Introduction. Motorised intramedullary lengthening nails are considered more expensive than external fixators for limb lengthening. This research aims to compare the cost of femoral lengthening in children using the PRECICE magnetic lengthening nail with external fixation. Materials and Methods. Patients: Retrospective analysis of 50 children who underwent femoral lengthening. One group included patients who were treated with PRECICE lengthening nails, the other group included patients who had lengthening with external fixation. Each group included 25 patients aged between 11–17 years. The patients in both groups were matched for age. Cost analysis was performed following micro-costing and analysis of the used resources during the different phases of the treatments. Results. : Each group's mean patient age was 14.7 years.
Background:. External fixators are not as well tolerated around the femur when compared to the tibia.
Background.
The practice of limb lengthening using intramedullary nails has surged in popularity in recent years. Our study explores the relationship between femur lengthening and overall height gain in adults undergoing cosmetic limb lengthening with telescoping magnetic intramedullary lengthening nails (MILNs). Demographic information, pre- and postoperative radiographic data, and secondary outcomes, such as mechanical angles and sagittal alignment, were analyzed for 42 adult femurs MILNs (PRECICE 2, NuVasive, Inc.). Height was assessed with a digital stadiometer. Limb lengthening was defined as the amount of nail distraction seen on a calibrated weight bearing X-ray at consolidation. mLDFA, mMPTA, MAD, AMA, and femoral sagittal bow were evaluated as secondary outcomes.Introduction
Materials & Methods
Introduction. The purpose of this research is to compare the quality of life in children during gradual deformity correction using external fixators with intramedullary lengthening nails. Materials and Methods. Prospective analysis of children during lower limb lengthening. Group A included children who had external fixation, patients in group B had lengthening nails. Patients in each group were followed up during their limb reconstruction. CHU-9D and EQ-5DY instruments were used to measure quality of life at fixed intervals. The first assessment was during the distraction phase (1 month postop.), the second was during the early consolidation phase (3 months postop.) and the final one was late consolidation phase (6–9 months depends on the frame time). Results. Group B patients reported significantly better utility compared to Group A. This was observed during all the stages of the treatment. Group B children were less worried (P 0.004), less sad (P 0.0001), less pain (p <0.0001), less tired (P 0.0002), better school work (P0.0041), better sleep (p 0.016), more able to do sports activities (p 0.004) and, they were more independent (p <0.0001) compared to group B. QALYS was better for the nails group compared to external fixation group 0.44 compared to 0.36 for external fixators. Conclusions.
Introduction. The objective of this study is to report the first cases of femoral lengthening in children using Ilizarov fixator. Materials and Methods. We carried out a retrospective study about the cases of femoral lengthening done in 2010 to 2020 in our BARI-ILIZAROV Orthopaedic centre Dhaka. Results. 48 lengthening were done during this period using Ilizarov fixator. The procedure was done incongenital bone diseases in 20 cases and after a distal femoral epiphysiodesis in 10 cases. The mean age at surgery was 12.8 years.
Purpose of Study.
Aims: Present our experience with a protocol for acute Ç gradual È femoral distraction for post- traumatic femoral shotening. Methods: Six females and four men with an average age of 35 y/o with al least one year follow-up and an average shortening of 4.5 cm (range 3–6). A butterßy osteotomy was performed at the diaphysary-subtrochanteric level. A femoral distractor was applied to the lateral side of the femur. An antegrade femoral intramedullary nail was then inserted and locked proximally. The patients were admitted to the orthopaedic ßoor and distraction started the same day under clinical monitoring of the neurovascular status. When the desired length was achieved, intrelocking was completed and the femoral distractor removed. Limb length was evaluated with scanograms. Radiographic healing was deþned as bridging callus at both sides of the osteotomy on AP, lateral and oblique views. Range of motion was evaluated at the one year follow-up visit. Results: Lenghening averaged 4.2 cm (range 2.7–6). Distraction period averaged 6 days (range 3–12). Distraction rate averaged 7 mm a day (range 3–11). Average healing time was 5 months (range 2–11). Shanz pins bent in 6 cases. Pin tract superþcial infections were identiþed in 3 cases. All infections subsided with oral antibiotics and no deep infection was detected. No nails or interlocking screws breakage were detected. Conclusion:
Introduction: The aim of the study is to assess the complication rate in lengthening of the femur and to analyze the main factors inducing complications. Materials &
method: A retrospective study of 151 cases of lengthening with different methods (External Fixator of Judet 9, Callotasy with Orthofix :89, Ilizarov 9, External Fixator of Wagner 9,
Background:. Leg length discrepancy related to absence of the femoral head with proximal migration of the femur presents a treatment dilemma. Late sequelae of neonatal hip sepsis and chronic hip dislocation due to developmental dysplasia are the most common causes. Traditional teaching dictates that the hip is stabilised prior to limb lengthening. Reconstructive options alter the shape of the proximal femur which complicates future surgery. Methods:. We retrospectively reviewed 3 cases of femoral lengthening with an ‘unstable’ hip without prior stabilization. The aetiology was neonatal hip sepsis in 2 cases and chronic hip dislocation due to developmental dysplasia in 1 case.
