Deformity correction followed by lengthening with the Ilizarov method

Deformity combined with shortening of 18 lower limb segments of 17 patients was treated with the Ilizarov method. Limb lengthening was done at the same treatment (monofocal treatment) or a separate osteotomy (bifocal treatment) was done after acute or gradual correction of the deformity using the Ilizarov hinge system. The external fixation time, amount of deformity correction, length gained, and incidence of complications were examined. Results were compared between monofocal versus bifocal treatment groups and between femoral versus tibial procedures. The average deformity corrected was 22.3 degrees, and the average lengthening was 44.4 mm. The external fixation index was 49.3 days/cm on average, ranging from 24.4 to 90 days/cm, and the mean duration of external fixation was 198 days, ranging from 77 to 352 days. Major complications requiring surgical treatment, such as premature consolidation and fracture, were seen in four patients. There were no statistically significant differences between the results for monofocal and bifocal treatment or treatment indices for femoral and tibial operations. The Ilizarov method was very effective for treatment of limb deformity combined with shortening. Monofocal treatment might be better if the total amounts of lengthening required are short to reduce surgical invasion. Longer treatment indices for tibial operations could not be verified from the current study.     

一期短缩二期延长治疗下肢Gustilo ⅢC型开放性骨折的疗效分析

目的:探讨一期短缩二期延长治疗下肢Gustilo ⅢC型开放性骨折的疗效。方法:回顾性分析武汉市第四医院骨科2010年1月至2018年1月急诊收治的12例下肢Gustilo ⅢC型开放性骨折的患者资料,男8例,女4例;年龄22~67岁,平均41.2岁。所有患者均伴有骨与皮肤软组织缺损,合并下肢神经、血管损伤。软组织缺损...     

Limb lengthening and correction of deformity in the lower limbs of children with osteogenesis imperfecta

We performed limb lengthening and correction of deformity of nine long bones of the lower limb in six children (mean age, 14.7 years) with osteogenesis imperfecta (OI). All had femoral lengthening and three also had ipsilateral tibial lengthening. Angular deformities were corrected simultaneously. Five limb segments were treated using a monolateral external fixator and four with the Ilizarov frame. In three children, lengthening was done over previously inserted femoral intramedullary rods. The mean lengthening achieved was 6.26 cm (mean healing index, 33.25 days/cm). Significant complications included one deep infection, one fracture of the femur and one anterior angulation deformity of the tibia. The abnormal bone of OI tolerated the external fixators throughout the period of lengthening without any episodes of migration of wires or pins through the soft bone. The regenerate bone formed within the time which is normally expected in limb-lengthening procedures performed for other conditions. We conclude that despite the abnormal bone characteristics, distraction osteogenesis to correct limb-length discrepancy and angular deformity can be performed safely in children with OI.     

Bifocal compression-distraction in the acute treatment of grade III open tibia fractures with bone and soft-tissue loss: a report of 24 cases

OBJECTIVE: To evaluate the results of bifocal compression-distraction method for the acute treatment of open tibia fractures with bone and soft-tissue loss. DESIGN: Patients were selected for bifocal compression-distraction (shortening and lengthening) who had open tibia fractures with bone and soft-tissue loss and a Mangled Extremity Severe Score of 6 and below indicating good leg viability. PATIENTS: Bifocal compression-distraction osteogenesis using the Ilizarov type circular external fixator was applied to 24 patients with 14 grade IIIA and 10 grade IIIB open tibia fractures with bone and soft-tissue loss. Mean age of the patients was 30.6 years (range 18-53). The mean bone defect was 5 cm (range 3-8.5). The mean soft tissue defect was 2.5 x 3.5 (1 x 2-10 x 5) cm. INTERVENTIONS: Acute shortening at the fracture site was done for patients with bone defects up to 3 cm to achieve apposition of bone ends. Gradual shortening at a rate of 2 mm/d was done for patients who had bone defects more than 3 cm. Leg length discrepancy was overcome by lengthening at the same time through a corticotomy at a proximal or distal level depending on fracture localization, until there was equalization of leg lengths. RESULTS: Mean follow-up period was 30 months (range 18-60). Mean bone healing time was 7.5 months (range 4-11). The mean time in external fixation was 7.1 months (range 3-10), and the average external fixator index was 1.4 months/cm. Results were evaluated using the Paley bone and functional assessment scores. The bone assessment results were excellent in 21 and good in 3 patients. Functional assessment scores were excellent in 19, good in 4, and fair in 1 patient. Pin site infections were present in 10.7% of the pin sites. There were 52 complications in 24 patients, for a complication rate per patient of 2.08. Of the complications, 48.1% were problems (minor complications), 38.5% obstacles (major complications requiring a surgical solution), and 13.4% sequelae (true complications). Minor complications included soft tissue inflammation and infection, translation/angulation, and delayed maturation during distraction and transient knee contracture and loss of motion. All grade 1 and 2 soft tissue inflammations and infections healed with nonoperative therapy. Major complications included pin tract infection and reinfection, equinus deformity, frame failure, and premature consolidation, all of which required additional surgery to correct the problem. Sequelae included leg length discrepancy, loss of knee/ankle range of motion, knee flexion contracture, malalignment, and chronic osteomyelitis. CONCLUSION: Bifocal compression-distraction osteogenesis is a safe, reliable, and largely successful method for the acute treatment of open tibia fractures with bone and soft-tissue loss. Further nonoperative or operative treatment can correct most complications.     

