title: Risk factors for and complications of distraction osteogenesis.
abstract: OBJECTIVE
  Distraction osteogenesis is commonly used for limb deformities and reconstruction of bone defects with satisfactory outcome for the patients. However, it is associated with a risk of complications. The present study aims to assess the incidence of complications and to identify the risk factors that may predict distraction osteogenesis-related complications.
  
  
  METHODS
  We retrospectively studied 63 patients (mean age 13.5 years; range 3-57 years) who had 74 distraction osteogenesis procedures from 2004 to 2009. A circular external fixator was used in 58 procedures, and a monolateral in 16 procedures. Fixator's time, days of treatment, lengthening percentage, bone healing index, distraction regenerate length and index, risk factors and complications were evaluated. The mean follow-up was 5 years (range 2-7 years).
  
  
  RESULTS
  Complications occurred in 57 of the 74 procedures (77%); 70% were major complications and 30% were minor. Complications were more common in adults. Bone healing index, days of treatment and fixator's time were univariate predictors of complications. Bone healing index and adult age were the only multivariate predictors of complications.
  
  
  CONCLUSIONS
  Adult age and bone healing index are the most important multivariate predictors of distraction osteogenesis-related complications. Routine follow-up after implant removal, selection of younger patients with minor risk factors and shorter fixator's time are necessary to reduce the rate of distraction osteogenesis-related complications.
authors.affiliation: First Department of Orthopaedics, ATTIKON University Hospital, Athens University Medical School, 41 Ventouri Street, 15562, Holargos, Athens, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Liantis
authors.forename: Andreas F
authors.initials: AF
authors.lastname: Mavrogenis
authors.forename: Nikolaos A
authors.initials: NA
authors.lastname: Stavropoulos
authors.forename: Anastasios D
authors.initials: AD
authors.lastname: Kanellopoulos
authors.forename: Panayiotis J
authors.initials: PJ
authors.lastname: Papagelopoulos
authors.forename: Panayotis N
authors.initials: PN
authors.lastname: Soucacos
authors.forename: George C
authors.initials: GC
authors.lastname: Babis
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005592:Fracture Fixation / Q000706:statistics & numerical data; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D007870:Leg Length Inequality / Q000503:physiopathology / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019857:Osteogenesis, Distraction / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult