Download Limb Lengthening

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