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PubMed2004

Bone lengthening for congenital differences of the hands and digits in children.

PURPOSE: We investigated the growth of bones after lengthening to evaluate the effectiveness and usefulness of bone lengthening in congenital hand deficiencies. METHODS: Bone lengthening was performed to treat congenital hand deficiencies including hypoplastic thumb, hypoplasia of the small finger, cleft hand, metacarpal synostosis, brachymetacarpia, symbrachydactyly, and amniotic band syndrome. A total of 15 patients (1-13 years old) underwent lengthening of 23 bones. The average of distraction was 10 mm. The mean follow-up period was 59 months. The length of the bones at follow-up evaluation was measured and then compared with the length of the bones immediately after lengthening. The bone growth after lengthening, the percentage of growth after lengthening, and the growth rate were compared among diagnostic groups. RESULTS: In the cases involving older patients the bone length changed little and the growth plates of these patients closed naturally soon after lengthening. In contrast, in the cases in which the patients were younger than 7 years old the lengthened bones grew continuously. The amount of bone growth was different for each disease in the younger patients. In patients with amniotic band syndrome the lengthened bones grew at the same rate as the bones in the hand. Other diagnoses such as symbrachydactyly had a different growth pattern in the hand. CONCLUSIONS: We conclude that bone lengthening is a reliable method for the correction of congenital differences of the hand. The indications for this procedure must be determined while considering the relationship between the specific disease and subsequent bone growth.

Adolescent↗
PubMed1975

[Distraction epiphyseolysis. An experimental study for bone lengthening. Part I (author's transl)].

Distraction epiphyseolysis is an operation for bone lengthening in children and adolescent which is often performed in Russia. Our experimental examination in rabbits has shown a lot of problems with this method. With distraction epiphyseolysis it is possible to get a primary lengthening of bone and a soon consolidation of the distraction-cleft. During further growth this primary lengthening is going lost. After the end of growth there was no significant difference between operated and non operated bone. The cause of the growth-disturbance is discussed in a further publication guided by histological findings.

Age Factors↗
PubMed1992

A model for evaluating the strength of bones lengthened by distraction osteogenesis.

In an effort to evaluate the strength of bones lengthened by distraction osteogenesis, a modified Ilizarov-type external fixator was applied to the right tibiae of five adult mongrel dogs. Diaphyseal corticotomies were performed, and distraction (lengthening) was carried out at a rate of approximately 1 mm per day for 20 days. After completion of the lengthening, the animals were killed, the fixators were removed, and the right and left tibiae were harvested and stripped of soft tissue. The ends of all harvested bones were fixated in polymethylmethacrylate to allow testing on a materials testing system (MTS) machine. Testing under torsional loads was performed on the MTS machine (50 degrees maximum angle of rotation at ten seconds) until failure. The right tibiae were lengthened an average of 12 mm (range, 7-15 mm). The slopes of the linear portion of the torque versus rotation curves were determined. A comparison of slopes revealed a mean change in stiffness between test and control bones of 20.32% (range, 0.64%-40.5%). All tibiae exhibiting mature regenerate bone demonstrated stiffness greater than the matched controls (range, 0.64-24.09% stiffer). Four of five dogs had problems with proximal and distal ring impingement. This study presents a reproducible model for evaluating the strength of bones lengthened by distraction osteogenesis. The lengthened bones that exhibited bony or mature regeneration were as strong as the control bones.

Animals↗
PubMed1980

Thumb reconstruction through metacarpal bone lengthening.

The experience with thumb reconstruction through metacarpal bone lengthening in 35 patients treated over a period of 12 years is presented. In 25 cases a spontaneous consolidation of the gap between the distracted fragments occurred, whereas in the remaining 10 the gap was bridged by a bone graft. The elongation of the metacarpal achieved varied from 2 to 4 cm. Examination of patients followed from 4 to 8 years after the treatment shows a good appearance of the reconstructed thumb without osteolysis or other trophic changes in the distal end. The quality of the skin sensibility in the amputation stump is preserved after the lengthening.

Adolescent↗
PubMed1995

[Bone lengthening of the extremities using the Ilizarov method].

We describe the indications and the results in 18 bone lengthenings carried out on 14 patients in our department during the period January 1991 to September 1993. Seven patients had limb length inequality, five patients had dysplasia or aplasia, one patient had Turner's syndrome and one patient had suffered traumatic amputation of all the fingers of one hand. The mean lengthenings achieved were: femur 4.9 cm; tibia 5.6 cm; fibula 1.5 cm; humerus 7.5 cm; ulna 3.5 cm; radius 1.9 cm; and metacarpals 1.6 cm. There were 14 cases of pin-problems which needed surgery. Nine cases of infection around the pin holes were treated with antibiotics only. We had five cases with severe pain due to distraction. We had two cases of fracture after removal of the external fixation. Both fractures healed without further problems, but in one case there was three cm loss of the achieved lengthening. Our conclusion is that the Ilizarov method for bone lengthening is a demanding procedure. Because of the many--often minor--complications the patients must be seen frequently, as one must be prepared for "aggressive" treatment of the problems.

