The relationship between distraction length and treatment indices during distraction osteogenesis

 To evaluate the indices used to compare the results of limb lengthening with distraction osteogenesis, we analyzed the relationship between the lengthening and external fixation period in a series of 28 patients (30 limbs). The average lengthening was 4.6  cm (range, 2.0–8.9). The average age at operation was 16.6 years (range, 4–47). Limbs treated included 15 femurs and 15 tibias of 19 male and 9 female patients. The external fixation period and the maturation period had a direct linear relationship with length gain. There was a negative hyperbolic relationship between the external fixation index, maturation index, and length gain. Segments that were lengthened 0–3.0  cm had a maturation index of 38.3 days/cm and external fixation index of 57.6 days/cm, both of which were significantly higher than for those lengthened more than 3.0  cm. When comparing the maturation and external fixation indices between different patients or studies, the length of the distraction must be taken into consideration. Received: June 14, 2001 / Accepted: January 7, 2002     

The influence of osteotomy technique on distraction osteogenesis]

The authors reviewed the clinical results of leg lengthening by distraction osteogenesis, where two different osteotomy techniques were used: classical corticotomy according to Ilizarov or osteoclasis. Evaluation of results of 64 patients were bases on orthopedic examination and detailed X-ray analysis which included criteria assessing osseous regeneration rate. In those cases where osteoclasis was performed bone formation in the distraction gap was faster than in after osteotomy. An accelerated rate of regenerate formation, as well as a more active regenerate remodelling was observed. This allowed to shorten the time of external fixator application and an earlier rehabilitation.     

The role of proximal osteomy of the tibia in the treatment of arthrosis of the knee joint]

The results of heigh tibia osteotomy performed between 1970 and 1975 in 20 cases in the material of the Orthopaedic Department of the "Semmelweis" University Medical School, Budapest, are reported. In 13 cases good--in 6 cases satisfactory results have been obtained. In 1 case the surgical intervention was of no effect. With regard to the explicit pain-relieving effect the operation is recommended by the authors in the treatment of knee arthrosis.     

Osteosarcoma around the knee. Intraepiphyseal excision and biological reconstruction with distraction osteogenesis

In 11 patients juxta-articular osteosarcoma around the knee was treated by intraepiphyseal excision of the tumour and reconstruction of the bone defect by distraction osteogenesis. Preoperative and postoperative chemotherapy was given to eight patients with high-grade tumours. The articular cartilage of the epiphysis and a maximum of healthy soft tissues were preserved. Distraction osteogenesis was then carried out. The mean gain in length was 9.7 cm. Full function of the limb was preserved in all except one patient, with a mean follow-up of 53.8 months. Treatment of juxta-articular osteosarcomas around the knee with joint preservation and biological reconstruction using distraction osteogenesis can give excellent functional results.     

Low-intensity pulsed ultrasound shortens the treatment time in tibial distraction osteogenesis

Purpose

Low-intensity pulsed ultrasound (LIPUS) has been used successfully to accelerate healing of fresh fractures and non-unions. It also improved callus maturation with distraction osteogenesis in animal trials. However, only few clinical studies are available to support its widespread use for the latter indication in humans.

Methods

Twenty-one patients undergoing callus distraction for posttraumatic tibial defects were randomized into two groups: the trial group (12 men; mean age 32 years) which received 20 minutes LIPUS daily during treatment and the control group (six men and three women; mean age 29 years) without LIPUS treatment. The Ilizarov ring fixator was used in all cases. Results were examined clinically and radiologically, analysing callus maturation with a computer-assisted measurement.

Results

Patients in the LIPUS group needed a mean of 33 days to consolidate every 1 cm of new bone in comparison to 45 days in the control group. The healing index was therefore shortened by 12 days/cm in the LIPUS group. This means that callus maturation was 27 % faster in the LIPUS group. The fixator time was shortened by 95 days in the LIPUS group. The overall daily increase in radiographic callus density was 33 % more in the LIPUS group than in the control group.

Conclusions

LIPUS treatment is an effective non-invasive adjuvant method to enhance callus maturation in distraction osteogenesis. With the help of this treatment, the healing time and the duration of external fixation can be reliably shortened.     

"High" arcuate osteotomy of the tibia in the treatment of arthrosis deformans of the knee joint]

The article shows the urgency of the problem of treatment of genu varus deformity consequent upon Stage III arthrosis deformans; nonoperative treatment of this contingent of patients was ineffective. The authors show the results of an operative method for valgoid osteotomy conducted in 52 cases; the patients' ages ranged from 42 to 78 years. The work discusses the clinical picture, techniques, and postoperative management of the patients. The late-term results were studied in follow-up periods of up to 7 years. The results were good in 92% and satisfactory in 8% of patients.     

Extraoral vs. intraoral distraction osteogenesis in the treatment of hemifacial microsomia

During hemifacial microsomia (HMF), an important phase of the treatment is elongation of the hypoplastic mandible, mainly the ramus, at an early stage. Twenty-two patients with HFM were treated with distraction osteogenesis: 12 with an extraoral device (10 unidirectional and 2 multidirectional) and 10 with an intraoral device. The mean elongation with the extraoral device was 21 mm, and with the intraoral device was 17 mm, resulting in a more symmetrical facial appearance. The advantages and disadvantages of both methods are presented, based on the authors' experience and a review of the literature. The extraoral device permits elongation of a greater distance, enables extraoral control of the vector of elongation, and conserves the gonial angle by working in many directions. The main disadvantages of the extraoral device are the social inconvenience to the patient and the extraoral cutaneous scars. Conversely, the intraoral device is much more socially convenient to the patient and avoids residual scarring. However, in 2 patients treated with an intraoral device, an undesired contralateral open bite appeared as a result of reduced vector control. The intraoral method should always be considered first because of its previously mentioned advantages. However, in severely hypoplastic patients, when three-dimensional correction and gonial angle control are necessary, or when there is a limited space along the planned distracted bone, the extraoral device has an advantage over the intraoral device.     

Management of varus knee arthrosis by high tibial osteotomy]

Authors made a follow-up of 69 varsus knee arthrosis treated with high tibial osteotomy. Beside the general results the effect of the severeness of the arthrosis before the correction and that of the gain of the axial correction on the result were also investigated. 56 (81 per cent) of the reexamined patient reported excellent or good results. The ratio of the successful operations was even higher in cases in which the femorotibial axis was corrected to physiological valgus (95 per cent). The best prognosis of the osteotomy is in the early stage of arthrosis (Ahlb?ck 0-II). In cases of the more advanced process the ratio of the unsuccessful cases increases. In consequence it is stated that the best results can be expected after osteotomies performed in the early stage and leading to the physiological femorotibial valgus position.     

Growth factors in distraction osteogenesis

Although growth factors have been demonstrated during bone healing, their presence has not yet been confirmed in callus distraction. Therefore, in 3 patients we searched for cytokines during callus distraction. Bone biopsies were immuno-histochemically stained for TGF-beta1, IGF-I, TGF-beta type II receptor, IGF receptor, and proliferating cell nuclear antigen (PCNA). Histologically we found immature woven bone in the middle of the callus zone and increasing calcification and lamellar bone in the re-modelling zone. Osteoblasts and fibroblast-like cells in the middle zone, and osteoblasts in all zones stained for TGF-beta and its receptor. The number of positive staining cells related to proliferous activity as assessed both by PCNA, and by bone density in radiographs. IGF-I could be detected everywhere. In conclusion, growth factors are present in bone formation and in areas of re-modelling during callotasis. Their relation to proliferous activity and radiographic density supports their involvement in osteogenesis.