应用Orthofix重建外固定架治疗骨缺损

目的 总结应用Orthofix重建外固定架分别利用骨运输术、一期清创 短缩肢体 截骨延长技术以及一期清创 短缩肢体 二期截骨延长技术治疗26例骨缺损的经验，探索肢体安全短缩的限度。方法 在患肢上安放Orthofix重建外固定架。对17例胫骨和2例股骨骨缺损5～22cm者行骨运输术。对5例胫骨干骨缺损小于5cm合并皮肤缺损及感染者和1例股骨干骨缺损4cm合并感染者行一期清创 短缩肢体 延长技术进行治疗。对2例胫骨缺损5cm和1例股骨干骨缺损4cm者合并感染的患者采用先一期清创 部分短缩肢体，术后继续短缩肢体，二期截骨延长恢复肢体的长度。截骨术后10～14d开始延长，每天4次，每天延长1mm。16例胫骨和2例股骨在远、近缺损端相遇后于骨缺损端行清创术和自体骨植骨术。结果 平均随访13个月。骨缺损均得以重建，患肢肢体长度完全恢复，骨折愈合，无感染复发。在5例使用一期清创 短缩 延长法的胫骨缺损和1例行一期短缩 延长法的股骨缺损患者中，3例胫骨和1例股骨短缩至4cm时出现血管危象，立即恢复1cm长度后肢体远端血运恢复。术后第3天开始继续短缩肢体，每天4mm，每天4次。1例术后出现腓总神经麻痹，术后2个月恢复。4例胫骨缺损患者诉膝部疼痛。3例胫骨缺损患者出现马蹄内翻足。2例胫骨缺损患者出现下胫腓分离。结论 应用Orthofix重建外固定架进行骨运输是治疗骨缺损的有效方法，谨慎使用短缩 延长技术。对于软组织有损伤的肢体一期短缩不应超过3cm，可以于术后第2天开始继续短缩，每天短缩4mm，每天4次，每次1mm。     

应用胫骨Ⅰ期短缩加Ⅱ期延长治疗严重胫骨开放性骨折

目的 评价应用胫骨Ⅰ期短缩加Ⅱ期延长的方法治疗严重胫骨开放性骨折的临床效果.方法 自2006年5月至2009年8月应用胫骨Ⅰ期短缩加Ⅱ期延长治疗5例严重胫骨开放骨折患者,均为男性;年龄23～41岁,平均35岁.清创和胫骨短缩后用单边外固定支架临时固定,血管损伤者行动脉吻合.1例伤口Ⅰ期闭合,2例经植皮后愈合,2例分别通过腓肠神经营养支筋膜瓣和交腿皮瓣闭合伤口.伤口愈合后从胫骨近端做截骨,应用Ilizarov架行胫骨延长,恢复小腿的长度.胫骨短缩3～5 cm,平均4.2 cm.结果 所有患者术后获18～24个月(平均20个月)随访.患者骨折短缩处伤口均获愈合,无一例发生感染.全部患者骨折均获愈合,愈合时间为6～12.5个月,平均9.6个月,平均愈合指数1.7个月/cm,患肢长度均恢复,与健侧无差别.按Paley功能评价标准:优3例,良1例,可1例.结论 应用胫骨Ⅰ期短缩加Ⅱ期延长治疗严重胫骨开放性骨折,具有安全可靠、简化治疗过程及减少皮瓣应用等优点,是一种较好的方法.

