title: Plate-assisted Lengthening of the Femur and Tibia in Pediatric Patients.
abstract: BACKGROUND
  Limb lengthening over a percutaneous plate can be used during pediatric distraction osteogenesis to decrease the time of external fixation.
  
  
  METHODS
  A retrospective, consecutive 2-surgeon experience of pediatric femoral and tibial lengthenings with a plate-assisted lengthening (PAL) technique was performed. The plate was placed at the time of index corticotomy. The primary outcome measures of external fixation index, consolidation index, and complications were assessed for each lengthening.
  
  
  RESULTS
  From 2005 to 2012, 38 lengthenings (23 femur, 15 tibia) in 30 patients were performed by a PAL technique. All patients experienced successful distraction and consolidation. The average achieved lengthening was 3.80±0.98 cm (range, 2.2 to 6.4) with an average consolidation index of 27 days/cm and a mean external fixation index of 13.1±4.29 days/cm (range, 7.8 to 30). Patients returned to full weight-bearing activity after an average of 98.3±28.5 days. There were an average of 1.08±1.05 total complications and 0.39±0.75 severe complications per lengthening. Complications were encountered most commonly during femoral lengthening, including procurvatum and varus deformity through the regenerate. These deformities were usually corrected by frame adjustment before removal.
  
  
  CONCLUSIONS
  PAL is a safe technique that minimizes time of external fixation, accelerates rehabilitation and weight-bearing, and can be successfully used on the femur or tibia. The most common complications are angular deformities of the regenerate that can be treated with adjustment before or at the time of plate locking.
  
  
  METHODS
  Level IV-retrospective case series.
authors.affiliation: *Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI †University of Minnesota Medical School, Minneapolis, MN ‡Department of Orthopaedic Surgery, Gillette Children's Specialty Healthcare, St Paul, MN §Department of Orthopaedic Surgery, Nemours Children's Health System, Orlando, FL.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Georgiadis
authors.forename: Jeffrey K
authors.initials: JK
authors.lastname: Rossow
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Laine
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Iobst
authors.forename: Mark T
authors.initials: MT
authors.lastname: Dahl
mesh_terms: D000293:Adolescent; D001860:Bone Plates; D002648:Child; D002675:Child, Preschool; D016267:External Fixators / Q000009:adverse effects; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007870:Leg Length Inequality / Q000601:surgery*; D008297:Male; D019857:Osteogenesis, Distraction / Q000379:methods*; D011859:Radiography; D012107:Research Design; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome