Limb Lengthening in Children and Adolescents Using Mono Lateral Fixators

Abstract

Limb length inequality is a common problem in pediatric orthopedic practice. Shon limb is usually symptomatic. This problem has always been a strong motive for orthopedic surgeons throughout history. Numerous methods to correct limb length inequality have evolved. In our study, 22 limb lengthening were performed in 21 children and adolescents. There were 15 femoral lengthenings, 6 ulnar lengthenings and one radial lengthening. The average follow up period after removal of the fixator was 18.8 months (range 6 to 45 months). The total time of treatment (from the day of the osteotomy till the day when the screws or any brace or cast is removed) averaged 242 days (8 month) (range 85-660 days).

The value of overall pre-operative estimated limb shortening was 4.5 cm (range 2-13.5cm). For all the etiologies, the average lengthening achieved was 4.9cm (range 2.1-13.0cm), which represented an average of 22.4% increase in the lengthened i,esment (range 7-619.(,).

ln the upper limb group (7 limb segments), the estimated pre-operative shortening averaged 2.5cm (range 2-3cm). The average lengthening achieved in this group was 2.8cm (range 2.3-3.4), which represented an average of 19.5% increase in the upper limb segment length.

In the lower limb group (15 femoral lengthenings), the preoperative shortening averaged 5.5cm (range 2.5-13.Scm). The average lengthening achieved in this group was 5.9cm (range 2.1-13.0cm), which represented an average of23.8% increase in femoral length.

The Healing (HI) index of De Bastiani el al. (Number of days necessary to I lengthen and consolidate lcm) averaged 45.8 days/cm. In calculating the I consolidation time (HJ index) all the patients who where complicated by callus fracture and needed further internal or external fixation or bone grafting were I excluded (7 limb segments). I

In the upper limb group (7 limb segments), the healing (HI) index averaged I 47.6 days /cm. In the lower limb group, the HI index was calculated for only 8 limb I segments and averaged 44.2 days/cm . The total number of operative procedures for each patient averaged 2.2 surgeries (range 1-5).

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