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Reaching Greater Heights: Limb Lengthening By Julie An Purpose Internship Research Question Primary Research Future Plans Internship Julie An, Howard High School Potomac Valley Orthopaedic Association in Columbia Dr. Daniel Tang Internship Observed clinical sessions with patients Observed surgeries Learned it is not just about medicine Research Question How are different limb lengthening techniques effective in correcting bone discrepancies and abnormalities? Hypothesis The PRECICE technique is most effective out of LATN and Ilizarov techniques in correcting bone discrepancies and deformities. Limb Lengthening Implemented to fix various bone abnormalities Growth of New Bone New bone develops in between the gap http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3293955/ Angular deformity Before After Tibial Non-union Before After Primary Research Meta-analysis of PubMed articles Created a chart to record data Observed that PRECICE method had less complications compared to other methods Final conclusion: PRECICE = lengthening Ilizarov = angular deformity Primary Research Article # Etiology congenital skeletal dysplasia longitudinal reduction defects idiopathic shortening posttraumatic condition previous infection previous resection 24650027 post-tumor resection trauma 24321414 polio Avg. Preoperative Discrepancy Average Age # Cases 19 6 20 Avg. Length Achieved (cm) 3.7316 21.67 BHI (months/cm) 3.6947 Retro/Pros Method PRECICE 6 need ECR adjustment 3 patients with complications -nail breakage of welding seam during consolidation period; required exchange nailing (1) PHENIX 2 early arrest of distraction 1 acute pain, paralysis, paraesthesia Ilizarov Pin tract infection delayed union hypaesthesia fracture Retro LON 13 patients -4 limbs failed to lengthen initally -3 fractures -2 nail failures -4 deep infections -2 joint sublaxations requiring operative care Retro Retro Ilizarov ISKD Retro 4.5 (1.3-7.6) Growth arrest after arthritis Growth arrest after fracture Congenital 23838853 14 congenital short femur 9 proximal femoral focal deficiency 1 Russell-Silver syndrome 1 spondyloepiphyseal dysplasia 8 physeal arrest 3 enchondromatosis 23872802 1 fracture with shortening 23000037 congenital abnormality 22933497 22377509 posttraumatic shortening 22083361 15 12.27 4.9 (2.2-14.8) 7 (3-11.4) 20.4% of preoperative length 37 11.6 (8.1-17) 59 4.8 ±0.16 ( 2-8) 24 32 (16-37) 11 33 ± 7 6 6 26.3 ± 1.22 days/cm 2.8 (0-7) 4.4 (1.5-8) 3.6 ± 1.7 41.3 41.1 ISKD 3.1 3.2 Complications 2.1 Retro 2.2 Retro Function ROM Avg. Length of Follow Up (months) 3 26.18 days/cm 7.3 (3-11) 2 persistant knee stiffness 41.27 (15-99) full function in 94% of patients 68 (15-148) 4.5 +/- .2 years 4 runaway nail 2 difficult-to-distract nail 3 poor bone regenerate Taylor Spatial Frame LAP 1 knee stiffness Classic Time to Full Weight Bearing 1 regenerate collaspe 2 pin site infection 3 knee stiffness 45 Knee Preop: Extension: -1.7 ° Flexion: 130.6 ° Postop: E: -.1 ° F: 127 ° 80.4 Future Plans UMBC Biology major Medical school Reference http://www.limblengthening.com/beforeafter.html http://www.ouh.nhs.uk/limbreconstruction/information/documents /limb-lengthening-booklet.pdf http://lermagazine.com/wp-content/uploads/2014/05/PRECICE-Xray2.jpg