Abstract：

Objective To evaluate clinical results of primary shortening plus secondary lengthening of the tibia for sever tibial fractures. Methods From May 2006 to August 2009, 5 men with severe open tibial fracture were treated with primary shortening plus secondary lengthening of the tibia in our center. They were aged from 23 to 41 years (average, 35 years) . Four cases were Gustilo type MB and one was Gustilo type M C. The primary procedure included debridement, shortening of the tibia and temporary fixation with a unilateral external fixator, and arterial anastomosis in cases of vessel injury. The wounds healed primarily in one case, after skin graft in 2 cases, and after flap transplantation in 2 cases. After wound healing, secondary lengthening of the tibia was performed following osteotomy of the proximal tibia with an Ilizarov fixator to restore the length of the injured leg. The average shortening was 4. 2 cm (range, 3 to 5 cm). Results The average follow-up period was 20 months (range, 18 to 24 months). All the wounds were healed without signs of osteomyelitis. All the fractures united. The mean bone healing time was 9. 6 months (range, 6 to 12. 5 months) . The average healing index was 1. 7 months/cm. A normal length was restored in all the affected lower limbs. By Paley functional assessment system, 3 cases were excellent, one was good and one was fair. Conclusion Primary shortening plus secondary lengthening of the tibia is a reliable and successful method for sever tibial fractures, because it can simplify management and minimize the need for flap coverage.     

Primary shortening with secondary limb lengthening for Gustilo IIIB open tibial fractures: a report of six cases

BACKGROUND: The treatment of type IIIB open tibial fractures remains a challenge for orthopedic surgeons, particularly with respect to the soft-tissue and subsequent bony reconstruction. The primary shortening and limb lengthening (PSLL) simplifies wound closure for severe open injuries without requiring microsurgical procedures as a main advantage. This method is thought to be also useful for type IIIB patients with polytrauma and other life-threatening injuries because it helps to control both wound sepsis and their general state. In the present study, we attempted to assess the problems, long-term functional outcome, and quality of life (QOL) of patients who were treated by PSLL for Gustilo type IIIB open tibial fractures in our facility. METHODS: Six patients with type IIIB open tibial fractures treated with PSLL were retrospectively reviewed. The mean shortening length was 7.4 cm (range, 4.5-10.3 cm). The mean percent shortening of the entire bone was 18.7% (range, 12.3-29.7%). Limb lengthening started at a mean interval of 10.3 months (range, 3-18 months) after the original injury. The mean healing index was 56.5 days/cm (range, 31.3-86.7 days/cm). The complications, functional outcome, and quality of life were evaluated for all cases. RESULTS: One superficial infection at the initial corticotomy, one deep infection around the shortening site, one refracture at the healed docking site, several wire breaks in external frames in two cases, and two severe equinovarus deformities occurred as complications of these procedures. Regarding functional outcome, three patients showed good outcome, two showed fair outcome, and one showed poor outcome. The percent shortening of the entire bone in the two fair cases were more than 25%. The median scale of physical health summary, mental health summary, and total general health summary in Short Form-36 (QOL) were lower than the standard scale in age-matched individuals. CONCLUSION: This PSLL treatment was thought to be a useful option for severe open fracture of the tibia, which had bony defect in more than 4.5 cm in length after serial debridement, although several complications occurred in this regimen. However, it is difficult to achieve an excellent function and QOL using these techniques. In addition, it is difficult for patients who underwent limb lengthening after shortening more than 25% of the total length of bone to gain good function.     

Is bone lengthening over an intramedullary prosthesis stem possible and safe?

Here we report the case of a 13-year-old girl with a history of massive left knee arthroplasty after excision of a proximal tibial osteosarcoma with subsequent leg length inequality. Owing to her short stature and her parents' refusal of surgical shortening by epiphysiodesis of the right lower limb, tibial lengthening over the prosthesis stem using an Ilizarov apparatus was undertaken and achieved 5 cm good quality regenerate but with a secondary infection leading to prosthesis removal. To the best of the authors' knowledge, no similar case has been previously reported in the literature. Although the goal of bone lengthening was achieved, this procedure should be avoided because of the high risk of secondary infection.     

