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Femoral lengthening

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By David Bennett Pediatric Orthopaedic Surgeon in the United States
Albert Martin Pendleton, Peter Morris Stevens, Man Hung
The purpose of this study was to evaluate the effectiveness and complication rate of guided growth for the treatment of patients with a moderate leg-length discrepancy. The authors retrospectively reviewed all patients treated with guided growth for a moderate leg-length discrepancy at their institution between October 2004 and December 2010. Thirty-four patients met the inclusion criteria from an initial cohort of 105 patients. All patients were followed until screw removal or maturity occurred. Nine patients had a developmental leg-length discrepancy, and 25 had a congenital leg-length discrepancy...
May 2013: Orthopedics
Paweł Koczewski, Milud Shadi
BACKGROUND: The dynamics and effectiveness of new bone formation in the Ilizarov method varies according to different factors. Some of them may result in substantial prolongation of treatment time. The lengthening index (LI), defined as the number of months in a frame necessary to achieve 1 cm lengthening, is the main indicator of bone healing potential. The purpose of the study was to assess the effectiveness of distraction osteogenesis by analysing the lengthening index (LI) in relation to: age, limb length discrepancy, aetiology, bone segment involved, axial correction and lengthening achieved...
November 2013: Ortopedia, Traumatologia, Rehabilitacja
Seung-Ju Kim, Wendy Pierce, Sanjeev Sabharwal
BACKGROUND AND PURPOSE: Distraction osteogenesis (DO) has been used to gain height in short statured individuals. However, there have been no studies comparing the clinical outcome of limb lengthening based on the etiology of the short stature. We assessed whether different underlying diagnoses are associated with varied clinical outcomes in these patients. METHODS: We performed a systematic review of the literature pertaining to lower limb lengthening using external fixation for short stature...
April 2014: Acta Orthopaedica
Konstantin I Novikov, Koushik N Subramanyam, Serghei O Muradisinov, Olga S Novikova, Elina S Kolesnikova
BACKGROUND: Compelled by the psychosocial implications of short stature, patients with short stature are increasingly undergoing distraction osteogenesis for cosmetic limb lengthening. To the degree that this is true, evaluation of the risks and benefits of this treatment are very important, but to date, there are few studies reporting on using distraction osteogenesis for this indication. QUESTIONS/PURPOSES: We reviewed a group of patients undergoing cosmetic lower-extremity lengthening in terms of (1) soft tissue challenges, (2) bone-related complications, and (3) functional and subjective clinical outcomes...
November 2014: Clinical Orthopaedics and related Research
Yoshihisa Nunotani, Muneaki Abe, Hisaya Shirai, Hisashi Otsuka
BACKGROUND: Osteoinductive ability of bone morphogenetic protein-2 (BMP-2) has been studied in recent reports. In this study, we evaluated the efficacy of BMP-2 during distraction osteogenesis. METHODS: A group of 24 Japanese white rabbits were divided into four groups randomly and underwent lengthening of the right femur. Distraction was performed for 2 weeks (1.0 mm/day). Group A began distraction following a 7-day waiting period after surgery. For all other groups (B-D), distraction was started immediately after surgery...
September 2005: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
N Yasui, M Sato, T Ochi, T Kimura, H Kawahata, Y Kitamura, S Nomura
We developed a rat model of limb lengthening to study the basic mechanism of distraction osteogenesis, using a small monolateral external fixator. In 11-week-old male rats we performed a subperiosteal osteotomy in the midshaft of the femur with distraction at 0.25 mm every 12 hours from seven days after operation. Radiological and histological examinations showed a growth zone of constant thickness in the middle of the lengthened segment, with formation of new bone at its proximal and distal ends. Osteogenic cells were arranged longitudinally along the tension vector showing the origin and the fate of individual cells in a single section...
September 1997: Journal of Bone and Joint Surgery. British Volume
Valentin Antoci, Craig M Ono, Valentin Antoci, Ellen M Raney
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...
