[Analysis of the results of bone healing in femurs lengthened by the gradual distraction method in children and adolescents].
OBJECTIVE
Treatment of leg length inequality via lengthening of the shorter extremity is an infrequent orthopedic procedure due to the requirement of special distraction devices and possible serious complications. Essential qualitative changes in operative technique development are associated with the name of G. A. Ilizarov, who paved the way for the autoregenerate gradual distraction method in the 1950s.


METHODS
In the years 1990 through 2007 a total of 67 patients underwent femur lengthening via gradual distraction using various types of external fixators at the Department of Pediatric Surgery, Orthopedics, and Traumatology, Faculty Hospital in Brno. The quality of bone healing was monitored and a number of parameters followed and statistically evaluated using regularly scheduled X-ray examinations.


RESULTS
In 13 cases we had to remove the external fixator following the distraction phase, perform an osteosynthesis via a splint and fill the distraction gap via spongioplasty. The bone healing was satisfactory in the remaining 54 patients and the lengthened bone required no other fixation method. The analysis showed statistically significant deceleration in bone healing following distraction in female patients over 12 years of age, and in boys over 14 years of age. Lack of periosteal callus five weeks after surgery always signified serious problems in further healing. Severe complications were recorded in 11 cases during the distraction phase, and in 12 cases after the removal of the distraction apparatus.


CONCLUSIONS
Our results fully correspond with the data and experience of others cited authors. In addition our study showed deceleration in bone healing in girls over 12 years and in boys over 14 years of age and serious problem in healing when is lack of periostal callus five weeks after surgery.


CONCLUSIONS
The aim of this report was to present the results of our study of distraction gap bone healing using the gradual lengthening approach. Key words: leg lengthening, gradual distraction, external fixation, leg discrepancy, complication.
Jochymek
J
J
Klinika detské chirurgie, ortopedie a traumatologie FN a LF MU, Brno. jockymek@fnbrno.cz
Skvaril
J
J
Ondrus
S
S
D000293:Adolescent; D001861:Bone Regeneration; D002648:Child; D016267:External Fixators; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007870:Leg Length Inequality / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D019857:Osteogenesis, Distraction / Q000295:instrumentation; D011859:Radiography