Skip to main content
SpringerLink
Log in

Axial deformity correction in children via distraction osteogenesis

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

We performed a retrospective analysis of the results of 62 tibial and 54 femoral lengthenings in 88 consecutive patients. The patients mean age was 13.5 years and mean follow-up was four years. There was a significant difference between metaphyseal (27±1.2 days/cm) and diaphyseal (39.4±1.7 days/cm), tibial (34±1.7 days/cm) and femoral (31±1.4 days/cm) lengthening (P<0.05), but no significant difference among the lengthening indexes when treating one-, two-, or three-dimensional deformities, congenital (34±2.4 days/cm) and acquired (32±1.0 days/cm) limb length discrepancy (LLD) (P>0.05). The lengthening index was 33±1.1 days/cm, distraction regenerate length 6±0.4 cm, and lengthening percentage 21±2.1. The scatter plots of new regenerate length against time and the scatter plots of neurological complication, residual deformities, broken pins, joint contractures, and hypertension rate against lengthening percentage showed a positive linear relationship (r=0.8). We found the correlations between quantitative and qualitative parameters that should help to predict the treatment outcomes. Lengthening index depends on the amount of length gained. Higher length of new bone regenerate leads to a decrease in lengthening index. Expected gain in bone length can aid in estimating the duration of treatment. The lengthening percentage correlates very well with the complication rate and can be used to predict the complication rate.

Résumé

Nous avons pratiqué une analyse rétrospective du résultat de 62 allongementsdu tibia et de 54 allongements du fémur lors d’une série de 88 patients traitésconsécutivement. L’âge moyen était de 13 ans et demi, le suivi moyen de 4ans.Il y avait une différence significative entre les allongementsmétaphysaires (27±1.2 jours/cm), diaphysaires (39±1,4 jours/cm), tibiaux(34±1,7 jours/cm) et fémoraux (31±1,4 jours/cm) (P<0.05), mais pasde différence significative de l’index de consolidation au cours dutraitement des déformations congénitales de type 1, 2 ou 3 (34±2,4 jours/cm) ou acquise (32±1 jour/cm). L’inégalité de longueur était d’originecongénitale ou acquise (34 ou 32) (P>0.05). La moyenne d’allongement étaitde 33±1,1 jours/cm, l’allongement moyen était de 6±0,4 cm et lepourcentage d'allongement de 21±2.1%. Ce travail a montré une relationsignificative entre le pourcentage d'allongement et le taux de complicationsneurologiques, de déformation résiduelle, de rupture de broches, de raideursarticulaires, d’hypertension et d'anomalies du régénérat osseux (r=0.8).L’index de consolidation dépend du pourcentage d’allongement, avec unebonne régénération osseuse lorsque celui-ci est réduit. Le gain estiméd’allongement permet d’estimer la durée du traitement, le pourcentaged’allongement est tout à fait bien corrélé avec le taux de complications etpermet de prédire celles-ci aux patients.

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
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Antoci V, Betisor V (1996) The stable functional osteosynthesis with the external fixator in the treatment of fractures, dislocations, and their consequences. J Orthop Traumatol Rom 4:177–185

    Google Scholar 

  2. Antoci V Jr, Roberts C, Voor M, Antoci V (2004) Ankle-spanning external fixation of distal tibia periarticular fractures. J Orthop Trauma 9(Suppl):51

    Google Scholar 

  3. Antoci V, Roberts CS, Antoci V Jr, Voor MJ (2005) The effect of transfixion wire number and spacing between two levels of fixation on the stiffness of proximal tibial external fixation. J Orthop Trauma 19(3):180–186

    Article  PubMed  Google Scholar 

  4. Antoci V (1997) The osteosynthesis with external extrafocal apparatus in the treatment of fractures, dislocations, and their consequences. Chisinau, Moldova

    Google Scholar 

  5. Antoci V, Voor MJ, Antoci V Jr, Roberts CS (2005) Biomechanics of olive wire positioning and tensioning characteristics. J Pediatr Orthop 25(6):798–803

    Article  PubMed  Google Scholar 

  6. Antoci V, Voor MJ, Antoci V Jr, Roberts CS (2004) The effect of transfixion wires positioning within the bone on the stiffness of proximal tibia external fixation: a biomechanical study. J Orthop Trauma 9(Suppl):51

