Skip to main content

Advertisement

SpringerLink
Log in

Callus patterns in femur lengthening using a monolateral external fixator

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

We studied the callus pattern seen in femoral lengthening using monolateral external fixator to determine whether callus types and shapes can predict the final outcome of the procedure.

Material and methods

The radiographs of 41 cases of femoral lengthening (33 unilateral and 8 bilateral) in 33 patients with a mean age 11.9 years (range 4–22 years) were retrospectively analysed by four observers and classified into different shapes and types in concordance with the Ru Li classification. The classification was tested for concurrence and reproducibility by inter-observer studies.

Results

An average of 6.2 cm of lengthening (range 3–10.8) was achieved with an external fixator index of 36.5 (range 20.9–55.3). The fusiform type of callus (fixator index 32.04, maturation index 21.6) showed the best result followed by the cylinder type of callus (fixator index 35.7, maturation index 22.3) and the lateral type of callus (fixator index 33.2, maturation index 21.5). However, the concave type of callus showed poor results with a fixator index of 49.4 and a maturation index of 37.1. The homogeneous path showed the best results (fixator index 30.4, maturation index 18.6). The heterogeneous path also showed good results (fixator index 36.4, maturation index 23.9). The mixed path (fixator index 42.5, maturation index 30.8) and the lucent path (fixator index 45.1, maturation index 32.8) showed poor results.

Conclusion

Analysis of the callus pattern helps the surgeon to predict the outcome of the procedure and guide him in planning any additional interventions if necessary.

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. 1
Fig. 2

Similar content being viewed by others

References

  1. Young JWR, Kostrubiak IS, Resnick CS, Paley D. Sonographic evaluation of bone production at the distraction site in Ilizarov limb-lengthening procedures. Am J Roentgenol 1990; 154(1): 125–128.

    CAS  Google Scholar 

  2. Eyres KS, Bell MJ, Kanis JA. New bone formation during leg lengthening. J Bone Joint Surg Br 1993; 75: 96–106.

    PubMed  CAS  Google Scholar 

  3. Maffulli N, Cheng JCY, Sher A, Ng BK, Ng E. Bone mineralization at the callotasis site after completion of lengthening. Bone 1999; 25(3): 333–338.

    Article  PubMed  CAS  Google Scholar 

  4. Minematsu K, Tsuchiya H, Taki J, Tomita K. Blood flow measurement during distraction osteogenesis. Clin Orthop 1998; 347: 229–235.

    PubMed  Google Scholar 

  5. Li R, Saleh M, Yang L, Coulton L. Radiographic classification of osteogenesis during bone distraction. J Orthop Res 2006; 24(3): 339–347.

    Article  PubMed  Google Scholar 

  6. Vade A, Eissenstat R. Radiological features of bone lengthening procedures. Radiology 1990; 174: 531–537.

    PubMed  CAS  Google Scholar 

  7. Minty I, Maffuci N, Hughes TH, et al. Radiographic features of limb lengthening in children. Acta Radiol 1994; 35: 555–559.

    Article  PubMed  CAS  Google Scholar 

  8. Donnan LT, Saleh M, Rigby AS, et al. Radiographic assessment of bone formation in tibia during distraction histiogenesis. J Pediatr Orthop 2002; 22: 645–651.

    Article  PubMed  Google Scholar 

  9. Orbay JL, Frankel VH, Finkle JE, et al. Canine leg lengthening by Ilizarov technique. Clin Orthop 1992; 278: 265–273.

    PubMed  Google Scholar 

  10. Hamanishi C, Yasuwaki Y, Kikuchi H, et al. Classification of the callus in limb lengthening. Radiographic study of 35 limbs. Acta Orthop Scand 1992; 63(4): 430–433.

    Article  PubMed  CAS  Google Scholar 

  11. Skaggs DL, Leet AI, Money MD, Shaw BA, et al. Secondary fractures associated with external fixation in pediatric femur fractures. J Pediatr Orthop 1999; 19(5): 582–586.

    Article  PubMed  CAS  Google Scholar 

  12. Sakurakichi K, Tsuchiya H, Uehara K, Kabata T, Tomita K. The relationship between distraction length and treatment indices during distraction osteogenesis. J Orthop Sci 2002; 7(3): 298–303.

    Article  PubMed  Google Scholar 

  13. Noonan KJ, Leyes M, Forriol F, Canadell J. Distraction osteogenesis of the lower extremity with use of monolateral external fixation. A study of two hundred and sixty-one femora and tibiae. J Bone Joint Surg Am 1998; 80: 793–806.

    PubMed  CAS  Google Scholar 

  14. Kojimoto H, Yasui N, Goto T, et al. Bone lengthening in rabbits by callus distraction. The role of periosteum and endosteum. J Bone Joint Surg Br 1988; 70: 543–549.

    PubMed  CAS  Google Scholar 

  15. Fischgrund J, Paley D Suter C. Variables affecting time to bone healing during limb lengthening. Clin Orthop 1994; 301: 31–37.

    PubMed  Google Scholar 

  16. Aldegheri R, Renzi-Brivio L, Agostini S. The callotasis method of limb lengthening. Clin Orthop 1989; 241: 137–145.

    PubMed  Google Scholar 

  17. Ilizarov GA. Clinical application of the tension stress effect for limb lengthening. Clin Orthop 1990; 250: 8–26.

    PubMed  Google Scholar 

  18. Paley D, Fleming B, Catagni M, Kristiansen T, Pope M. Mechanical evaluation of external fixators used in limb lengthening. Clin Orthop 1990; 250: 50–57.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Rare Diseases Institute, Korea University Medical Centre, Guro Hospital, Guro Gu, #80 Guro dong, 152703, Seoul, South Korea

    Dileep Isaac, Harry Fernandez, Hae-Ryong Song, Tae-Young Kim & Ashok Kumar Shyam

  2. Department of Orthopaedic Surgery, Dongguk University International Hospital, Ilsan, South Korea

    Seok-Hyun Lee

  3. Department of Statistics, Korea University, Seoul, South Korea

    Jong-Chan Lee

Authors
  1. Dileep Isaac
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Harry Fernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hae-Ryong Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tae-Young Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ashok Kumar Shyam
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Seok-Hyun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jong-Chan Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hae-Ryong Song.

Additional information

Each author certifies that he has no commercial associations (e.g. consultancies, stock ownership, equity interests, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Isaac, D., Fernandez, H., Song, HR. et al. Callus patterns in femur lengthening using a monolateral external fixator. Skeletal Radiol 37, 329–334 (2008). https://doi.org/10.1007/s00256-007-0406-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-007-0406-3

Keywords

Search

Navigation