title: Tibial lengthening: extraarticular calcaneotibial screw to prevent ankle equinus.
abstract: Between 2003 and 2006, we used an extraarticular, cannulated, fully threaded posterior calcaneotibial screw to prevent equinus contracture in 10 patients (four male and six female patients, 14 limbs) undergoing tibial lengthening with the intramedullary skeletal kinetic distractor. Diagnoses were fibular hemimelia (two), mesomelic dwarfism (two), posteromedial bow (one), hemihypertrophy (one), poliomyelitis (one), achondroplasia (one), posttraumatic limb-length discrepancy (one), and hypochondroplasia (one). Average age was 24.5 years (range, 15-54 years). The screw (length, typically 125 mm; diameter, 7 mm) was inserted with the ankle in 10 degrees dorsiflexion. Gastrocnemius soleus recession was performed in two patients to achieve 10 degrees dorsiflexion. Average lengthening was 4.9 cm (range, 3-7 cm). Screws were removed after a mean 3.3 months (range, 2-6 months). Preoperative ankle range of motion was regained within 6 months of screw removal. No neurovascular complications were encountered, and no patients experienced equinus contracture. We also conducted a cadaveric study in which one surgeon inserted screws in eight cadaveric legs under image intensifier control. The flexor hallucis longus muscle belly was the closest anatomic structure noted during dissection. The screw should be inserted obliquely from upper lateral edge of the calcaneus and aimed lateral in the tibia to avoid the flexor hallucis longus muscle.
  
  
  METHODS
  Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: SPARSH Hospital, Bangalore, India.
authors.forename: Mohan V
authors.initials: MV
authors.lastname: Belthur
authors.forename: Dror
authors.initials: D
authors.lastname: Paley
authors.forename: Gaurav
authors.initials: G
authors.lastname: Jindal
authors.forename: Rolf D
authors.initials: RD
authors.lastname: Burghardt
authors.forename: Stacy C
authors.initials: SC
authors.lastname: Specht
authors.forename: John E
authors.initials: JE
authors.lastname: Herzenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000843:Ankle Joint; D001852:Bone Lengthening; D001863:Bone Screws; D002111:Calcaneus / Q000601:surgery; D004480:Ectromelia / Q000601:surgery; D004863:Equinus Deformity / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019857:Osteogenesis, Distraction; D011183:Postoperative Complications / Q000517:prevention & control; D013977:Tibia / Q000601:surgery
references.citation: Acta Orthop Scand. 1991 Aug;62(4):327-32
references.pmid: 1882670
references.citation: Clin Orthop Relat Res. 1990 Jan;(250):81-104
references.pmid: 2403498
references.citation: Orthop Clin North Am. 1991 Oct;22(4):633-41
references.pmid: 1945341
references.citation: Acta Orthop Scand. 1994 Aug;65(4):447-55
references.pmid: 7976296
references.citation: Rev Chir Orthop Reparatrice Appar Mot. 1994;80(6):532-41
references.pmid: 7784649
references.citation: J Am Coll Surg. 1996 May;182(5):394-402
references.pmid: 8620274
references.citation: J Pediatr Orthop. 1996 Mar-Apr;16(2):168-72
references.pmid: 8742278
references.citation: Clin Orthop Relat Res. 1997 Apr;(337):281-90
references.pmid: 9137201
references.citation: Clin Orthop Relat Res. 1997 Oct;(343):135-43
references.pmid: 9345218
references.citation: J Bone Joint Surg Am. 1999 May;81(5):624-34
references.pmid: 10360691
references.citation: Oper Orthop Traumatol. 2005 Feb;17(1):79-101
references.pmid: 16007380
references.citation: Acta Orthop. 2005 Apr;76(2):261-9
references.pmid: 16097554
references.citation: J Bone Joint Surg Br. 2006 Jul;88(7):938-42
references.pmid: 16799000
references.citation: Am J Emerg Med. 1992 Jan;10(1):14-7
references.pmid: 1736906
references.citation: Orthop Clin North Am. 1991 Oct;22(4):723-34
references.pmid: 1945348
references.citation: Clin Orthop Relat Res. 2000 Oct;(379):259-69
references.pmid: 11039815
references.citation: Injury. 2001 Dec;32 Suppl 4:SD129-39
references.pmid: 11812486
references.citation: J Pediatr Orthop. 2002 May-Jun;22(3):371-4
references.pmid: 11961458
references.citation: J Bone Joint Surg Am. 2003 May;85-A(5):838-48
references.pmid: 12728034
references.citation: Arch Orthop Trauma Surg. 2004 Mar;124(2):129-33
references.pmid: 14745566
references.citation: Clin Orthop Relat Res. 1978 Oct;(136):92-104
references.pmid: 729307
references.citation: Clin Orthop Relat Res. 1979 Nov-Dec;(145):150-3
references.pmid: 535265
references.citation: J Pediatr Orthop. 1987 Mar-Apr;7(2):135-8
references.pmid: 3558792
references.citation: J Pediatr Orthop. 1988 Jan-Feb;8(1):73-92
references.pmid: 3275690
references.citation: Dev Med Child Neurol. 1988 Feb;30(1):3-10
references.pmid: 3371569
references.citation: Orthop Clin North Am. 1991 Oct;22(4):625-31
references.pmid: 1945340