Acute shortening and lengthening following vascular repair with a vein graft for Gustilo–Anderson type IIIC open fracture: A report of two cases

We present two cases of lower extremity open fractures with vascular injury, where acute shortening and early lengthening were performed, following vascular repair with a vein graft. The two patients sustained Gustilo–Anderson type IIIC open fractures (one patient in the tibia and the other patient in the femur) with disruption of the popliteal artery. Initially, they were treated with debridement and stabilization using an external fixator. The disruptions of the popliteal artery were repaired by interposition of a saphenous vein graft. As soon as possible after the injury, the bone segment was resected and shortening was initiated with careful monitoring of blood circulation. After the bone gap and soft-tissue defects were closed at the end of the shortening, distraction osteogenesis was carried out in the proximal part of the tibia and the femur, respectively.There is not study reporting acute shortening and early lengthening performed on patients who underwent vascular repair with a vein graft. The procedures did not affect blood circulation, and resulted in a good clinical outcome. We consider this method a safe and effective way to treat lower extremity open fractures with vascular injury and massive soft tissue defects.     

Bone transport versus acute shortening for the management of infected tibial non-unions with bone defects

IntroductionThis study compared bone transport to acute shortening/lengthening in a series of infected tibial segmental defects from 3 to 10 cm in length.MethodsIn a retrospective comparative study 42 patients treated for infected tibial non-union with segmental bone loss measuring between 3 and 10 cm were included. Group A was treated with bone transport and Group B with acute shortening/lengthening. All patients were treated by Ilizarov methods for gradual correction as bi-focal or tri-focal treatment; the treating surgeon selected either transport or acute shortening based on clinical considerations. The principle outcome measure was the external fixation index (EFI); secondary outcome measures included functional and bone results, and complication rates.ResultsThe mean size of the bone defect was 7 cm in Group A, and 5.8 cm in Group B. The mean time in external fixation in Group A was 12.5 months, and in Group B was 10.1 months. The external fixation index (EFI) measured 1.8 months/cm in Group A and 1.7 months/cm in Group B (P = 0.09). Minor complications were 1.2 per patient in the transport group and 0.5 per patient in the acute shortening group (P = 0.00002). Major complications were 1.0 per patient in the transport group versus 0.4 per patient in the acute shortening group (P = 0.0003). Complications with permanent residual effects (sequelae) were 0.5 per patient in the transport group versus 0.3 per patient in the acute shortening group (P = 0.28).ConclusionsWhile both techniques demonstrated excellent results, acute shortening/lengthening demonstrated a lower rate of complications and a slightly better radiographic outcome. Bone grafting of the docking site was often required with both procedures.Level of evidence: Level III; Retrospective comparative study     

胫骨近端缓慢延长术在下肢缩短畸形中的应用

目的研究胫骨近端缓慢延长术在下肢缩短畸形治疗中的应用。方法对27例以小腿缩短为主的下肢缩短畸形患者进行胫骨近端截骨缓慢延长治疗,并观察疗效。结果所有患者均达到预期治疗目的 ,延长达3.5～7.2cm,延长率平均为（21.63±4.02）%。结论胫骨近端缓慢延长术治疗以小腿缩短为主的下肢缩短畸形疗效较好。     

Flexible intramedullary nailing in pediatric lower limb fractures

Seventy-three children (48 boys and 25 girls; mean age, 5.7 years) with unilateral femoral or tibial shaft fractures were treated using elastic intramedullary nails at the authors' institution. There were 61 simple type A fractures (84%) and 12 wedge type B fractures (16%). All but 3 children had closed fractures. Associated injuries were seen in one third of the cases. All fractures were reduced by closed manipulation. Union was achieved in all cases without additional intervention. Technical problems occurred in few patients. Improper nail length was seen in 4 cases. None of the study patients developed deep infection. No angulation greater than 15 degrees was found after femoral fractures. Nine patients had length discrepancy greater than 10 mm. Spiral fractures showed a tendency for shortening whereas transverse fractures were more associated with post-traumatic lengthening. No significant axial malalignment or shortening was seen in tibial fractures. Torsional differences of greater than 15 degrees were detected by computed tomography or navigated ultrasound examination in nearly half of the patients; however, only 4 children had clinically apparent gait changes. The study confirms the satisfactory results of treating pediatric lower limb fractures using elastic nails. Proper surgical technique and intraoperative control of limb alignment can help avoid postoperative deformities.     