Arm↗
PubMed1997

Measurement of bone lengthening forces; an experimental model in the lamb.

OBJECTIVE: To obtain the mechanical behaviour pattern of the lengthening process. DESIGN. IN VIVO: measurement of forces during bone lengthening in lambs. BACKGROUND: A series of parameters of a mechanical and biological nature have a bearing on all lengthening processes, and most of them are not fully understood. METHODS: A strain-gauge-monitored unilateral fixator was designed and used to obtain data about the changes which took place in the forces of elongation at a rate of 1 mm/day in four lambs while a 3 cm progressive lengthening of the left tibia was being performed, analysing how these forces behaved from day to day, and how they changed in the course of a single day. RESULTS: The maximum forces in all the animals each day occur after distraction, and the forces reach their greatest magnitude between days 21 and 25 after surgery, attaining values of slightly over 8 kg (40-50% of the animal's weight). The maximum daily force starts to drop 1 h after distraction, and continues to decrease gradually throughout the day until it reaches a value slightly greater than the initial force on the previous day. CONCLUSION: This pattern is due to the distraction of soft tissues which gradually adapt to their new situation, thereby reducing the level of stress. RELEVANCE: In the daily bone lengthening procedure, the greatest forces are produced in a short period of time immediately after lengthening. they could be reduced to decrease pain in the patient and loads on the device by performing lengthening over a greater number of steps or using dynamic equipment able to absorb these forces.

Journal Article↗
PubMed2002

Bone-lengthening for symbrachydactyly of the hand with the technique of callus distraction.

BACKGROUND: Bone-lengthening in the hand and foot is a relatively new application for distraction osteogenesis. We present the operative treatment and postoperative outcome for four patients with M ller type-D symbrachydactyly of the hand who underwent metacarpal lengthening with use of a distraction device to establish pinch function. METHODS: Four patients who underwent distraction osteogenesis for the treatment of congenital symbrachydactyly of the hand were evaluated over a thirteen-year period. The nondominant right hand was treated in two patients, and the nondominant left hand was treated in the other two. The patients included three boys and one girl; all patients had the operation between the ages of five and eleven years. Distraction osteogenesis was performed on the fifth metacarpal in one patient and on the fourth and fifth metacarpals in the remaining three, in whom both bones were lengthened simultaneously with use of a single device. Postoperative bone elongation was analyzed with radiographs made at the time of removal of the distractor. The sensory function of the treated fingers and any growth disturbance of the distracted bones were evaluated. RESULTS: The mean duration of distraction was 37.3 days (range, thirty-two to forty-nine days), and the distractor was removed at a mean of eighty-four days after surgery. The bones were lengthened by a mean of 22.3 mm (81.6% of their original length) at a rate of 0.6 mm/day. Pinch function was improved in all patients. CONCLUSIONS: On the basis of our limited experience, we found that distraction osteogenesis of the metacarpals was an effective technique for the establishment of pinch function. We also found that an intramedullary Kirschner wire could maintain the alignment of the osteotomized bone. Although distraction requires a longer treatment period, it is apparently more effective than bone-grafting in terms of achieving adequate bone length. Simultaneous lengthening of two metacarpals also was found to be an effective technique.

Child↗
PubMed2001

Effects of gradual bone lengthening on the rabbit tibial nerve.

Little is known about the effect of gradual bone lengthening on peripheral nerves. In the present study, an external fixation device was applied to the rabbit tibia, which was then divided. After seven days, the tibia was subjected to 0.7 mm/day callus distraction for periods of up to one month. The tibial nerve was fixed in glutaraldehyde and plastic sections were cut in longitudinal and transverse planes for light and electron microscopy. Light microscopy showed a 64% increase in the gap length at the node of Ranvier in myelinated axons from the experimental side compared with the control side. The cross-sectional area of the non-myelinated axons was not altered significantly. We conclude that gradual stretching of the nerve elongates the nerve fibres at least at the region of the nodes, perhaps a point of least resistance. Diameters of fibres seem to be held more constant during the lengthening procedure.

Animals↗
PubMed1988

Bone lengthening in rabbits by callus distraction. The role of periosteum and endosteum.

