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Limb lengthening

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https://www.readbyqxmd.com/read/27914027/the-role-of-guided-growth-as-it-relates-to-limb-lengthening
#1
REVIEW
Peter M Stevens
For decades, the classic indication for limb lengthening has been reserved for anisomelia that was expected to reach or exceed 5 cm at maturity. Epiphysiodesis was reserved for discrepancies in the 2-5 cm range. With the increasing sophistication of fixators, including rail, hexapod, and hybrid, complex deformities may be corrected simultaneously while moderate to extreme lengthening is achieved. More recently, iterations of telescoping intramedullary rods have further strengthened our armamentarium. Meanwhile, permanent epiphysiodesis techniques, both open and percutaneous, have yielded to more versatile and reversible tethering of one (angle) or both (length) sides of a physis...
December 2, 2016: Journal of Children's Orthopaedics
https://www.readbyqxmd.com/read/27909861/surgical-reconstruction-for-fibular-hemimelia
#2
REVIEW
Dror Paley
Fibular hemimelia presents with foot deformity and leg length discrepancy. Previous classifications have focused on the degree of fibular deficiency rather than the type of foot deformity. Published methods of surgical reconstruction have often failed due to residual or recurrent foot deformity. The purpose of this report is to introduce new classification and reconstruction methods. The Paley SHORDT procedure is used to stabilize the ankle when there is a hypoplastic distal fibula with a dynamic valgus deformity...
December 1, 2016: Journal of Children's Orthopaedics
https://www.readbyqxmd.com/read/27909134/what-is-the-morbidity-of-a-non-invasive-growing-prosthesis
#3
M M Gilg, C L Gaston, M C Parry, L Jeys, A Abudu, R M Tillman, S R Carter, R J Grimer
AIMS: Extendible endoprostheses have been available for more than 30 years and have become more sophisticated with time. The latest generation is 'non-invasive' and can be lengthened with an external magnetic force. Early results have shown a worryingly high rate of complications such as infection. This study investigates the incidence of complications and the need for further surgery in a cohort of patients with a non-invasive growing endoprosthesis. PATIENTS AND METHODS: Between 2003 and June 2014, 50 children (51 prostheses) had a non-invasive growing prosthesis implanted for a primary bone sarcoma...
December 2016: Bone & Joint Journal
https://www.readbyqxmd.com/read/27904734/recurrence-of-a-unicameral-bone-cyst-in-the-femoral-diaphysis
#4
Hyun Se Kim, Kyung Sup Lim, Sung Wook Seo, Seung Pil Jang, Jong Sup Shim
Diaphyseal unicameral bone cysts of the long bone are generally known to originate near the growth plate and migrate from the metaphysis to the diaphysis during skeletal growth. In the case of unicameral bone cysts of diaphyseal origin, recurrence at the same location is extremely rare. We report a case of recurrence of a unicameral bone cyst in the diaphysis of the femur that developed 8 years after treatment with curettage and bone grafting. We performed bone grafting and lengthening of the affected femur with an application of the Ilizarov apparatus over an intramedullary nail to treat the cystic lesion and limb length discrepancy simultaneously...
December 2016: Clinics in Orthopedic Surgery
https://www.readbyqxmd.com/read/27878660/residual-bone-growth-after-lengthening-procedures
#5
Pierre Journeau, Pierre Lascombes, Dominique Barbier, Dmitry Popkov
The prognosis of limb length discrepancy is a major subject in paediatric orthopaedic surgery. The strategy depends on the prognosis and must be adapted to each patient. The residual growth of the lengthened segment often remains unknown, but is dependent on age, the percentage of lengthening and other factors. Using a large cohort of 150 children who had undergone bone lengthening procedures, we describe five patterns of post-intervention growth and identify factors that are favourable for normal residual growth...
November 23, 2016: Journal of Children's Orthopaedics
https://www.readbyqxmd.com/read/27866145/cosmetic-limb-lengthening-in-a-patient-of-normal-stature-ethical-considerations
#6
Karthik Vishwanathan, Somashekhar Nimbalkar
Recently, a 23-year-old male patient underwent cosmetic limb lengthening, despite the fact that his height was that of the average Indian male (5 feet 7 inches). The patient's parents and the media criticised the orthopaedic surgeon who had performed the surgery for undertaking an unethical operation. This paper discusses the relevant clinical evidence, ethical aspects and ethical theories surrounding the case. We conclude that the surgeon's decision to perform the surgery seems to be fair and appropriate from the ethical and clinical perspectives...
November 11, 2016: Indian Journal of Medical Ethics
https://www.readbyqxmd.com/read/27865314/surgical-treatment-options-for-the-diabetic-charcot-midfoot-deformity
#7
REVIEW
Yousef Alrashidi, Thomas Hügle, Martin Wiewiorski, Mario Herrera-Perez, Victor Valderrabano
Management of diabetic Charcot midfoot deformity is one of the most demanding aspects of foot and ankle surgery. Its treatment should aim at reducing the rate of complications, including foot and ankle amputations or limb loss. Attempting reconstruction at Eichenholtz stages I and II carries the risk of infection and loss of fixation. It is advisable to limit surgical reconstruction to Eichenholtz stage III in the absence of any evidence of infection or vascular insufficiency. Achilles lengthening or gastrocnemius-soleus release is an essential initial step in surgery...