Reconstructive procedures for segmental resection of bone in giant cell tumors around the knee

Background:

Segmental resection of bone in Giant Cell Tumor (GCT) around the knee, in indicated cases, leaves a gap which requires a complex reconstructive procedure. The present study analyzes various reconstructive procedures in terms of morbidity and various complications encountered.

Materials and Methods:

Thirteen cases (M-six and F-seven; lower end femur-six and upper end tibia -seven) of GCT around the knee, radiologically either Campanacci Grade II, Grade II with pathological fracture or Grade III were included. Mean age was 25.6 years (range 19-30 years).Resection arthrodesis with telescoping (shortening) over intramedullary nail (n=5), resection arthrodesis with an intercalary allograft threaded over a long intramedullary nail (n=3) and resection arthrodesis with intercalary fibular autograft and simultaneous limb lengthening (n=5) were the procedure performed.

Results:

Shortening was the major problem following resection arthrodesis with telescoping (shortening) over intramedullary nail. Only two patients agreed for subsequent limb lengthening. The rest continued to walk with shortening. Infection was the major problem in all cases of resection arthrodesis with an intercalary allograft threaded over a long intramedullary nail and required multiple drainage procedures. Fusion was achieved after two years in two patients. In the third patient the allograft sequestrated. The patient underwent sequestrectomy, telescoping of fragments and ilizarov fixator application with subsequent limb lengthening. The patient was finally given an ischial weight relieving orthosis, 54 months after the index procedure.After resection arthrodesis with intercalary autograft and simultaneous lengthening the resultant gap (∼15cm) was partially bridged by intercalary nonvascularized dual fibular strut graft (6-7cm) and additional corticocancellous bone graft from ipsilateral patella. Simultaneous limb lengthening with a distal tibial corticotomy was performed on an ilizarov fixator. The complications were superficial infection (n=5), stress fracture of fibula (n=2). The stress fracture fibula required DCP fixation and bone grafting. The usual time taken for union and limb length equalization was approximately one year.

Conclusion:

Resection arthrodesis with intercalary dual fibular autograft and cortico-cancellous bone grafting with simultaneous limb lengthening achieved limb length equalization with relatively short morbidity.     

On the behavior of closed tibial fractures: clinical/radiological correlations

OBJECTIVE: To review the treatment of closed diaphyseal tibial fractures with functional braces and to identify patient and fracture characteristics, as well as possible correlations, that could be used to determine final outcomes. DESIGN: A comprehensive review of data obtained from 1,000 diaphyseal tibial fractures. SETTING: Major university teaching hospital. INTERVENTION: Identification of patient and fracture characteristics, including type and level of fracture, initial shortening and angulation, and severity of injury, to be correlated with final shortening and angulation and speed of healing. MAIN OUTCOME MEASUREMENTS: Degree of shortening and angulation; speed of healing. RESULTS: Neither the level nor the type of tibial fracture significantly influenced healing time, although there was a considerably higher probability of delayed union in fractures produced from vehicular accidents, as well as in comminuted and segmental fractures. Any delay in application of the functional brace resulted in slower healing. Maximum shortening of the fractures occurred at the time of the initial injury, with no additional shortening experienced after the introduction of graduated weight-bearing ambulation. Compared with a mean initial shortening of 4.25 millimeters, the overall final shortening of fractures was 4.28 millimeters. CONCLUSIONS: Correlations exist between patient and fracture characteristics that influence the final outcome for closed diaphyseal fractures treated with functional braces.     

Simultaneous treatment of tibial bone and soft-tissue defects with the Ilizarov method