Introduction:
Shortness of an extremity due to different causes is an issue that may adversely affect human life functional and psychologically. In this study, in the light of previous studies, it is aimed to develop a new expandable intramedullary system, providing lengthening in order to remove previous problems and complications and to annihilate leg length discrepancies at present and future without second surgical intervention as far as possibble by lenghtening the intramedullary nail. To this end, a new electromechanically activated intramedullary nail has been designed and generated. The intramedullary nail was designed to perform extremity lengthening electro-mechanically. The 3D design of the system is performed with computer software and the rapid and metal prototype of the system has been produced. The intramedullary nail system is comprised of three main units; Mechanical transmission unit, Electronic unit,
Forearm lengthening in children is controversial. Paley (1990) and Peterson (1994) advocate aggressive treatment of the deformity for cosmetic and functional reasons. Scoenecker (1997) has shown that mature patients are comfortable with their appearance and functional deficit. We reviewed 8 forearm lengthenings performed in 8 children in the 14 year period from 1991 to 2004. Five patients had ulnar shortening (osteochondromata = 4, growth arrest due to trauma = 1). Of the three patients with radial shortening, one was due to a congenital short radius and two following growth arrest (post trauma and meningococcal septicemia). The shortening resulted in a cosmetically unacceptable ulnar or radial tilt with absent radial or ulnar deviation of the wrist and decreased supination and/or pronation. One patient with a proximal ulnar osteochondroma had a dislocation of the radial head with cubitus varus. Excision of the osteochondroma was done 6 months prior to lengthening.
There is no doubt that the future of limb lengthening lies with internal lengthening. Complication rates are reduced and patient satisfaction is increased. The evolution of internal lengthening peaked with the dual direction, easily inserted and externally controlled PRECICE Nail. It has excelled in performance in accuracy and satisfaction. Its versatility increased with smaller sizes and increased excursion. A field safety notice was issued was issued in October 2021 by the parent company NuVasive. The advice was monitoring of current cases and a hold on implantation until after a review of process. At the National Orthopaedic Hospital Cappagh we elected to remove all implanted nails and assess the nail integrity and physiological changes associated with implantation. All patients in who a retained Precice nail at the time of the field safety notice were identified. Patients and families were contacted to explain the issued safety notice from the company and explain that we would be scheduling them for nail removal. This was part of our standard care but we prioritised this group on our waiting list. Consent was obtained for nail removal but also for histological assessment of canal scrapings, blood ion level analysis and independent assessment of the retrieved nail by our academic collaborators at University College Dublin. Ion levels were then repeated at an interval post removal with consent.Introduction
Materials & Methods
Introduction. Hallux valgus surgical correction has a variable but significant risk of recurrence. Symptoms result from an iatrogenic first brachymetatarsia following the index surgical procedure. First metatarsal shortening has been shown to correlate with the onset of transfer metatarsalgia. We describe the use of the scarf osteotomy to both correct the recurrent deformity and lengthen the shortened first metatarsal. Methods. 36 lengthening scarf osteotomies were undertaken in 31 patients. Clinical (AOFAS and SF12 scores) and radiographic measures (IMA, HVA) were taken pre- and post-operatively. The maximum theoretical lengthening was 10mm, to prevent first MTP joint stiffness post-operatively. The actual lengthening was determined and measured intra-operatively. Results. There were 28 female and three male patients, with mean age at presentation 53.4 years. The mean follow-up was 3.9 years. Four cases were lost to follow-up. The mean first metatarsal lengthening achieved was 4.9mm (range 1–8mm). All of the osteotomies united without complication. The mean IMA reduction was 4.0° (p<0.001) and HVA 13.0° (p<0.001). The mean AOFAS score increase was 33.8 (p<0.001). There was no correlation between change in IMA and AOFAS score (r=−0.13) or between improvement in HVA and AOFAS score (r=−0.02). There was a positive trend but no correlation (r=0.28) between amount of metatarsal lengthening and change in AOFAS score. The inter- and intra-observer correlation was excellent. The SF12 physical sub-domains improved more than the mental sub-domains. Conclusion. We describe the largest series of lengthening scarf osteotomies for recurrent hallux valgus and symptomatic iatrogenic first brachymetatarsia. The significant improvement in both clinical and radiographical measures suggests the procedure is successful, with a low complication rate.
Cosmetic lengthening is currently growing, raising Ethical concerns. In cosmetic lengthening, the psychological benefit vs process and risks is not quantified in publications. We designed a prospective longitudinal study for evaluating quantitatively the psychological PROMs of patients with cosmetic lengthening and value its interest. Forty five cosmetic patients were operated on with the G-Nail with full weight-bearing, and sports: M/F 34/11, age 29.3±11.5 year-old, Gain 79 mm (range 86–187). All undertook preoperative preparation, psychological tests, post-operating training (lengthening period, twice daily) and a specific psychological program. No patient presented sequels. Questionnaires were provided before and 40.0 month after surgery (scale 0–10) with: Psychological suffering, Happiness in Life (HiL), Quality of Live (QoL), Self-Esteem, Self-Image, Self-Confidence, Professional, Family, Friends and Sexual Relations, Sexual Attraction. Average, SD of changes and T-Test (unequal variances) were computed.Introduction
Materials and Methods
Percutaneous EndoProsthetic Osseointegration for Limbs (PEPOL) facilitates improved quality of life (QOL) and objective mobility for most amputee's discontent with their traditional socket prosthesis (TSP) experience. Some amputees desiring PEPOL have residual bone much shorter than the currently marketed press-fit implant lengths of 14-16 cm, potentially a risk for failure to integrate. We report on the techniques used, complications experienced, the management of those complications, and the overall mobility outcomes of seven patients who had femur distraction osteogenesis (DO) with a Freedom nail followed by PEPOL. Retrospective evaluation of a prospectively maintained database identified nine patients (5 females) who had transfemoral DO in preparation for PEPOL with two years of follow-up after PEPOL. Six patients had traumatic causes of amputation, one had perinatal complications, one was performed to manage necrotizing fasciitis and one was performed as a result of osteosarcoma. The residual femurs on average started at 102.2±39.7 mm and were lengthened 58.1±20.7 mm, 98±45% of goal (99±161% of the original bone length). Five patients (56%) had a complication requiring additional surgery. At a mean of 3.4±0.6 (2.6-4.4) years following osseointegration six patients had K-level >2. The 6 Minute Walk Test remained unchanged (267±56 vs 308 ± 117 meters). Patient self-rating of prosthesis function, problems, and amputee situation did not significantly change from before DO to after osseointegration. Six patients required additional surgery following osseointegration: six to remove fixation plates placed to maintain distraction osteogenesis length at osseointegration; two required irritation and debridement for infection. Extremely short residual femurs which make TSP use troublesome can be lengthening with externally controlled telescoping nails, and successfully achieve osseointegration. However, it is imperative to counsel patients that additional surgery to address inadequate regenerate or to remove painful hardware used to maintain fixation may be necessary. This may improve the amputee's expectations before beginning on a potentially arduous process.
Percutaneous EndoProsthetic Osseointegration for Limbs (PEPOL) facilitates improved quality of life (QOL) and objective mobility for most amputees discontent with their traditional socket prosthesis (TSP) experience. Some amputees desiring PEPOL have residual bone much shorter than the currently marketed press-fit implant lengths of 14–16 cm, potentially a risk for failure to integrate. We report on the techniques used, complications experienced, the management of those complications, and the overall mobility outcomes of seven patients who had femur distraction osteogenesis (DO) with a Freedom nail followed by PEPOL. Retrospective evaluation of a prospectively maintained database identified nine patients (5 females) who had transfemoral DO in preparation for PEPOL with two years of follow-up after PEPOL. Six patients had traumatic causes of amputation, one had perinatal complications, one was performed to manage necrotizing fasciitis and one was performed as a result of osteosarcoma.Introduction
Materials & Methods
Introduction and Aims: Fibular hemimelia presents a problem with leg length discrepancy and equinovalgus foot deformity. Our protocol is to simultaneously treat both problems, with the goals of equalising limb length and achieving a plantigrade painless functional foot. Method: Seventy-eight patients with fibular hemimelia underwent 92 lengthenings and foot deformity correction. Equinovalgus foot deformity was corrected by four different methods in 67 cases: distraction, soft tissue release, release plus supramalleolar and/or subtalar osteotomy, and fibular transport. Results: Goals of lengthening and foot deformity correction were achieved in all cases. Foot deformity recurred in 19 patients and was retreated: 9/16 (56%) distraction cases, 4/18 (22%) soft tissue release cases, 2/28 (7%) release plus osteotomy cases, and 4/5 (80%) fibular transport cases. Genu valgum developed in many cases with no or partial anlage resection. Genu valgum did not develop in any cases with complete anlage resection. Final results based on functional and radiographic evaluation: 46 excellent, 28 good, 18 fair. Final result did not correlate with number of rays in foot. Conclusion: Limb length discrepancy and foot deformity can be successfully treated by simultaneous lengthening and foot deformity correction. Soft tissue release plus osteotomy and complete anlage resection yielded best results.
Introduction: Achondroplasia is a form of rhizomelic dwarfism. Even if patients can compensate for their short arms through the mobility in their spine during the childhood, the flexibility in their spine becomes less with aging. Because of that, as they get older they experience problems in maintaining personal hygiene especially in reaching the back. In addition putting on socks and tying their own shoes might become difficult. Methods: Inclusion criteria included any patient with a history of achondroplasia who had undergone humeral lengthening in the proximal part of the humerus (just distal to deltoid muscle insertion). Patients who had distal humeral (supracondylar) osteotomy and/or who received other than monolateral external fixator were excluded from the study. 50 humeri of 25 patients with achondroplasia were lengthened using Orthofix mono-lateral external fixator utilizing proximal humeral osteotomy. Sixteen patients were female and nine were male. Mean age was 15.4 months (range, 9.6 – 21.8).