humeral lengthening performed with monolateral fixators improve function? (2) Does monolateral external fixation produce comparable restoration of length and complication rate when compared with historical results, using circular external fixation for humeral lengthening?

Methods

We retrospectively reviewed 11 patients who underwent 15 humeral lengthenings with monolateral external fixation. Clinical and radiographic data were collected, including preoperative and postoperative DASH scores as a metric of functional status. The minimum postremoval followup was 14 months (average, 38 months; range, 14–84 months).

Results

Fifteen humeri were lengthened an average of 7 cm (range, 4–9 cm), for a mean lengthening of 41% (range, 23%–52%). Lengthening required an average of 7 months (range, 5–8 months) of fixation, resulting in an external fixation index of 32 days/cm (range, 23–45 days/cm). The major complication rate (three of 15) and postoperative ROM (unchanged at the elbow and improved in seven of 15 shoulders) were comparable to those in previous studies using circular frames. In nine of 15 humeri for which DASH scores were available, the mean preoperative score improved from 14 to 9 after 1 year. The monolateral frame allowed the patient to keep their arm by the side without abducting the shoulder and without impinging the device into the chest wall.

Conclusions

Humeral lengthening with monolateral external fixation is well tolerated by patients and an effective means of improving patient function with a complication rate similar to that for traditional circular frames.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We acknowledge the administrative assistance of Eugene Borst for making this project possible.

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Authors and Affiliations

  1. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Abhijit Y. Pawar MD, Thomas H. McCoy Jr MD, Austin T. Fragomen MD & S. Robert Rozbruch MD

Authors
  1. Abhijit Y. Pawar MD
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  2. Thomas H. McCoy Jr MD
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  3. Austin T. Fragomen MD
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  4. S. Robert Rozbruch MD
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Corresponding author

Correspondence to S. Robert Rozbruch MD.

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Each author certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

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

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Pawar, A.Y., McCoy, T.H., Fragomen, A.T. et al. Does Humeral Lengthening With a Monolateral Frame Improve Function?. Clin Orthop Relat Res 471, 277–283 (2013). https://doi.org/10.1007/s11999-012-2543-9

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  • DOI: https://doi.org/10.1007/s11999-012-2543-9

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