Tibial lengthening and concomitant foot deformity correction in 14 patients with permanent deformity after poliomyelitis.
BACKGROUND
In neuromuscular diseases, limb lengthening and foot deformity correction are associated with a high risk of complications associated with distraction callus and joint contracture. We have found no published articles of tibial lengthening and concomitant foot deformity correction using the Ilizarov method or traditional methods. To compare result of gradual distraction with triple arthrodesis for foot deformity combined with tibial lengthening, we investigated healing index and complications of two methods.


METHODS
We reviewed 14 patients with permanent deformity after poliomyelitis who underwent tibial lengthening and concomitant foot deformity correction using the Ilizarov external fixator. Tibial lengthening over an intramedullary nail was performed in 3 patients and lengthening without a nail was performed in 11 patients.


RESULTS
The mean external fixation time was 6 (3.6-10) months without nail and 1.6 (1.5-1.7) months with nail, whereas the mean healing index was 1.8 (0.8-3.1) months/cm without nail and 2 (1.8-2.3) months/cm with nail. Concomitant foot treatments included triple arthrodesis in 7 patients, pantalar arthrodesis in 2 patients with flail ankle, and gradual foot frame distraction without bony foot procedures in 5 patients. Delayed consolidation and recurrent equinus contracture of the ankle requiring additional lengthening of the Achilles tendon were the most common bone and joint complications during tibial lengthening.


CONCLUSIONS
The gradual foot frame distraction method was associated with major complications, such as recurrent foot deformity, joint luxation, and arthritis. We therefore recommend triple arthrodesis as a concomitant procedure during tibial lengthening
Song
Hae-Ryong
HR
Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul. songhae@kumc.or.kr
Myrboh
Valencia
V
Oh
Chang-Wug
CW
Lee
Sung-Tae
ST
Lee
Suk-Ha
SH
D000293:Adolescent; D000328:Adult; D001174:Arthrodesis / Q000379:methods; D001858:Bone Nails; D016267:External Fixators; D005260:Female; D005531:Foot Deformities, Acquired / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D018889:Ilizarov Technique / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011051:Poliomyelitis / Q000150:complications; D011859:Radiography; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery*