The effect of lower extremity lengthening on physeal growth is still controversial. We aim to compare data of the patients who had bilateral simultaneous femur and tibia lengthening with the patients who underwent the lengthening surgery separately for the femur and tibia at the end of completed skeletal maturation in terms of the effect of physeal growth. Twenty-six patients were included who operated in our clinic between 1995 and 2015 for limb lengthening. Fourteen patients with bilateral lengthening of the femur and tibia at the same time were named as simultaneous lengthening (SL). Twelve patients with bilateral lengthening of the femur and then bilateral tibia lengthening seperately were named consecutively lengthening (CL). All patients were followed until completion of growth. The physeal arrest was measured using predicted length (investigated with the multiplier method), the total amount of lengthening and final length.Introduction
Materials and Methods
This study aims to evaluate the effect of using different types of fixator on the quality of callus and complications during distraction osteogenesis in patients with achondroplasia. Forty-nine achondroplasia patients with a minimum follow-up of 36 months who underwent limb lengthening between 2005 and 2017 with external fixator only were included. Thirty-three of the patients underwent lengthening using classical Ilizarov frame, while spatial frame used for sixteen. Regenerate quality is evaluated according to the Li classification on the X-ray taken one month after the end of the distraction. Complications were noted in the follow-up period.Introduction
Materials and Methods
Callus distraction over an intramedullary nail is a rarely used technique for the reconstruction of intercalary defects of the femur and tibia after radical debridement of chronic osteomyelitic foci. The aim of this study was to summarize our experience of distraction osteogenesis with an external fixator combined with an intramedullary nail for the treatment of bone defects and limb shortening produced as a result of radical debridement of chronic osteomyelitis. Sixteen patients aged 16 to 63 years underwent radical debridement to treat nonunion associated with chronic osteomyelitis of 8 tibias and 8 femurs. The lesions were staged as Cierny and Mader type IVA (10) and IVB (6). The resulting segmental defects and any limb length discrepancy were then reconstructed by distraction osteogenesis over an intramedullary nail. A monolateral frame was used for the femur, and a ring type external fixator for the tibia. Two patients required local gastrocnemius flaps. Free non-vascularised fibula grafts were added to the regenerate for augmentation of a femoral defect at the time of external fixator removal and locking of the nail. At the latest follow-up, functional and radiographic results were evaluated using the Paley’s criteria. In the femur, the mean defect was 10 centimeters (range 6 to 13 centimeters), while in the tibia it was 8.4 centimeters (range 5 to 11 centimeters). The mean external fixator index was 13.5 days per centimeter, the consolidation index was 36 days per centimeter and the mean time to union at the docking site was 9 (range 5–16) months. The average follow-up was 31.3 months. We obtained 81.25% (13 of 16) excellent results in terms of both bone and functional assessment. There were two recurrences of infection necessitating nail removal. These patients underwent revision with an Ilizarov fixator. Subsequently, infection was controlled and the non-unions healed. This combined method may prove to be an improvement on the classic techniques for the treatment of long bone nonunions associated with chronic osteomyelitis, in terms of external fixation period and consolidation index. These appears to be no increase in the risk of complications, and the earlier removal of the external fixator is associated with patient comfort, decreases the complication rate and facilitates convenient and quick rehabilitation.
Infection of a megaprosthesis implanted following tumor resection leads to major morbidity and sometimes amputation. Their treatment is like treatment of infected total knee or hip prosthesis, except there is a dramatically larger dead or infected tissue, and immune deficiency due to oncologic treatments. Two-stage revision of infected megaprosthesis seems to be the safest solution except amputation. Between 1990–2005, we have implanted 282 megaprosthesis in the upper and lower extremity following tumor resection. Sixteen prostheses became infected after a median of 48 months (2–96) following the index intervention. All of them underwent two-stage revision. The infections were staged after Mc Pherson classification, revealing that 75% of them were ‘stage IIIB’. The first stage included debridement, insertion of culture specific antibiotic-loaded bone cement in the form of beads and/or rods, temporary fixation with a custom made IM nail or self-designed, mobile hinged-joint prosthesis covered with antibiotic- loaded PMMA. The most common grown microorganism was MRSA. Following parenteral antibiotherapy, the second staging was performed after a median of 6 weeks (5–11). The reconstruction stage included reimplantation of a cemented prosthesis in 5 patients, a cemented prosthesis in 6 patients, arthrodesis through segment transfer with an external fixator in 4 patients. Eight patients necessitated a local or a distant flap for soft tissue coverage. A patient with recurrent deep infection was amputated. Patients were followed up for a median of 86 months (24–146). Infection was controlled in 15 patients, with an overall success rate of 94%. The mean functional outcome for the retained limb using the MSTS score was 70%. Two-stage revision in infected mega prosthesis yields results close to conventional joint replacements, if general guidelines are followed and good soft tissue coverage is provided.