January 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/27858886/fixator-assisted-tibial-lengthening-over-a-plate-in-a-patient-with-sequelae-of-poliomyelitis
#8
Haci Bayram Tosun, Sancar Serbest, Abuzer Uludag, Seyitali Gumustas, Suat Celik
There are many techniques for limb lengthening. Lengthening over a plate is an alternative choice of fixation in children or when nailing is difficult. We present a new technique for tibial lengthening with using a monolateral external fixator over a lengthening plate.Lengthening over an intramedullary nail is a commonly used method in patients with short stature or limb-length discrepancy. However, in patients with a narrow and excessively sclerotic intramedullary cavity in the pediatric age group where the skeletal system has not yet fully developed, difficulties have been observed in lengthening methods with nailing...
November 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27848194/intramedullary-lengthening-nails-can-we-also-correct-deformities
#9
REVIEW
U Lenze, A H Krieg
Unlike external fixators, the use of solid intramedullary lengthening nails is restricted to defined anatomical preconditions, such as an adequate bone length. Furthermore, all deformity corrections except the lengthening procedure have to be implemented intraoperatively and cannot be adjusted postoperatively. Conversely, even complex deformity corrections can be performed using intramedullary devices after a thorough preoperative planning. For preparation of the intramedullary cavity as well as positioning of the lengthening nail according to the preoperative planning, reaming the medullary canal with rigid reamers which don't follow the line of least resistance is inevitable...
November 15, 2016: Journal of Children's Orthopaedics
https://www.readbyqxmd.com/read/27848193/from-prevention-of-pin-tract-infection-to-treatment-of-osteomyelitis-during-paediatric-external-fixation
#10
REVIEW
Dimitri Ceroni, Catherine Grumetz, Odile Desvachez, Sophie Pusateri, Pierre Dunand, Eleftheria Samara
Pin-tract infection (PTI) is the most commonly expected problem, or even an almost inevitable complication, when using external fixation. Left unteated, PTI will progress unavoidably, lead to mechanical pin loosening, and ultimately cause instability of the external fixator pin-bone construct. Thus, PTI remains a clinical challenge, specifically in cases of limb lengthening or deformity correction. Standardised pin site protocols which encompass an understanding of external fixator biomechanics and meticulous surgical technique during pin and wire insertion, postoperative pin site care and pin removal could limit the incidence of major infections and treatment failures...
November 15, 2016: Journal of Children's Orthopaedics
https://www.readbyqxmd.com/read/27837313/cosmetic-lengthening-what-are-the-limits
#11
F Guerreschi, H Tsibidakis
OBJECTIVES: In the last decades, limb lengthening has not been limited to the treatment of patients with dwarfism and deformities resulting from congenital anomalies, trauma, tumor and infections, but, has also been used for aesthetic reasons. Cosmetic lengthening by the Ilizarov method with circular external fixation has been applied to individuals with constitutional short stature who wish to be taller. MATERIALS AND METHODS: From January 1985 to December 2010, the medical records of 63 patients with constitutional short stature (36 M, 27F; 126 legs) who underwent cosmetic bilateral leg lengthening using a hybrid advanced fixator according to the Ilizarov method, were reviewed, retrospectively...
November 11, 2016: Journal of Children's Orthopaedics
https://www.readbyqxmd.com/read/27826909/updates-on-preoperative-planning-limb-deformity-analysis-and-surgical-correction-for-the-growing-children-epos-meeting-marseille-2015-proceedings
#12
Eitan Segev
Successful deformity correction depends on establishing the aetiology of the deformity. Clinical examination, additional laboratory tests and consultation with other experts may be needed to complete the workup. Imaging studies should include full-length standing X-rays in all relevant planes, and additional imaging modalities like computed tomography (CT) and magnetic resonance imaging (MRI) may add information on bone morphology and growth plates' anatomy. Based on the data, analysis of the deformity and length differences is performed, followed by prediction of deformities at skeletal maturity...
November 8, 2016: Journal of Children's Orthopaedics
https://www.readbyqxmd.com/read/27826907/the-unstable-knee-in-congenital-limb-deficiency
#13
REVIEW
Gabriel T Mindler, Christof Radler, Rudolf Ganger
PURPOSE: Instability of the knee is a common finding in patients with congenital limb deficiency. The instability can be attributed to soft tissue abnormalities, frontal, sagittal or rotational deformity of the lower limb and bony dysplasia of the patella or of the femoral condyles. In most of the cases, these pathomorphologic changes stay asymptomatic in daily activity. However, instability can appear during deformity correction and bone-lengthening procedures, leading to flexion contracture or subluxation of the knee...
