S-osteotomy with lengthening and then nailing compared with traditional Ilizarov method.
ABSTRACT The purpose of this study was to explore the clinical effect of the novel method combined longitudinal S-osteotomy and Lengthen And Then Nail (LATN) technique for leg lengthening and compare with the classic Ilizarov method.
This retrospective study was performed from March 2008 to April 2012. A total of 176 leg lengthenings (88 consecutive patients) were performed at our institution. The mean duration of follow-up was 2.2 years (range, one to four years). In group A, 78 tibial lengthenings were performed with longitudinal S-osteotomy and LATN technique. In group B, 98 tibial lengthenings were performed with the classic method. The final gain in length, mean surgical time for bilateral tibial osteotomy, the external fixation index and the radiographic consolidation index were calculated and compared. The complications encountered during operation and follow-up were documented.
There was no significant difference in the final gain in length between the two groups. Mean surgical time in group A (130.05 ± 6.60 min) was significantly longer than that in group B (91.4 ± 6.61 min; P < 0.05). External fixation index in group A (21.02 ± 3.16 days/cm) was significantly lower than that in group B (76.19 ± 8.32 days/cm; P < 0.05). Consolidation index was significantly lower (more rapid healing) in group A (43.38 ± 5.35 days/cm) than that in group B (76.19 ± 8.32 days/cm; P < 0.05). There was a significant difference in pin-tract problems and axial deviation between the two groups.
The novel method combined longitudinal S-corticotomy and LATN technique safely reduces the consolidation time, rate of pin-tract problems and axial deviation during leg lengthening, compared with the classic Ilizarov method.
- SourceAvailable from: Ma’ad F. Al-Saati[show abstract] [hide abstract]
ABSTRACT: PurposeThe purpose of this study was to evaluate whether the use of a longitudinal corticotomy (S-Z osteotomy) results in more rapid consolidation following distraction osteogenesis of short tibiae. MethodsSixty-seven lengthening procedures were performed in 51 patients ranging in age from nine to 38(mean 25)years. Diagnoses included short stature (32 tibiae), postpolio limb deformity (22 tibiae), osteomyelitis (three tibiae), trauma (two tibiae) and other diagnoses (eight tibiae). Forty-five lengthenings were performed via a longitudinal corticotomy, and 22 were performed via a transverse corticotomy. Patients were followed until consolidation of the regenerated bone was noted radiographically (consolidation time). The healing index (consolidation time per centimetre of lengthening) was calculated for each patient and compared between groups. ResultsThe healing index was significantly lower in the S-Z group (30.8 ± 9.6days/cm) than in the transverse corticotomy group (46.8 ± 20.2days/cm) (p < 0.0001). Mean lengthening was 6.6(range 2.5–12.5)cm in the S-Z group and 5.8(range 2.0–12.0)cm in the transverse group (p = 0.28). Mean consolidation time was 6.3 ± 2.8(range 3–16)months in the S-Z group and 8.1 ± 3.8(range 3–13.5)months in the transverse group (p = 0.03). ConclusionThe S-Z osteotomy safely reduces consolidation time of regenerative bone during distraction osteogenesis in the tibia relative to a transverse corticotomy.International Orthopaedics 01/2011; 36(5):1073-1077. · 2.32 Impact Factor
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ABSTRACT: To evaluate the potential for limb salvage using the Ilizarov method to simultaneously treat bone and soft-tissue defects of the leg without flap coverage. Retrospective study. Level I trauma centers at 4 academic university medical centers. Twenty-five patients with bone and soft-tissue defects associated with tibial fractures and nonunions. The average soft-tissue and bone defect after debridement was 10.1 (range, 2-25) cm and 6 (range, 2-14) cm respectively. Patients were not candidates for flap coverage and the treatment was a preamputation limb salvage undertaking in all cases. Ilizarov and Taylor Spatial Frames used to gradually close the bone and soft-tissue defects simultaneously by using monofocal shortening or bifocal or trifocal bone transport. Bone union, soft-tissue closure, resolution or prevention of infection, restoration of leg length equality, alignment, limb salvage. The average time of compression and distraction was 19.7 (range, 5-70) weeks, and time to soft-tissue closure was 14.7 (range, 3-41) weeks. Bony union occurred in 24 patients (96%). The average time in the frame was 43.2 (range, 10-82) weeks. Lengthening at another site was performed in 15 patients. The average amount of bone lengthening was 5.6 (range, 2-11) cm. Final leg length discrepancy (LLD) averaged 1.2 (range, 0-5) cm. Use of the trifocal approach resulted in less time in the frame for treatment of large bone and soft-tissue defects. There were no recurrences of osteomyelitis at the nonunion site. All wounds were closed. There were no amputations. All limbs were salvaged. The Ilizarov method can be successfully used to reconstruct the leg with tibial bone loss and an accompanying soft-tissue defect. This limb salvage method can be used in patients who are not believed to be candidates for flap coverage. One also may consider using this technique to avoid the need for a flap. Gradual closure of the defect is accomplished resulting in bony union and soft-tissue closure. Lengthening can be performed at another site. A trifocal approach should be considered for large defects (>6 cm). Advances in technique and frame design should help prevent residual deformity.Journal of Orthopaedic Trauma 03/2006; 20(3):197-205. · 1.75 Impact Factor
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ABSTRACT: Infected tibial nonunions with bone loss pose an extremely challenging problem for the orthopaedic surgeon. A comprehensive approach that addresses the infection, bone quality, and overlying soft-tissue integrity must be considered for a successful outcome. Acute shortening with an Ilizarov frame has been shown to be helpful in the treatment of open tibia fractures with simultaneous bone and soft-tissue loss. Cases in which the soft-tissue defect considerably exceeds bone loss may require an Ilizarov frame along with a concomitant soft-tissue procedure; however, there are a number of potential difficulties with vascularized pedicle flaps and free tissue flaps, including anastomotic complications, partial flap necrosis, and flap failure. The technique described in this report involves acute shortening and temporary bony deformation with the Ilizarov apparatus to facilitate wound closure and does not require a concomitant soft-tissue reconstructive procedure. Once the wound is healed, osseous deformity and length are gradually corrected by distraction osteogenesis with the Ilizarov/Taylor Spatial frame.Journal of Orthopaedic Trauma 08/2006; 20(6):419-24. · 1.75 Impact Factor