Complications of limb lengthening. A learning curve.
Major complication rates during limb lengthening were plotted in a consecutive series to produce a learning curve. All unwanted events during and after treatment were considered complications, and graded as minor, serious, and severe. All serious and severe complications were considered major. A novel system was used to classify the preoperative severity of each deformity. One-hundred ten patients had 140 bone segments lengthened between 2.2 cm and 10.5 cm, with a mean of 4.4 cm. Three methods were used in lengthening: the Wagner method in 22 patients, the DeBastiani method in 34 patients, and the Ilizarov method in 84 patients. Ninety-eight complications categorized as serious or severe occurred, for a total major complication rate of 72%. The percentage of major complications began to drop after 30 lengthenings to a current rate of 25%. Major complications were frequent in patients with more severe deformities, particularly in those whose cases occurred early in the series. Bone healing complications were high (72%) in the Wagner segments but were also high (80%) in the first ten patients treated with the DeBastiani technique. The first ten Ilizarov patients, who were treated later in the series, had a 40% rate of bone-healing complications. The current rate of major complications is 13% for those patients treated with DeBastiani's method and 33% for those patients treated with Ilizarov's method. This difference in complication rates appears to relate to the severity of the deformity, rather than the device used. There was a significant decrease in complications as experience was gained. Directed formal study and surgical instruction should help diminish these complications.
Dahl
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Limb Length Clinic, Gillette Children's Hospital, St. Paul, MN 55101.
Gulli
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Berg
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D000293:Adolescent; D000328:Adult; D001852:Bone Lengthening / Q000009:adverse effects* / Q000295:instrumentation; D016723:Bone Remodeling; D002648:Child; D002675:Child, Preschool; D016267:External Fixators; D005260:Female; D006801:Humans; D016916:Joint Deformities, Acquired / Q000145:classification / Q000601:surgery; D007870:Leg Length Inequality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014945:Wound Healing