The histology and mechanics of leg lengthening by callus distraction were studied in 27 growing rabbits. Tibial diaphyses were subjected to subperiosteal osteotomy, held in a neutral position for 10 days and then slowly distracted at 0.25 mm/12 hours, using a dynamic external fixator. Radiographs showed that the gap became filled with callus having three distinct zones. Elongation appeared to occur in a central radiolucent zone; this was bounded by two sclerotic zones. Histologically, the radiolucent zone consisted of longitudinally arranged cartilage and fibrous tissue while the sclerotic zones were formed by fine cancellous bone. New bone occasionally contained islands of cartilage, suggesting it had been formed by endochondral ossification. After completion of distraction, the two sclerotic zones fused, shrank and were eventually absorbed, leaving tubular bone with a new cortex. When the periosteum had been removed at the operation, callus formation was markedly disturbed and there was failure of bone lengthening. Scraping of endosteum, in contrast, did not have a pronounced effect. These results suggest that the preservation of periosteum is essential if bone lengthening by callus distraction is to succeed, and that preservation of the periosteum is more important than careful corticotomy.

Animals↗
PubMed1998

Midface membranous bone lengthening: A one-year histological and morphological follow-up of distraction osteogenesis.

Midface bone lengthening was performed on three young, adult sheep using distraction osteogenesis following osteotomy of the maxilla and mounting of an extraoral fixation device. The midface was gradually distracted, 2 mm/day, for 21 days, up to approximately 40 mm. A marked midface advancement was noted. Following a further 6 weeks of retention, the device was removed and the animals were followed for 1 year. Biopsies specimens were taken from the distracted area at the end of the distraction period, after the additional 6 weeks of retention, and finally 1 year later. A nondistracted area of the maxillary bone served as control. The specimens were analyzed histologically, histochemically, and by scanning electron microscopy for the ultrastructural pattern, mineralization, mineral content, and approximate Ca2+ concentration. Clinically and radiographically, all sheep fully bridged the experimental gap. Histologically, at the completion of distraction, collagen bundles and slender bone trabeculae oriented in the direction of the distraction could be seen. At the end of the retention period, the trabeculae thickened noticeably and were partially replaced by mature lamellar bone. At the end of 1 year and after completion of the process of remodeling, the pattern of the distracted area resembled the control area. The mineralization, as reflected by quantitative calcium analysis, compared with the nondistracted area, demonstrated a low rate of mineralization after 3 weeks of lengthening, increased 6 weeks later, and after 1 year became nearly the same as in the nondistracted area. In conclusion, distraction osteogenesis provides satisfactory quantitative and structural new bone.

Animals↗
PubMed1992

Delayed distraction in bone lengthening. Improved healing in lambs.

We compared delayed distraction (DD) with immediate distraction (ID) in bone-lengthening. Open femoral diaphyseal osteotomy was performed on 24 three-month-old lambs, and external distractor fixators were applied. In the ID group (n 12), distraction commenced on the first postoperative day; in the DD group (n 12), distraction was delayed until the tenth day after surgery. In all the animals, the femur was lengthened by 2 cm at the rate of 1 mm/day. The animals were killed 1, 2, and 3 months postoperatively. Radiography and densitometry of the lengthened callus showed that DD, compared with ID, improved the quality of the callus with quicker, denser, and more homogeneous bone formation.

Animals↗
PubMed2005

Changes of osteocalcin and IGF-I during bone lengthening.

OBJECTIVE: To examine the changes of osteocalcin and insulin-like growth factor I (IGF-I) during bone lengthening, and to clarify the mechanism of bone healing. METHODS: Thirty-two shepherd dogs were divided into five groups randomly. Their tibiae were lengthened by Ilvzarov's external fixator at the rate of 1 mm/day. The lengthening area was the experimental side and the opposite side was the control. Samples were obtained on the 2nd, 4th, 6th, 8th, 12th weekend respectively. The samples were defatted, dried, powdered, centrifuged and measured by radioimmunoassay. RESULTS: The osteocalcin concentration increased at the subsequent periods, but it was significantly lower in the experimental side than that of the control side, P<0.05 and the IGF-I concentration was not significantly lowered. CONCLUSIONS: Different noncollagenous bone growth factors may be different at different stage.

Analysis of Variance↗
PubMedDate not supplied

[Progressive bone lengthening using Wagner's technique (author's transl)].

The authors have reviewed the results of 30 surgical procedures of progressive bone lengthening using the Wagner's technique. In 28 cases, internal fixation was applied at the end of the lengthening period. There were 17 femora and 13 tibae operated on. In 6 cases, lengthening was associated with a correction of the alignment of the femur, and in 2 cases was associated with the treatment of a non-union of the tibia. Complications are described; they were found to be relatively rare.

Adolescent↗
PubMed1978

Bone-lengthening for shortness of the fourth toe.

Short fourth metatarsals were observed in 102 patients, often bilaterally. Forty-six of these patients were treated by variations on Jinnaka's bone-lengthening method--that is, interposing a spindle-shaped bone graft within the metatarsophalangeal joint. We examined twenty-six patients clinically and roentgenographically after a follow-up averaging 11.4 years. Satisfactory results were obtained in 74.4 per cent.

Adolescent↗