Submuscular plating after distraction osteogenesis in children.
Although distraction osteogenesis has solved limb length discrepancies, many complications are inevitable from long duration of external fixation. Use of intramedullary nails for early removal of fixators has its own challenges especially in pediatric age group. To facilitate early removal of external fixators in children, we tried a novel method of submuscular plating over the distraction callus, which is described, and the results and complications of this technique are presented. In eight children (four girls and four boys), of limb lengthening (four cases) and bone transport (four cases) done in three femurs and five tibiae with external fixators (five Ilizarov ring fixators and three monofixators), submuscular plating was done over the distraction callus. The causes of limb length discrepancy included traumatic and septic growth arrest, congenital pseudoarthrosis of tibia, fibular hemimelia, tumor salvage, and Perthes' disease. The purpose of plating was to remove the external fixator earlier after achieving the target length. Mean age of plating procedure was 11.62 years, and mean amount of distraction was 5.47 cm. In all patients, the distraction callus healed on maintaining its length or correcting into the original alignment. The mean external fixation index was 26.93 days/cm and healing index was 52.01 days/cm. One complication of superficial pin-track infection occurred, which resolved completely with conservative treatment. None of the patients developed deep infection or implant failures. The mean follow-up after plating was 28 months (range, 18-62 months). Submuscular plating over the distraction callus may be a successful method that permits early removal of fixator with fewer complications. This method can be a useful alternative in children or when nailing is difficult.
Oh
Chang-Wug
CW
Kyungpook National University Hospital, Daegu, Republic of Korea. cwoh@knu.ac.kr
Shetty
Gautam M
GM
Song
Hae-Ryong
HR
Kyung
Hee-Soo
HS
Oh
Jong-Keon
JK
Min
Woo-Kie
WK
Lee
Byung-Woo
BW
Park
Byung-Chul
BC
D000293:Adolescent; D001860:Bone Plates; D002648:Child; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D018889:Ilizarov Technique; D007870:Leg Length Inequality / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D019857:Osteogenesis, Distraction / Q000295:instrumentation* / Q000379:methods; D010149:Postoperative Pain / Q000503:physiopathology; D011183:Postoperative Complications / Q000503:physiopathology; D011859:Radiography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology