title: Distraction by a monotube fixator to achieve limb lengthening: predictive factors for tibia trauma.
abstract: BACKGROUND
  Management of post trauma tibia bone gap varied with orthopedic surgeons' experience and tools available. Study aims to determine predictive factors for distraction by a monotube fixator (DMF) outcome in post tibia trauma limb length discrepancy.
  
  
  METHODS
  A prospective descriptive cross sectional study of post traumatized tibia bone gap and limb length discrepancy patients at tertiary hospitals. Patient's informed consent and institutional ethical committee approval were obtained. Bio-data, clinical and healing indexes were documented. DMF was applied for patient that met inclusion criteria. The Statistic tests used included the Chi-square, the Student's two-tailed t test, and the Wilcox on rank-sum test when appropriate. Mantel-Haenszel Common Odds Ratio (OR) and 95% confidence intervals for poor outcome potential risk factors were recorded. Bivariate correlation and logistic regression were evaluated. Significance level was set at a p value <0.05.
  
  
  RESULTS
  Thirty-six patients with mean age, 37.2 ± 10.3 year and male/female ratio of 1:1.25 had DMF applied. Motorcycle accident accounted for 50.0% of patients and diaphyseal segment was most commonly affected 25 (69.4%). The mean bone lengthened was 10.1 ± 4.0 cm (range: 5-21 cm) and mean duration of bone transport was 105.6 ± 38.2 days. The means of rate of distraction, healing index and percentage of lengthening were 0.99 ± 0.14 mm/day, 15.6 ± 4.3 days/cm and 38.0 ± 14.3 respectively. The mean follow up was 9.7 ±4.9 months (range: 2-17.0). Per operative complications varied and outcome was satisfactory in 30 (83.3%). Obesity (p <0.0001), multiple surgery (p = 0.012) and transfusion (p = 0.001) correlated to poor outcome. Percentage lengthening ≥ 50%, bone gap >10 cm, anemia, blood transfusion, general anesthesia administration, distraction rate >1 mm/day, osteomyelitis and prolong partial weight bearing were significant predictive factors for poor outcome in post traumatic tibia distraction.
  
  
  CONCLUSIONS
  Distraction by a monotube fixator appears effective in achieving correction >38.0% original tibia lengthening following traumatic bone gap. Predictive factors for poor outcome were useful for prognostication.
authors.affiliation: Department of Orthopedic Surgery & Traumatology, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria. olayinkaadegbehingbe@yahoo.co.uk.
authors.forename: Olayinka O
authors.initials: OO
authors.lastname: Adegbehingbe
authors.forename: Owolabi D
authors.initials: OD
authors.lastname: Ojo
authors.forename: Paul O
authors.initials: PO
authors.lastname: Abiola
authors.forename: Abimbola L
authors.initials: AL
authors.lastname: Ariyibi
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Oginni
authors.forename: John A
authors.initials: JA
authors.lastname: Obateru