Acta Ortopédica Mexicana

Márquez NJCC, Madinaveitia VJA, Hernández SIH, Alvarado SJC
An assessment of 120 cases of bone lengthening in different limbs. Inter-institutional trial
Acta Ortop Mex 2002; 16 (2)

Language: Español
References: 32
Page: 62-69
PDF: 306.29 Kb.

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Objective. This retrospective paper has been designed to evaluate our results in cases of dyaphyseal bone lengthening. Particular emphasis has been focused in the complications of the procedure. Material and methods. A whole 144 long bones were lengthened in 120 patients of both genders by an Orthofix external fixator, except for 37 metatarsals which were elongated by a mini-fixator (Instituto Nacional de Ortopedia, Mex. design). Age ranked 5 to 41 years. Causes of bone-shortening were: hemimelia, club foot, tibial pseudoarthrosis, trauma, tumor, achondroplasia or infection. Affected bones were: femur 67, tibia 38, metatarsals 37 and humerus 2. Patients were treated from 1992 through 1996 in three hospitals as outlined in headings of this paper. A bone growing of 1 mm daily was scheduled in all cases. Complimentary procedures such as iliotibial fasciotomy or heel cord lenghtening were carried out before starting on the bone elongation, aiming to avoid bone malalignment while in progress. A permanent rehabilitation program and periodical electromyography recordings were performed along the complete span of the bone growing. Results. Obtained lenght increasing was from 3.5 to 18 cm, however it seldom was needed to increase more than 10 cm. A whole 31 cm of body growing were obtained in one case of achondroplasia. Best results in children were produced when periodical elongation was repeatedly performed through the growth, thus preventing the necessity of a one-time major elongation which increase the complications risk. Complications ocurred in 34 cases, 19 major and 15 mild (23.6%) that were: pin trac infection in 10 cases, knee valgus of 6-20 degrees in 7, flexion knee contracture in 4, broken pins in 4, no bone formation in 3, fracture in the new formed bone in 2, toe retraction in 2, premature bone formation in 1 and broken of fixator in 1. All complications were resolved either by conservative measures or by a second surgical procedure. Conclusion. Objectives of bone lenghtening surgery can be accomplished by external fixation procedures, however most of the still common complications should be significantly reduced by clear explanation and a closer observation of patients.

Key words: bone, external fixation, rehabilitation, complication, elongation.


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