August 2006: International Orthopaedics
Neil Saran, Reggie C Hamdy
UNLABELLED: Premature removal of the fixator after a lengthening procedure can result in gradual bending or acute fracture of the regenerate. We reviewed the records of 26 patients who underwent 28 limb lengthenings between 1997 and 2005 to assess the post lengthening regenerate fracture rate and bone healing index when using dual energy xray absorptiometry (DEXA) to aid in deciding on when to remove the fixator. Sixteen male and 10 female patients with an average age at lengthening of 12...
December 2008: Clinical Orthopaedics and related Research
M Sato, T Ochi, T Nakase, S Hirota, Y Kitamura, S Nomura, N Yasui
Bone lengthening with osteotomy and gradual distraction was achieved in 57 rats, and the effect of mechanical tension-stress on gene expression of bone morphogenetic proteins (BMPs) was investigated by in situ hybridization and Northern blot analysis using probes of BMP-2, BMP-4, BMP-6, BMP-7, and growth/differentiation factor (GDF)-5. There was a lag phase for 7 days after femoral osteotomy until gradual distraction was carried out for 21 days at a rate of 0. 25 mm/12 h using a small external fixator. The signals of the above BMPs mRNA were not detected in the intact rat bone but they were induced after osteotomy except those for BMP-7...
July 1999: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
Jonathan R Schiller, Douglas C Moore, Michael G Ehrlich
BACKGROUND: The rate of lengthening has a profound impact on bone regeneration during distraction osteogenesis. Rapid distraction can delay or completely inhibit union, whereas distracting too slowly may lead to premature consolidation. However, the mechanisms responsible for retardation of healing due to rapid distraction have not been elucidated. This study explored whether rapid distraction alters the expression of certain angiogenic growth factors, in particular, fibroblast growth factor 2 (FGF-2), vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF-AA), and subsequent new vessel formation as evidenced by platelet endothelial cellular adhesion marker expression (CD31), an indicator of vascular budding...
December 2007: Journal of Pediatric Orthopedics
Antti Ritvanen, Juha Haaja, Harri Hallila, Jari Peltonen, Dietrich Schlenzka
Severe anisomelia and stunting of the lower limbs are treated with distraction osteogenesis, which involves osteotomy of the femur and tibia and distraction of bone ends by using a device designed for this purpose. Sufficiently slow distraction induces bone growth into the generated gap, whereby the limb can be lengthened by up to 15 cm at a time. Attempts have been made to diminish the disadvantages associated with commonly utilized external distraction devices by using completely implantable lengthening devices, which have been shown to result in an at least equal treatment outcome...
2010: Duodecim; Lääketieteellinen Aikakauskirja
M Sato, N Yasui, T Nakase, H Kawahata, M Sugimoto, S Hirota, Y Kitamura, S Nomura, T Ochi
Distraction osteogenesis is a recently advanced principle of bone lengthening in which a bone separated by osteotomy is subjected to slow progressive distraction using an external fixation device. Appropriate mechanical tension-stress is believed not to break the callus but rather to stimulate osteogenesis. To study the molecular features of this process, the expression and localization of the mRNAs encoding osteopontin (OPN), osteocalcin (OC), matrix Gla protein (MGP), osteonectin (ON), and collagen type I and I during distraction osteogenesis were examined by in situ hybridization and Northern blot analysis...
August 1998: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
Chanchit Sangkaew
INTRODUCTION: The author has developed a new simple technique of distraction osteogenesis using conventional monolateral external fixator for femoral lengthening. The primary purpose of the present study was to evaluate the results of treatment with this new technique of femoral lengthening and also to evaluate the effect of preoperative and intraoperative variables on the outcome of distraction osteogenesis in general. MATERIALS AND METHODS: Fifty-one femora in 50 patients were lengthened...
September 2008: Archives of Orthopaedic and Trauma Surgery
Dong Yeon Lee, Tae-Joon Cho, Hye Ran Lee, Moon Seok Park, Won Joon Yoo, Chin Youb Chung, In Ho Choi
INTRODUCTION: Distraction osteogenesis (DO) is a unique postnatal bone formation process, which is characterized by a profuse increase in vascularization. Recently endothelial progenitor cells (EPCs) have been reported to circulate in substantial numbers under physiologic conditions and to contribute to bone regeneration. The authors investigated EPC mobilization in patients undergoing limb lengthening. MATERIALS AND METHODS: Thirteen of 24 consecutive patients who underwent limb-lengthening procedures on weight-bearing long bones (femur and tibia) were included in this study...
