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Does Lengthening and Then Plating (LAP) Shorten Duration of External Fixation?

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

Abstract

Background

Classic bone lengthening requires patients wear external fixation for the distraction and consolidation phases and there is fracture risk after frame removal. Our technique of lengthening with the Taylor Spatial FrameTM and then insertion of a locked plate allows earlier removal of the external fixator during consolidation. Plate insertion is accomplished through a clean pin-free zone avoiding contamination and before frame removal maintaining bone position.

Questions/purposes

We asked (1) whether lengthening and then plating (LAP) decrease the time for external fixation (2) how alignment and complications compare with those of the classic method.

Methods

We performed a retrospective case-matched comparison between LAP and the classic technique with 27 extremities in each group. We compared time wearing the frame, bone healing index, external fixation index, joint ROM, alignment, and complications.

Results

The time wearing the frame and external fixation index were lower in the LAP group (4.5 versus 6.2 months and 1.5 versus 2 months/cm). Deviation from normal alignment was observed in seven and six patients in the LAP and classic group, respectively. Varus malalignment in two patients in the LAP group was associated with plate breakage. The incidence of pin-tract infection was greater in the classic group (12 versus two). No deep infections occurred in the LAP group.

Conclusions

The LAP technique shortened the time patients wore the external fixator but was associated with a high incidence of varus deformity. Stronger plates may help prevent deformity and allow earlier removal of the frame.

Level of Evidence

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

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Acknowledgments

We thank Margaret Peterson PhD for assistance with the statistical analysis.

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Authors and Affiliations

  1. Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, 10021, USA

    Ryhor Harbacheuski MD, Austin T. Fragomen MD & S. Robert Rozbruch MD

Authors
  1. Ryhor Harbacheuski MD
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  2. Austin T. Fragomen MD
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  3. 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 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.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

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.

Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted inconformity with ethical principles of research, and that informed consent for participating in the study was obtained.

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Harbacheuski, R., Fragomen, A.T. & Rozbruch, S.R. Does Lengthening and Then Plating (LAP) Shorten Duration of External Fixation?. Clin Orthop Relat Res 470, 1771–1781 (2012). https://doi.org/10.1007/s11999-011-2178-2

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  • DOI: https://doi.org/10.1007/s11999-011-2178-2

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