Simultaneous Bilateral Femoral and Tibial Lengthening in Achondroplasia
Previous studies on lengthening for achondroplasia have reported bilateral extensive femoral lengthening followed by bilateral extensive tibial lengthening. To decrease trauma on soft tissues and joints, we propose bilateral simultaneous moderate femoral lengthening and moderate tibial lengthening f...
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doaj-d472d09255d149279dd98bfcf995d2b72021-09-25T23:54:33ZengMDPI AGChildren2227-90672021-08-01874974910.3390/children8090749Simultaneous Bilateral Femoral and Tibial Lengthening in AchondroplasiaLior Shabtai0Julio J. Jauregui1John E. Herzenberg2Martin G. Gesheff3Shawn C. Standard4Philip K. McClure5Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY 11549, USADepartment of Orthopaedics, University of Maryland Medical Center, 110 S. Paca Street, 6th Floor, Suite 300, Baltimore, MD 21201, USAInternational Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 W. Belvedere Ave, Baltimore, MD 21215, USAInternational Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 W. Belvedere Ave, Baltimore, MD 21215, USAInternational Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 W. Belvedere Ave, Baltimore, MD 21215, USAInternational Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 W. Belvedere Ave, Baltimore, MD 21215, USAPrevious studies on lengthening for achondroplasia have reported bilateral extensive femoral lengthening followed by bilateral extensive tibial lengthening. To decrease trauma on soft tissues and joints, we propose bilateral simultaneous moderate femoral lengthening and moderate tibial lengthening followed by a similar repeat lengthening a few years later. Fifty patients with achondroplasia underwent 65 simultaneous bilateral femoral and tibial lengthening procedures. Segment lengthening amount and adverse events were obtained from medical records. Mean follow-up after bone healing was 35.6 months. Mean tibial lengthening was 52 mm; mean femoral lengthening was 72 mm. Average healing index was 1.4 months/cm for the tibia and 1 month/cm for the femur. Mean duration of treatment with external fixation was 6.7 months (range, 4.4–10.5 months). Thirty-eight (76%) of 50 patients experienced one or more adverse events during lengthening. We observed 78 adverse events, 35 (45%) of which required additional surgical procedures. All resolved by the end of treatment. Mechanical axis deviation improved from a mean of 15 mm medially to 8 mm medially. Simultaneous lengthening of four segments in patients with achondroplasia is a feasible strategy. Compared with isolated femoral or tibial lengthening, distributing the lengthening between the femur and tibia decreases total external fixator time.https://www.mdpi.com/2227-9067/8/9/749bone lengtheningachondroplasiaexternal fixationdistraction osteogenesis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Lior Shabtai Julio J. Jauregui John E. Herzenberg Martin G. Gesheff Shawn C. Standard Philip K. McClure |
spellingShingle |
Lior Shabtai Julio J. Jauregui John E. Herzenberg Martin G. Gesheff Shawn C. Standard Philip K. McClure Simultaneous Bilateral Femoral and Tibial Lengthening in Achondroplasia Children bone lengthening achondroplasia external fixation distraction osteogenesis |
author_facet |
Lior Shabtai Julio J. Jauregui John E. Herzenberg Martin G. Gesheff Shawn C. Standard Philip K. McClure |
author_sort |
Lior Shabtai |
title |
Simultaneous Bilateral Femoral and Tibial Lengthening in Achondroplasia |
title_short |
Simultaneous Bilateral Femoral and Tibial Lengthening in Achondroplasia |
title_full |
Simultaneous Bilateral Femoral and Tibial Lengthening in Achondroplasia |
title_fullStr |
Simultaneous Bilateral Femoral and Tibial Lengthening in Achondroplasia |
title_full_unstemmed |
Simultaneous Bilateral Femoral and Tibial Lengthening in Achondroplasia |
title_sort |
simultaneous bilateral femoral and tibial lengthening in achondroplasia |
publisher |
MDPI AG |
series |
Children |
issn |
2227-9067 |
publishDate |
2021-08-01 |
description |
Previous studies on lengthening for achondroplasia have reported bilateral extensive femoral lengthening followed by bilateral extensive tibial lengthening. To decrease trauma on soft tissues and joints, we propose bilateral simultaneous moderate femoral lengthening and moderate tibial lengthening followed by a similar repeat lengthening a few years later. Fifty patients with achondroplasia underwent 65 simultaneous bilateral femoral and tibial lengthening procedures. Segment lengthening amount and adverse events were obtained from medical records. Mean follow-up after bone healing was 35.6 months. Mean tibial lengthening was 52 mm; mean femoral lengthening was 72 mm. Average healing index was 1.4 months/cm for the tibia and 1 month/cm for the femur. Mean duration of treatment with external fixation was 6.7 months (range, 4.4–10.5 months). Thirty-eight (76%) of 50 patients experienced one or more adverse events during lengthening. We observed 78 adverse events, 35 (45%) of which required additional surgical procedures. All resolved by the end of treatment. Mechanical axis deviation improved from a mean of 15 mm medially to 8 mm medially. Simultaneous lengthening of four segments in patients with achondroplasia is a feasible strategy. Compared with isolated femoral or tibial lengthening, distributing the lengthening between the femur and tibia decreases total external fixator time. |
topic |
bone lengthening achondroplasia external fixation distraction osteogenesis |
url |
https://www.mdpi.com/2227-9067/8/9/749 |
work_keys_str_mv |
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