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Fulltext Femoral deformity correction and lengthening on nail with monorail external fixator : a case report

Mohd Bakrynizam Abu Bakar Siddiq, Kamarul Izham Kamarudin, Kamarul Al Haq, Suresh Chopr

International e-Journal of Science, Medicine & Education, 2018;12(2):26-29.
MyJurnal

Limb length discrepancy (LLD) is quite common.
Lower limb shortening is one of the causes of limb
length discrepancy. The common treatment that is
used is the llizarov technique for bone lengthening.
The new technique uses an intramedullary nail with
a monoplanar external fixator. Using this technique,
bone lengthening duration in patients can be reduced
and knee joint mobility can be improved without
jeopardizing bone regeneration. We report a case of a
27-year-old gentleman who had right femur shortening
from childhood and was referred to us for corrective
deformity. He underwent bone lengthening on the nail
which lenghthens and equalizes the leg while avoiding
stiffness and reduces joint mobility which leads to good
patient satisfaction outcome. The use of the external
fixator with intramedullary nailing to lengthen the
femur is one method that can reduce patient burden
mentally and physically. However although it has many
advantages we must watch out for the complications
during the regular visits to ensure good outcome.

Matched MeSH terms: Bone Lengthening
Fulltext Growing endoprosthesis in management of bone tumours in Malaysia

Saravanan S, Vivek AS

Med J Malaysia, 2007 Dec;62(5):418-9.
PMID: 18705481 MyJurnal

This is to report on the use of growing endoprosthesis, also known as lengthening prosthesis in the management of four patients in the paedriatic age group in the Orthopaedic Oncolgy Unit at University Malaya Medical Centre. These are custom made prosthesis, designed and made in India based on measured roentrograms. The ages of these patients vary from 6 to 13 years old. These are cases of Osteosarcoma and Ewing's sarcoma around the knee. This is the first time these custom made prosthesis have ever been used in Malaysia. We feel that this is a feasible option for limb salvage in the treatment of primary bone tumours in growing children.

Matched MeSH terms: Bone Lengthening/methods
Rod Lengthening With the Magnetically Controlled Growing Rod: Factors Influencing Rod Slippage and Reduced Gains During Distractions

Cheung JPY, Yiu KKL, Samartzis D, Kwan K, Tan BB, Cheung KMC

Spine (Phila Pa 1976), 2018 04 01;43(7):E399-E405.
PMID: 28767632 DOI: 10.1097/BRS.0000000000002358

STUDY DESIGN: Prospective study.
OBJECTIVE: To identify the factors that are associated with rod slippage and to study the pattern of achieved length gain with a standard distraction methodology.
SUMMARY OF BACKGROUND DATA: Ability to achieve successful magnetically controlled growing rod (MCGR) distraction is crucial for gradual spine lengthening. Rod slippage has been described as a failure of internal magnet rotation leading to a slippage and an inability to distract the rod. However, its onset, significance, and risk factors are currently unknown. In addition, how this phenomenon pertains to actual distracted lengths is also unknown.
METHODS: A total of 22 patients with MCGR and at least six distraction episodes were prospectively studied. Patients with rod slippage occurring less than six distraction episodes were considered early rod slippage whereas those with more than six episodes or have yet to slip were grouped as late rod slippage. The association of parameters including body habitus, maturity status, age of implantation, total number of distractions, months of distraction from initial implantation, initial and postoperative Cobb angle, T1-T12, T1-S1, T5-T12 kyphosis, curve flexibility, instrumented length, and distance between magnets in dual rods and between the magnets and apex of the curve with early or late onset of rod slippage were studied. Differences between expected and achieved distraction lengths were assessed with reference to rod slippage episodes and rod exchanges to determine any patterns of diminishing returns.
RESULTS: Patients had mean age of 7.1 years at diagnosis with mean follow-up of 49.8 months. A mean 32.4 distractions were performed per patient. Early rod slippage occurred in 14 patients and late rod slippage occurred in eight patients. Increased height, weight, body mass index, older age, increased T1-12 and T1-S1 lengths, and less distance between magnets were significantly associated with early rod slippage. Expected distraction lengths did not translate to achieve distraction lengths and reduced gains were only observed after achieving one-third of the allowable distracted length in the MCGR. Length gains return to baseline after rod exchange.
CONCLUSION: This is the first study to specifically analyze the impact of rod slippage on distraction lengths and the risk factors associated with its onset and frequency. Increased body habitus and reduced distance between internal magnets significantly influenced rod slippage events. Diminishing returns in distracted length gains were only observed after a period of usage.
LEVEL OF EVIDENCE: 3.

Matched MeSH terms: Bone Lengthening*
Fulltext Treatment for flexion contracture of the knee during Ilizarov reconstruction of tibia with passive knee extension splint

Kwan MK, Penafort R, Saw A

Med J Malaysia, 2004 Dec;59 Suppl F:39-41.
PMID: 15941159

Joint stiffness is one of the complications of limb procedure. It developes as a result of failure of knee flexors to lengthen in tandem with the bone, especially when there is inadequate physical therapy to provide active and passive mobilization of the affected joint. We are reporting four patients who developed fixed flexion contracture of their knees during bone lengthening procedure for the tibia with Ilizarov external fixator. Three of them were treated for congenital pseudoarthrosis and one was for fibular hemimelia. None of them were able to visit the physiotherapist even on a weekly basis. A splint was constructed from components of Ilizarov external fixator and applied on to the existing frame to passively extend the affected knee. Patients and their family members were taught to perform this exercise regularly and eventually near complete correction were achieved. With this result, we would like to recommend the use of this "Passive Knee Extension Splint" to avoid knee flexion Contracture during limb lengthening procedures with Ilizarov external fixators.

Matched MeSH terms: Bone Lengthening/adverse effects; Bone Lengthening/methods
Fulltext Limb reconstruction surgery with external fixators--university hospital experience

Aik S, Sengupta S

Med J Malaysia, 2000 Sep;55 Suppl C:86-92.
PMID: 11200049

We are describing 21 limb reconstruction procedures performed in 18 patients with the use of external fixators from 1996 to 1998. The average age of patients was 21, ranging from 1 to 50 years old. Indications for surgery included short limb, non-union, pseudoarthrosis and bone or soft tissue deformities. Average length obtained for cases of limb lengthening was 6 cm. All the seven clubfoot deformities in five children were fully corrected. Equinus deformity recurred in one foot and was treated with supramalleolar osteotomy. Out of the seven cases with infected nonunion and bone loss, three failed to achieve union and required additional bone grafting procedures. One patient with unilateral external fixator for the correction of tibia shortening developed valgus deformity.

Matched MeSH terms: Bone Lengthening