    Google Scholar 

  7. Antoci V, Voor MJ, Seligson D, Roberts CS (2004) Biomechanics of external fixation of distal tibial extra-articular fractures: is spanning the ankle with a foot plate desirable? J Orthop Trauma 18(10):665–673

    Article  PubMed  Google Scholar 

  8. Aronson J, Shen X (1994) Experimental healing of distraction osteogenesis comparing metaphyseal with diaphyseal sites. Clin Orthop 301:25–30

    PubMed  Google Scholar 

  9. Dahl MT, Gulli B, Berg T (1990) Complications of limb lengthening. A learning curve. Clin Orthop 301:10–18

    Google Scholar 

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

    PubMed  Google Scholar 

  11. Goodship AE, Kenwright J (1985) The influence of induced micromovement upon the healing of experimental tibial fractures. J Bone Joint Surg Br 67:650–655

    PubMed  CAS  Google Scholar 

  12. Guichet JM, Braillon P, Bodenreider S, Lascombes P (1998) Periosteum and bone marrow in bone lengthening: a DEXA quantitative evaluation in rabbits. Acta Orthop Scand 69:527–531

    Article  PubMed  CAS  Google Scholar 

  13. Ilizarov GA (1989) The tension-stress effect on the genesis and growth of tissues: part I. The influence of stability of fixation and soft tissue preservation. Clin Orthop 238:249–281

    PubMed  Google Scholar 

  14. Ilizarov GA (1989) The tension-stress effect on the genesis and growth of tissues: part II. The influence of the rate and frequency of distraction. Clin Orthop 239:263–285

    PubMed  Google Scholar 

  15. Karger C, Guille JT, Bowen JR (1993) Lengthening of congenital lower limb deficiencies. Clin Orthop 293:83–88

    Google Scholar 

  16. Maffulli N, Fixsen JA (1996) Distraction osteogenesis in congenital limb length discrepancy: a review. J R Coll Surg Edinb 41:258–264

    Google Scholar 

  17. Merloz P (1992) Lower limb lengthening using the Ilizarov method. Sem Orthop 7:167–178

    Google Scholar 

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

    PubMed  CAS  Google Scholar 

  19. Paley D (1993) The correction of complex foot deformities using Ilizarov’s distraction osteotomies. Clin Orthop 293:97–111

    PubMed  Google Scholar 

  20. Putti V (1934) Operative lengthening of the femur. Surg Gynecol Obstet 58:318–321

    Google Scholar 

  21. Roberts CS, Antoci V, Antoci V Jr, Voor MJ (2004) The accuracy of fine tensioners. A comparison of five tensioners used in hybrid and ring external fixation. J Orthop Trauma 18(3):158–162

    Article  PubMed  Google Scholar 

  22. Roberts CS, Antoci V, Antoci V Jr, Voor MJ (2005) The effect of transfixion wire crossing angle on the stiffness of fine wire external fixation: a biomechanical study. Injury 36(9):1107–1112

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  24. Starr KA, Fillman R, Raney EM (2004) Reliability of radiographic assessment of distraction osteogenesis site. J Pediatr Orthop 24:26–29

    PubMed  Google Scholar 

  25. Voor MJ, Antoci V, Antoci Jr V, Robert CS (2005) The effect of wire plane tilt and olive wires on proximal tibia fragment stability and fracture site motion. J Biomech 38(3):537–541

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Shriners Hospitals for Children, Honolulu, HI, USA

    Valentin Antoci, Craig M. Ono, Valentin Antoci Jr & Ellen M. Raney

  2. 789 West Ferry Street, #E5, Buffalo, NY, 14222, USA

    Valentin Antoci

Authors
  1. Valentin Antoci
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Craig M. Ono
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Valentin Antoci Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ellen M. Raney
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Valentin Antoci.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Antoci, V., Ono, C.M., Antoci, V. et al. Axial deformity correction in children via distraction osteogenesis. International Orthopaedics (SICO 30, 278–283 (2006). https://doi.org/10.1007/s00264-005-0071-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-005-0071-x

Keywords

Search

Navigation