THE VILARRUBIAS METHOD OF LIMB LENGTHENING.

Abstract

To assess the results and complications of this method in a consecutive study of 99 segments with a 5 year follow up

The Vilarrubias method of limb lengthening aims to reduce soft tissue tension and protect joints in order to achieve longer lengthenings with fewer complications. Between 1988–1993 we operated on 99 segments using a modification of this method. The procedure combines a Wagner fixator with percutaneous soft tissue releases, static joint splintage and non-weightbearing mobilisation in a semi-reclining wheelchair. During the consolidation phase the fixator is removed and a moulded plaster applied. In Sheffield we used the Orthofix lengthener and permitted weight bearing and dynamisation in the consolidation phase. The criteria for patient selection were a lengthening aim of greater than 20% of the original bone length or other at risk features (Saleh and Hamer). There were 54 children, 19 with short stature and 35 with asymmetry, age range 4–19 years.

The mean length gained was 92 mm (range 21–173) and the mean BHI 41.3 days/cm (range 16.9–308). In 19 patients there were no complications. In the remainder there were 47 pin site problems, 33 flexion contractures, 33 angular deformities and 15 stress fractures. There were no deep infections or neurological sequelae. Some complications such as flexion contracture; angulation of the regenerate and stress fracture could be secondary to excessive soft tissue tension. Therefore, the length gained and BHI was compared for segments with these complications and those without, using the Students t test, and this was not significant (p> 0.15).

The method appears effective in achieving long lengthenings. Callus formation was satisfactory despite long periods non weight bearing. Considering the lengthening aims and high-risk cases it compares favourably with other reported series. We believe it remains an effective technique for cases of intermediate complexity.