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Leg lengthening by distraction osteogenesis using the Ilizarov apparatus: a novel concept of tibia callus subsidence and its influencing factors

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Abstract

This article studies the incidence and magnitude of delayed callus subsidence, which will also help in study the hypothesis of three cortex corticalisation to determine the time of fixator removal during distraction osteogenesis (DO). Eighty-one tibia segments with mean lengthening of 7.7 ± 2.9 cm were studied with age, gender, skeletal maturity, amount and percentage of lengthening, callus pattern, callus shape, number of cortices seen at the time of fixator removal, bone mineral density (BMD) ratio, and callus diameter ratio analysed for their effect on callus subsidence. All segments had tibia callus subsidence ranging from 4 mm to 3.2 cm with 54% having significant subsidence of more than 1 cm. Multivariate regression analysis revealed only the amount of lengthening and callus patterns to be significant. In conclusion, we can say that tibia callus subsidence is a significant delayed complication and factors affecting it can be used to determine the time of fixator removal.

Résumé

Le but de ce travail est d’évaluer l’importance du régénérat et de vérifier l’hypothèse selon laquelle il est nécessaire d’avoir une corticalisation des 3 corticales avant d’enlever le fixateur lors d’allongements de membres. 81 tibias ont été allongés en moyenne de 7.7 à 2.9 cm et analysés en fonction de l’âge, du sexe, de la maturité squelettique et du pourcentage d’allongement, de même en ce qui concerne l’évaluation du cal et le nombre de corticales consolidées au moment de l’ablation du fixateur. Nous avons également réalisé une étude densitométrique (BMD). Tous les régérats osseux, au niveau du tibia, avaient un écart au niveau du cal osseux de 4 mm à 3,2 cm, 54% ayant un écart de plus d’1 cm. L’analyse statistique a montré que les facteurs significatifs étaient surtout dûs à l’importance de l’allongement. En conclusion, dans l’allongement du tibia,nous pouvons affirmer que l’aspect du régénérat est un facteur important qui doit être pris en compte pour déterminer le moment de l’ablation du fixateur.

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Authors and Affiliations

  1. Rare Disease Institute, Department of Orthopedics, Korea University Guro Hospital, #80 Guro-Dong, Guro-Gu, Seoul, South Korea, 152-703

    Ashok K. Shyam, Surya Udai Singh, Hitesh N. Modi & Hae-Ryong Song

  2. Department of Orthopedic Surgery, Dongguk University International Hospital, Ilsan, South Korea

    Seok-Hyun Lee

  3. Department of Biostatistics, College of Medicine, Korea University, Anam Hospital, Seoul, South Korea

    Hyonggin An

Authors
  1. Ashok K. Shyam
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  2. Surya Udai Singh
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  3. Hitesh N. Modi
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  4. Hae-Ryong Song
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  5. Seok-Hyun Lee
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  6. Hyonggin An
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Correspondence to Hae-Ryong Song.

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Shyam, A.K., Singh, S., Modi, H.N. et al. Leg lengthening by distraction osteogenesis using the Ilizarov apparatus: a novel concept of tibia callus subsidence and its influencing factors. International Orthopaedics (SICOT) 33, 1753–1759 (2009). https://doi.org/10.1007/s00264-008-0660-6

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  • DOI: https://doi.org/10.1007/s00264-008-0660-6

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