title: The Accordion Maneuver: A Noninvasive Strategy for Absent or Delayed Callus Formation in Cases of Limb Lengthening.
abstract: The distraction osteogenesis (DO) technique has been used worldwide to treat many orthopaedic conditions. Although successful, absent or delayed callus formation in the distraction gap can lead to significant morbidities. An alternate cycle of distraction-compression (accordion maneuver) is one approach to accelerate bone regeneration. The primary aim of our study is to report our experience with the accordion maneuver during DO and to provide a detailed description of this technique, as performed in our center. The secondary aim is to present a review of the literature regarding the use of accordion maneuver. We reviewed the database of all patients undergoing limb lengthening from the year of 1997 to 2012. Four patients (6.15%) out of 65 showed poor bone regenerate in their tibiae and therefore accordion maneuver was applied for a mean of 6.75 weeks. Of these, three patients have had successful outcome with this technique. The literature showed that this technique is successful approach to trigger bone healing. However, details of how and when to apply this combination of distraction-compression forces were lacking. In conclusion, the accordion technique is safe noninvasive approach to promote bone formation, thus avoiding more invasive surgical procedures in cases of poor callus formation in limb lengthening.
authors.affiliation: Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, 1529 Cedar Avenue, Montreal, QC, Canada H3G 1A6 ; Department of Orthopaedic Surgery, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
authors.forename: Asim M
authors.initials: AM
authors.lastname: Makhdom
authors.affiliation: Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, 1529 Cedar Avenue, Montreal, QC, Canada H3G 1A6.
authors.forename: Adrian Sever
authors.initials: AS
authors.lastname: Cartaleanu
authors.affiliation: Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, 1529 Cedar Avenue, Montreal, QC, Canada H3G 1A6.
authors.forename: Juan Sebastian
authors.initials: JS
authors.lastname: Rendon
authors.affiliation: Canada Research Chair in Mechanobiology of the Pediatric Musculoskeletal System, Department of Mechanical Engineering, Polytechnique Montreal, Montreal, QC, Canada.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Villemure
authors.affiliation: Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, 1529 Cedar Avenue, Montreal, QC, Canada H3G 1A6.
authors.forename: Reggie C
authors.initials: RC
authors.lastname: Hamdy