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39649

Limb lengthening in children and adolescents using mono lateral fixators

Thesis

Last updated: 06 Feb 2023

Subjects

-

Tags

Orthopedic surgery

Advisors

El-Subki, Muhammad, Basha, Nagib, Hanna, Atef A. Z.

Authors

Wanis, Maged Ramsis

Accessioned

2017-04-26 12:42:28

Available

2017-04-26 12:42:28

type

M.D. Thesis

Abstract

Limb length inequality is a common problem in pediatric orthopedic practice. Short limb is usually symptomatic. This problem has always been a strong motive for orthopedic surgeons throughout history. Numerous methods to correct limb length inequality have evolved.In our study, 22 limb lengthening were performed in 21 children and adolescents. There were 15 femoral lengthenings, 6 ulnar lengthenings and one radial lengthening. The average follow up period after removal of the fixator was 18.8 months (range 6 to 45 months). The total time of treatment (from the day of the osteotomy till the day when the screws or any brace or cast is removed) averaged 242 days (8 month) (range 85-660 days).The value of overall pre-operative estimated limb shortening was 4.5 cm (range 2-13.5cm). For all the etiologies, the average lengthening achieved was 4.9cm (range 2.1-13.0cm), which represented an average of 22.4% increase in the lengthened segment (range 7-61%).In the upper limb group (7 limb segments), the estimated pre-operative shortening averaged 2.5cm (range 2-3cm). The average lengthening achieved in this group was 2.8cm (range 2.3-3.4), which represented an average of 19.5% increase in the upper limb segment length.In the lower limb group (15 femoral lengthenings), the preoperative shortening averaged 5.5cm (range 2.5-13.5cm). The average lengthening achieved in this group was 5.9cm (range 2.1-13.0cm), which represented an average of 23.8% increase in femoral length.The Healing (HI) index of De Bastiani et al. (Number of days necessary to lengthen and consolidate 1cm) averaged 45.8 days/cm. In calculating the consolidation time (HI index) all the patients who where complicated by callus fracture and needed further internal or external fixation or bone grafting were excluded (7 limb segments). In the upper limb group (7 limb segments), the healing (HI) index averaged 47.6 days /cm. In the lower limb group, the HI index was calculated for only 8 limb segments and averaged 44.2 days/cm . The total number of operative procedures for each patient averaged 2.2 surgeries (range 1-5).From the results produced in this work, we have found that the callotasis method in association with the Orthofix LRS monolateral external fixator is a reliable method of limb lengthening and that the fixator is a reliable tool suitable for the use in pediatric age group, as they are better tolerated than circular fixators. The apparatus showed a profound ability in extensive lengthenings without any incidence of mechanical failure.The complication rate was very high in our study, but still comparable with other published results. The high complication rate can be linked to increased soft tissue resistance, which represented the main obstacle during lengthening. In the upper limb lengthening, excellent results were achieved owing to the small muscles bulk in the fore arm with much lower soft tissue resistance.The results in sever congenital shortening were not satisfactory, making the efficacy of the monolateral fixators in doubt as regards major lengthenings in congenitally short femora.Our study is a further confirmation of the fact that callotasis and monolateral fixators are reliable and acceptable techniques limb lengthening in pediatrics and adolescents

Issued

1 Jan 2003

DOI

http://dx.doi.org/10.21473/iknito-space/33593

Details

Type

Thesis

Created At

05 Feb 2023