Bone lengthening: bridging joints, soft tissue releases, physiotherapy

Current trends on limb length discrepancy treatment: results of a survey among 11 dedicated Italian centres

Limb length discrepancies (LLD) are quite frequent, especially in lower limbs. The evolution of the available devices and the refinement of the techniques for correcting the differences in limb length have progressively improved the approach to these deformities. Nevertheless, several points still remain debated. The aim of the study was to investigate the Italian pediatric orthopedic surgeons' choices in approaching and treating LLD in both lower and upper limbs. A survey on the treatment of limb length discrepancy was sent to a group of 11 Italian orthopedic centers, specialising in limb lengthening and belonging to the Italian Society of Pediatric Orthopedics and Trauma and the Italian Society of External Fixation. Despite improvements in knowledge of bone biology and distractional osteogenesis as well as the increase in available hardware for lengthening, many aspects of LLD correction still remain debated. Both the relative rarity of the conditions which lead to significant shortening and the lack of wide groups of patients analysed at adult age, continue to be the main limitations for every surgeon who deals with LLD. Only by overcoming our own convictions and sharing our experiences in multicentric studies, may we reach our goal of developing a shared treatment protocol.

[Effectiveness of minimally invasive osteotomy Ilizarov technique combined with intramedullary nail for femoral lengthening]

Objective

To explore the effectiveness of minimally invasive osteotomy Ilizarov technique combined with intramedullary nail for femoral lengthening.

Methods

Seventy-one patients with femoral shortening deformity who met the selection criteria between January 2013 and June 2016 were randomly divided into trial group (36 cases were treated with minimally invasive osteotomy Ilizarov technique combined with intramedullary nail for femoral lengthening) and control group (35 cases were treated with simple Ilizarov technique for femoral lengthening). There was no significant difference in age, gender, causes of femoral shortening, length of femoral shortening, rate of femoral deformity between the two groups ( P>0.05). The operation duration, intraoperative blood loss, lengthening rate, external fixation duration, frequency of pin tract infection, osteotomy healing time, and range of motion (ROM) of knee at 1 year after operation were recorded and compared between the two groups.

Results

The patients of two groups were followed up 12-60 months (mean, 31 months). Pin tract infection occured in 8 cases (10 pins), including 1 case (1 pin) in the trial group and 7 cases (9 pins) in the control group. There was significant difference in the incidence of pin tract infection between the two groups ( χ2=5.265, P=0.022). All patients were cured by replacing the fixation pins, changing dressing actively, application of antibiotics, and adequate postoperative care. The operation duration, intraoperative blood loss, external fixation duration, osteotomy healing time, and ROM of knee at 1 year after operation of the trial group were superior to those of the control group, showing significant differences ( P<0.05). There was no significant difference in the lengthening rate between the two groups ( t=-1.581, P=0.153).

Conclusion

The minimally invasive osteotomy Ilizarov technique combined with intramedullary nail in femoral lengthening increases the operation time, but the external fixation duration and incidence of pin tract infection are significantly reduced and the function of knee is significantly improved.