title: Does lengthening after acute correction negatively affect bone healing during distraction osteogenesis?
abstract: OBJECTIVE
  Lengthening after acute correction has a negative effect on bone healing during distraction osteogenesis. In this study, we investigated whether correcting an acute deformity prior to lengthening resulted in a negative effect on bone healing.
  
  
  METHODS
  Patients with shortened femora were assigned to 3 matched groups. Retrograde femoral nailing after distal metaphyseal-diaphyseal osteotomy was used in all cases. Group 1 (9 femora) included cases of lengthening >4 cm using intramedullary distraction devices after acute correction. Group 2 (16 femora) included pure lengthening cases of ≥4 cm using intramedullary distraction devices. Group 3 (13 femora) included cases of lengthening ≥4 cm with lengthening and the retrograde nailing method (LORN) following acute correction.
  
  
  RESULTS
  Healing indices and full weight-bearing times of patients were evaluated. Mean lengthening values were 6.6 (range: 4-14 cm), 5.7 (range: 4-8 cm), and 5.2 cm (range: 4-6.5 cm) in Groups 1-3, respectively, and mean radiographic consolidation index and full weight-bearing times were 31.0±8.2, 30.2±5.5, and 39.0±5.0 day/cm in Groups 1-3, respectively. The consolidation index was significantly better in the Groups 1 and 2 compared to that in Group 3, but no difference was detected between Groups 1 and 2.
  
  
  CONCLUSIONS
  Acute correction had no negative effect on bone healing after distraction osteogenesis using new-generation intramedullary distraction devices. We suggest that the negative impact on healing and the prolonged consolidation index in patients undergoing LORN may be due to impaired periosteal blood supply due to fixator pins.
authors: Namık Kemal University Faculty of Medicine, Department of Orthopaedics and Traumatology, Tekirdağ, Turkey.
authors: Özgür
authors: Ö
authors: Karakoyun
authors: İstanbul Bilim University Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul, Turkey.
authors: Metin
authors: M
authors: Küçükkaya
authors: Namık Kemal University Faculty of Medicine, Department of Orthopaedics and Traumatology, Tekirdağ, Turkey.
authors: Mehmet Fatih
authors: MF
authors: Erol
mesh_terms: D000293:Adolescent; D000328:Adult; D001858:Bone Nails; D016267:External Fixators; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006801:Humans; D007870:Leg Length Inequality / Q000601:surgery*; D008297:Male; D019857:Osteogenesis, Distraction / Q000379:methods*; D010027:Osteotomy; D011859:Radiography; D016896:Treatment Outcome; D016474:Weight-Bearing; D014945:Wound Healing / Q000502:physiology*; D055815:Young Adult