November 8, 2016: Journal of Children's Orthopaedics
https://www.readbyqxmd.com/read/27826906/amputation-and-rotationplasty-in-children-with-limb-deficiencies-current-concepts
#14
REVIEW
Ralph Sakkers, Iris van Wijk
PURPOSE: Amputations and fitting surgery have a long history in children with limb deficiencies. With the current developments in limb reconstruction and new techniques in prosthetics, the indications for amputation and fitting surgery might have shifted, but still have a very important role in creating high functional performance, optimal participation and quality of life. The purpose of this current concepts article is to give an overview of the indications, dilemmas and technical considerations in the decision-making for amputation and fitting surgery...
November 8, 2016: Journal of Children's Orthopaedics
https://www.readbyqxmd.com/read/27826905/current-approaches-to-flexible-intramedullary-nailing-for-bone-lengthening-in-children
#15
REVIEW
Dmitry Popkov, Pierre Lascombes, Pierre Journeau, Arnold Popkov
Limb-length discrepancies and extremity deformities are among the most common non-traumatic orthopaedic conditions for which children are hospitalised. There is a need to develop new treatment options for lower-limb length discrepancy in order to ameliorate treatment outcomes, avoid or reduce rates of complication and provide early rehabilitation. The authors report on the basic principles, experimental and clinical data, advantages, problems and complications of a combined technique associating the Ilizarov method and flexible intramedullary nailing (FIN) in limb lengthening and deformity correction in children...
November 8, 2016: Journal of Children's Orthopaedics
https://www.readbyqxmd.com/read/27826904/forearm-lengthening-management-of-elbow-and-wrist
#16
REVIEW
Franck Launay, Sébastien Pesenti
The risk and consequences of an elbow or a wrist contracture are lower during a forearm lengthening than during a lower limb lengthening. This kind of complication can mostly be avoided by an active and intensive regimen of physiotherapy. However, there are some challenges to deal with in treating the disorder multiple exostoses and the radial club hand, including the lack of consensus on the best treatment for multiple exostoses. However, it is important to realize that the evolution of multiple exostoses can lead to a radial head dislocation which will damage the pronation and the supination range of motion...
November 8, 2016: Journal of Children's Orthopaedics
https://www.readbyqxmd.com/read/27808030/-a-free-musculocutaneous-flap-and-an-intramedullary-nail-made-the-use-of-a-prosthesis-possible-in-a-high-traumatic-femoral-amputation
#17
Jakob Felbo Paulsen, Finn Edgar Warburg, Knud Stenild Christensen, Rikke Holmgaard
The length of the stump and the quality of the soft tissue coverage are important for prosthesis fitting and mobility. In a high traumatic femoral amputation soft tissue reconstruction with a free musculocutaneous latissimus dorsi (LD) flap was performed to preserve bone length and provide proper tissue coverage. The extremely short stump was later on lengthened using a motorized intramedullary nail (Fitbone), and the achieved bone-lengthening was 14 cm. With the combined modalities of an LD-flap and Fitbone lengthening of the stump, the patient now has a useful limb function...
October 24, 2016: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/27800202/leg-lengthening-as-a-means-of-improving-ambulation-following-an-internal-hemipelvectomy
#18
Wakyo Sato, Hiroshi Okazaki, Takahiro Goto
Reconstructive surgery following an internal hemipelvectomy for a malignant pelvic tumor is difficult due to the structural complexity of the pelvis and the massive extension of the tumor. While high complication rates have been encountered in various types of reconstructive surgery, resection without reconstruction reportedly involved fewer complications. However, this method often results in limb shortening with resultant instability during walking. We reported herein leg lengthening performed to correct lower limb shortening after an internal hemipelvectomy, which improved ambulatory stability and overall QOL...
2016: Case Reports in Orthopedics
https://www.readbyqxmd.com/read/27752151/-new-treatment-for-peripheral-nerve-defects-nerve-elongation
#19
Y H Kou, B G Jiang
Peripheral nerve defects are still a major challenge in clinical practice, and the most commonly used method of treatment for peripheral nerve defects is nerve transplantation, which has certain limitations and shortcomings, so new repair methods and techniques are needed. The peripheral nerve is elongated in limb lengthening surgery without injury, from which we got inspirations and proposed a new method to repair peripheral nerve defects: peripheral nerve elongation. The peripheral nerve could beelongated by a certain percent, but the physiological change and the maximum elongation range were still unknown...
October 18, 2016: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
https://www.readbyqxmd.com/read/27748675/physeal-bar-equivalent
#20
Hamlet A Peterson, William J Shaughnessy, Anthony A Stans
Premature partial physeal arrest without the formation of an osseous bar - physeal bar equivalent (PBE) - is uncommon. Four children with a PBE had an infection near the distal femoral physis before the age of 11 months. Some growth was achieved after resection of the PBE in each case. Of two cases diagnosed and treated early, one required only contralateral physeal arrests to achieve limb-length equality at maturity. The other, currently 8 years and 4 months old, has a 1.1-cm limb-length discrepancy 6 years after PBE resection and will require observation until maturity...
September 29, 2016: Journal of Pediatric Orthopedics. Part B
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