Surgical technique and outcomes for bilateral humeral lengthening for achondroplasia: 26-year experience.

BACKGROUND: Elongation in patients with achondroplasia provides better overall skeletal proportionality and significantly improves such individuals' access to their perineal region to self-manage personal hygiene. This paper describes our surgical technique and outcomes for bilateral humeral lengthening in achondroplasia patients over 26 years. METHODS: Ours was a retrospective study of 55 patients with achondroplasia-related short stature, in whom bilateral humeral lengthening was performed from 1990 to 2016. We describe the surgical technique and analyze mean gain in humeral length, days using an external fixator, mean percentage of lengthening, external fixation index, type of callus, and complications. Pre- and postoperative radiographic measurements were obtained. Patients also were contacted by telephone and asked about their ability to perform peri-anal self-hygiene and about their overall satisfaction. RESULTS: In total, 110 humeri were lengthened (28 males and 27 females) with medium elongation of 9.5 cm on the right and 9.6 cm on the left, while averaging 220 days in an external fixator. We observed 14 minor complications. There was no significant association between pin position and type of callus, and elongation most often external and in the presence of a straight callus. Before elongation, 77.1% of patients reported difficulties with perineal hygiene and 85.4% could not put their hands in their pockets. Upon completion of lengthening, 100% could perform both tasks and 94.5% were very satisfied. CONCLUSIONS: Bilateral humeral elongation yields significant improvements in patient autonomy, with a relatively low complication rate and very high patient satisfaction.

Lengthening of the lower limbs and correction of lumbar hyperlordosis in achondroplasia.

The analysis of more than 500 elongations carried out over a period of 15 years has led to the development of a technique of elongation of limbs in which surgical trauma and operative risk have been reduced to a minimum since all of the surgical stages are performed percutaneously. This technique results in overall elongations of more than 30 cm in the lower limbs, which makes it highly effective in the correction of short stature (achondroplasia, osteochondrodysplasia, hypopituitarism, Turner's syndrome) and severe limb length discrepancy. The techniques are used for elongating tibiae and femora as well as the modifications required to decrease lumbar hyperlordosis after lengthening of the femur. A review of the results and complications of the latest series treated with this technique consists of 208 tibiae and 156 femura.

Lengthening of the lower limbs and correction of lumbar hyperlordosis in achondroplasia.

This paper describes the technical development as well as results obtained with the method of bone lengthening developed by the author and used over the past fifteen years for the treatment of short-statured conditions not susceptible to hormonal treatment.