March 2010: Bone
Jae-Hyuk Yang, Hak-Jun Kim, Sung-Eun Kim, Young-Pil Yun, Ji-Hoon Bae, Seung-Ju Kim, Kyung-Hee Choi, Hae-Ryong Song
BACKGROUND AIMS: Distraction osteogenesis (DO) is an increasingly popular technique used to stimulate new bone formation to treat orthopedic disorders resulting from bone defects and deficits. Because of various possible complications that can occur during the long consolidation period, the development of procedures to accelerate regenerated ossification is clearly desirable. The purpose of this study was to evaluate the effect of single insertions of bone morphogenic protein-2 (BMP-2), delivered by tri-calcium phosphate (TCP)/hydroxyapatite (HA), administered at osteotomy sites, on the rate of new bone formation during DO in a rat model...
March 2012: Cytotherapy
J Fischgrund, D Paley, C Suter
Radiographs and charts of 114 consecutive patients who underwent 140 lower-extremity bone-segment lengthening procedures using the Ilizarov external fixator were reviewed. Patient age, bone segment (femur, tibia), corticotomy level (metaphyseal, diaphyseal, double level), and distraction gap (DG) were recorded. Distraction-consolidation time (DCT) was defined as the interval in months from the date of the corticotomy until the DG was healed according to radiographic and manual testing criteria. Distraction-consolidation time had a direct linear relationship with the magnitude of the DG...
April 1994: Clinical Orthopaedics and related Research
A H Simpson, J Kenwright
We reviewed 173 patients undergoing distraction osteogenesis to determine the incidence, location and timing of fractures occurring as a complication of the procedure. There were 17 fractures in 180 lengthened segments giving an overall rate of fracture of 9.4%. Unexpectedly, the pattern and location of the fractures were very variable; six were within the regenerate itself, six at the junction between the regenerate and the original bone and five at distant sites in the limb. Of those occurring in the regenerate, five were noted to be associated with compression and partial collapse of the regenerate...
July 2000: Journal of Bone and Joint Surgery. British Volume
L Kaiser-Šrámková, J Poul, J Straka, K Urbášek, T Pavlík, M Cvanová
PURPOSE OF THE STUDY: To evaluate the results of femoral lengthening in the patients treated from 2000 to 2009 in whom complete radiographic data were available and the lengthening procedure involved mainly the use of a Mephisto fixator. MATERIAL AND METHODS: A total of 28 femoral lengthening procedures were carried out in 26 patients,16 girls and 10 boys. The external fixator Mephisto was used in 24 cases; fixators Prospon and Orthofix in one and three cases, respectively...
2011: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
Ashok Acharya, Jean-Marc Guichet
Gradual femoral lengthening causes loss of knee motion due to soft tissue tightness. Lengthening with an intramedullary device would be expected to retain good knee movements since it avoids soft tissue transfixation. To ascertain this we looked at the knee movements recorded in 27 patients before, during and after bilateral simultaneous femoral lengthening using Albizzia nails. The mean gain was 6.2 cm and the mean follow-up 28.6 months. No significant difference was noted between the mean preoperative and final knee flexions (148...
October 2006: Acta Orthopaedica Belgica
Woo-Kie Min, Byung-Guk Min, Chang-Wug Oh, Hae-Ryong Song, Jong-Keon Oh, Hyung-Soo Ahn, Byung-Chul Park, Poong-Taek Kim
The present experimental study investigated biomechanical differences in methods of femoral lengthening using a monolateral external fixator only and using an external fixator over an intramedullary nail. Three materials, namely polyvinyl chloride rods, composite synthetic bone, and cadaver-bone, were tested using the MTS machine. We evaluated the differences of axial stiffness according to the presence of a nail or the numbers of half-pins (two or three half-pins) that were fixed at each side of osteotomy...
January 2007: Journal of Pediatric Orthopedics. Part B
2014-10-04 20:15:50
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