title: Paediatric lower limb deformity correction using the Ilizarov technique: a statistical analysis of factors affecting the complication rate.
abstract: Limb length discrepancy (LLD) and other patient factors are thought to influence the complication rate in (paediatric) limb deformity correction. In the literature, information is conflicting. This study was performed to identify clinical factors that affect the complication rate in paediatric lower-limb lengthening. A consecutive group of 37 children was analysed. The median proportionate LLD was 15 (4-42)%. An analysis was carried out on several patient factors that may complicate the treatment or end result using logistic regression in a polytomous logistic regression model. The factors analysed were proportionate LLD, cause of deformity, location of corrected bone, and the classification of the deformity according to an overall classification that includes the LLD and all concomitant deformity factors. The median age at the start of the treatment was 11 (6-17) years. The median lengthening index was 1.5 (0.8-3.8) months per centimetre lengthening. The obstacle and complication rate was 69% per lengthened bone. Proportionate LLD was the only statistically significant predictor for the occurrence of complications. Concomitant deformities did not influence the complication rate. From these data we constructed a simple graph that shows the relationship between proportionate LLD and risk for complications. This study shows that only relative LLD is a predictor of the risk for complications. The additional value of this analysis is the production of a simple graph. Construction of this graph using data of a patient group (for example, your own) may allow a more realistic comparison with results in the literature than has been possible before.
authors.affiliation: aDepartments of Pediatric Orthopaedics, Juliana Children Hospital, The Hague bWilhelmina Children Hospital, University Medical Center Utrecht, Utrecht cDepartment of Biostatistics, University Medical Center Leiden, Leiden, The Netherlands.
authors.forename: Hubert J
authors.initials: HJ
authors.lastname: Oostenbroek
authors.forename: Ronald
authors.initials: R
authors.lastname: Brand
authors.forename: Peter M
authors.initials: PM
authors.lastname: van Roermund
authors.forename: René M
authors.initials: RM
authors.lastname: Castelein
mesh_terms: D000293:Adolescent; D017760:Bone Malalignment / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D005260:Female; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D018889:Ilizarov Technique / Q000009:adverse effects*; D015994:Incidence; D007870:Leg Length Inequality / Q000000981:diagnostic imaging / Q000601:surgery*; D017880:Limb Deformities, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013977:Tibia / Q000601:surgery; D016896:Treatment Outcome