OBJECTIVES: To evaluate the potential for limb salvage using the Ilizarov method to simultaneously treat bone and soft-tissue defects of the leg without flap coverage. DESIGN: Retrospective study. SETTING: Level I trauma centers at 4 academic university medical centers. PATIENTS/PARTICIPANTS: Twenty-five patients with bone and soft-tissue defects associated with tibial fractures and nonunions. The average soft-tissue and bone defect after debridement was 10.1 (range, 2-25) cm and 6 (range, 2-14) cm respectively. Patients were not candidates for flap coverage and the treatment was a preamputation limb salvage undertaking in all cases. INTERVENTION: Ilizarov and Taylor Spatial Frames used to gradually close the bone and soft-tissue defects simultaneously by using monofocal shortening or bifocal or trifocal bone transport. MAIN OUTCOME MEASUREMENTS: Bone union, soft-tissue closure, resolution or prevention of infection, restoration of leg length equality, alignment, limb salvage. RESULTS: The average time of compression and distraction was 19.7 (range, 5-70) weeks, and time to soft-tissue closure was 14.7 (range, 3-41) weeks. Bony union occurred in 24 patients (96%). The average time in the frame was 43.2 (range, 10-82) weeks. Lengthening at another site was performed in 15 patients. The average amount of bone lengthening was 5.6 (range, 2-11) cm. Final leg length discrepancy (LLD) averaged 1.2 (range, 0-5) cm. Use of the trifocal approach resulted in less time in the frame for treatment of large bone and soft-tissue defects. There were no recurrences of osteomyelitis at the nonunion site. All wounds were closed. There were no amputations. All limbs were salvaged. CONCLUSIONS: The Ilizarov method can be successfully used to reconstruct the leg with tibial bone loss and an accompanying soft-tissue defect. This limb salvage method can be used in patients who are not believed to be candidates for flap coverage. One also may consider using this technique to avoid the need for a flap. Gradual closure of the defect is accomplished resulting in bony union and soft-tissue closure. Lengthening can be performed at another site. A trifocal approach should be considered for large defects (>6 cm). Advances in technique and frame design should help prevent residual deformity.     

小腿外侧腓骨皮瓣交腿修复合并血管损伤的大段胫骨骨感染及缺损

 目的 探讨小腿外侧腓骨皮瓣交腿修复合并血管损伤、大面积皮肤软组织缺损的大段胫骨骨感染及缺损的疗效。方法 回顾性分析2004 年9 月至2008 年9月治疗8 例合并血管损伤的大段胫骨骨感染及缺损患者资料, 男6 例, 女2 例;年龄19~55 岁, 平均36 岁;病史2 周至3 个月, 平均2 个月;胫骨缺损长度8~20 cm, 平均13 cm;皮肤缺损面积10 cm x 7 cm~22 cm x 12 cm。彻底清创, 根据皮肤软组织缺损面积及胫骨缺损长度在健侧小腿设计外侧腓骨皮瓣的切取范围、腓骨切取长度、切取位置。切取皮瓣及腓骨, 将双下肢交叉于蒂部松弛位置, 外固定支架固定, 腓骨修复胫骨骨缺损, 外固定支架一期重建胫骨稳定性, 皮瓣覆盖创面修复皮肤软组织缺损。术后4~6 周, 二次手术断蒂。结果 8 例患者全部获得随访, 随访时间6~36 个月, 平均24 个月。术后8 例移植组织全部成活, 无一例发生感染及骨髓炎, 皮瓣均在术后2 周顺利愈合;骨折愈合时间6~15 个月, 平均11 个月;移植皮瓣外形良好;患者基本恢复负重行走功能。末次随访时, 根据Edwards 胫骨骨折评定标准, 优4 例, 良2 例, 差2 例。结论 小腿外侧腓骨皮瓣交腿修复合并血管损伤、大面积皮肤软组织缺损的大段胫骨骨感染及缺损具有手术操作相对简单、成功率高、疗效好等优点, 可恢复患者下肢行走功能。     

Outcome of limb reconstruction system in open tibial diaphyseal fractures

Background:Management of open tibial diaphyseal fractures with bone loss is a matter of debate. The treatment options range from external fixators, nailing, ring fixators or grafting with or without plastic reconstruction. All the procedures have their own set of complications, like acute docking problems, shortening, difficulty in soft tissue management, chronic infection, increased morbidity, multiple surgeries, longer hospital stay, mal union, nonunion and higher patient dissatisfaction. We evaluated the outcome of the limb reconstruction system (LRS) in the treatment of open fractures of tibial diaphysis with bone loss as a definative mode of treatment to achieve union, as well as limb lengthening, simultaneously.Results:Mean followup period was 15 months. The mean bone loss was 5.5 cm (range 4-9 cm). The mean duration of bone transport was 13 weeks (range 8-30 weeks) with a mean time for LRS in place was 44 weeks (range 24-51 weeks). The mean implant index was 56.4 days/cm. Mean union time was 52 weeks (range 31-60 weeks) with mean union index of 74.5 days/cm. Bony results as per the ASAMI scoring were excellent in 76% (19/25), good in 12% (3/25) and fair in 4% (1/25) with union in all except 2 patients, which showed poor results (8%) with only 2 patients having leg length discrepancy more than 2.5 cm. Functional results were excellent in 84% (21/25), good in 8% (2/25), fair in 8% (2/25). Pin tract infection was seen in 5 cases, out of which 4 being superficial, which healed to dressings and antibiotics. One patient had a deep infection which required frame removal.Conclusion:Limb reconstruction system proved to be an effective modality of treatment in cases of open fractures of the tibia with bone loss as definite modality of treatment for damage control as well as for achieving union and lengthening, simultaneously, with the advantage of early union with attainment of limb length, simple surgical technique, minimal invasive, high patient compliance, easy wound management, lesser hospitalization and the lower rate of complications like infection, deformity or shortening.     

双轴重合法胫骨干骺端截骨骨延长术

目的：探讨双轴重合法在骨延长术中的应用。方法：回顾性分析54例应用双轴重合法胫骨干骺端截骨骨延长术进行治疗的肢体，其中小儿麻痹症后遗症26例，创伤后双下肢不等长13例，软骨发育不全4例，遗传性矮身材6例，骨斑点病合并双下肢不等长1例，垂体性侏儒症4例。男28例，女26例；平均年龄22岁。所有患者均采用半环形双槽外固定架固定肢体并延长。结果：术后随访18-45个月，平均24．5个月。所有患者均得到肢体延长，延长幅度5—12cm，平均6．2cm。单纯足下垂1例，足下垂合并足外翻2例，较严重针孔感染l例，骨延迟愈合1例。结论：应用双轴重合法胫骨干骺端截骨骨延长术后遗症明显减少，其中骨性并发症减少尤其明显．并降低了手术操作要求，是比较理想的骨延长方法。     

脊髓灰质炎后遗症下肢不等长外科治疗策略(附1 582例报告)

目的 :探讨脊髓灰质炎后遗症下肢不等长外科治疗策略 ,介绍胫骨延长的新手术方法。方法 :回顾性分析 1985年 9月～ 2 0 0 3年 5月共收治脊髓灰质炎后遗症下肢不等长 15 82例 ,根据患者的年龄和下肢短缩的不同类型 ,应用 10种下肢均衡术 ,研制了复合式小腿延长器。结果 :15 2 9例术后获得了 3个月以上随访 ,下肢均衡最少1cm ,最多 11 3cm。未发生 1例严重手术并发症。结论 :根据下肢短缩的不同类型 ,选择适合的手术方式 ,方能获得优良效果 ,新研制的复合式小腿延长器 ,能一期矫正小腿短缩和足踝畸形。     

Limb lengthening and deformity correction with externally controlled motorized intramedullary nails: evaluation of 50 consecutive lengthenings

Background and purpose — Limb lengthening with an intramedullary motorized nail is a relatively new method. We investigated if lengthening nails are reliable constructs for limb lengthening and deformity correction in the femur and the tibia.

Patients and methods — 50 lengthenings (34 Precice and 16 Fitbone devices) in 47 patients (mean age 23 years [11–61]) with ≥12 months follow-up are included in this study. 30 lengthenings were done due to congenital and 20 because of posttraumatic deformity (21 antegrade femora, 23 retrograde femora, 6 tibiae). Initial deformities included a mean shortening of 42?mm (25–90). In 15 patients, simultaneous axial correction was done using the retrograde nailing technique.

Results — The planned amount of lengthening was achieved in all but 2 patients. 5 patients who underwent simultaneous axial correction showed minor residual deformity; unintentionally induced minor deformities were found in the frontal and sagittal plane. The consolidation index was 1.2 months/cm (0.6–2.5) in the femur and 2.5 months/cm (1.6–4.0) in the tibia. 2 femoral fractures occurred in retrograde femoral lengthenings after consolidation due to substantial trauma. There were 8 complications, all of which were correctable by surgery, with no permanent sequelae.

Interpretation — Controlled acute axial correction of angular deformities and limb lengthening can be achieved by a motorized intramedullary nail. A thorough preoperative planning and intraoperative control of alignment are required to avoid residual and unintentionally induced deformity. In the femur relatively fast consolidation could be observed, whereas healing was slower in the tibia.