Pseudoaneurysm as an unusual complication in bone lengthening.

One of the risks of distraction osteogenesis-based techniques is the development of vascular complications, such as pseudoaneurysms associated with the osteotomies performed or the fixation elements of the external fixator used in the procedure. Pseudoaneurysm are formed when the tunica adventitia of the artery is injured, resulting in a gradual and persistent blood extravasation into the surrounding tissues that is encapsulated and connected to the arterial lumen. This report describes a rare case of a late-presentation pseudoaneurysm in the anterior tibial artery resulting from a tibial lengthening procedure aimed at addressing a leg length discrepancy in a 57-year-old female with severe peripheral neuropathy resulting from long-standing poorly controlled diabetes mellitus. We describe the diagnostic process, the treatment options and confirm how the shape of the bony callus can be a reliable indicator of this pathology, as has already been described in the literature.

Aquatic therapy in congenital malformation during the use of external fixator for bone lengthening: It is possible?

OBJECTIVES: The objective of this study is to describe the rehabilitation of individuals with Congenital Malformations (CMF) during the use of an External Fixator (EF) in Aquatic Therapy (AT) and to analyze the association between diagnosis, EF type and location with rehabilitation process outcomes, surgical intervention, and adverse effects. METHODS: This retrospective study included 29 medical records from which the personal and rehabilitation data of the patient were collected. The AT used was described and the outcome variables were associated. The medical records were selected by screening the database of the CMF clinic at the AACD. The inclusion criteria were participants with CMF who used EF treated between 2011 and 2019 of both genders and without age restriction. The exclusion criteria were incomplete medical record data or not undergoing AT while using EF. The extracted data included diagnosis, gender, age, EF type and location, objective of the surgery, adverse events, surgical interventions, time of rehabilitation in AT, physiotherapeutic objectives, and rehabilitation process outcomes in AT. RESULTS: The mean age of the participants was 12.1 ± 3.99 years, with male predominance (55 %) and hemimelia cases (37 %). The most used EF was circular (51 %), located in the femur (37 %), and the main objective of surgery was bone lengthening (52 %). The most recurrent adverse effect was infection (62 %) and 76 % completed AT. There was no association between the variables analyzed. CONCLUSIONS: It was possible to describe CMF rehabilitation with EF in AT. There was no association between the variables analyzed.

Research progress on applications and mechanisms of osteogenesis effect of magnetic fields in oral field / 口腔疾病防治

@#Magnetic fields are safe and used in noninvasive physical therapies. Numerous studies have confirmed that magnetic fields have good osteogenic effects and certain value for clinical application in accelerating orthodontic tooth movement, promoting bone-implant integration, promoting fracture healing and improving the effects of distraction osteogenesis. Magnetic fields are expected to become applied as effective auxiliary methods for treating oral diseases. To support the clinical application of magnetic fields, this article reviews the applications of magnetic fields in the oral cavity, the biological effects on bone cells and the molecular mechanisms through which magnetic fields regulate bone metabolism. The biological effects of magnetic fields on bone cells include promoting osteogenesis by osteoblasts and mesenchymal stem cells and inhibiting bone resorption by osteoclasts. At the molecular level, bone cells sense and respond to magnetic stimulation, and through various mechanisms, such as displacement currents, Lorentz forces, and free radical pair effects, stimuli are transformed into biologically recognizable electrical signals that activate complex downstream signaling pathways, such as the P2 purinergic receptor signaling pathway, adenosine receptor signaling pathway, transforming growth factor-β receptor signaling pathway, mammalian target of rapamycin (mTOR) pathway, and Notch pathway. In addition, magnetic parameters, which are the factors affecting the osteogenic effects of magnetic fields, are discussed. However, the mechanisms of the osteogenic effects of magnetic fields are unclear, and further studies of these mechanisms could provide effective strategies for bone regeneration and periodontal tissue regeneration. In addition, considering the target of magnetic field therapies, combination with other drugs could lead to new strategies for the treatment of oral diseases.

[Options and limits of leg length correction in paediatric orthopaedics]. / Möglichkeiten und Grenzen der Beinlängenkorrektur in der Kinderorthopädie.

For paediatric orthopaedic surgeons treating leg length discrepancy, knowledge of the available procedures and their options and limits is just as important as mastery of the very different surgical methods and implants, as well as the possible complications, in order to be able to advise and treat the children and adolescents and their parents comprehensively and in the best interests. Both the growth inhibiting procedures and the complex bone lengthening procedures require a great deal of experience to successfully guide patients and families through what is often a lengthy and sometimes complicated treatment process. Careful preoperative indications and planning, precise surgical techniques with suitable instruments and implants, and attentive postoperative check-ups are mandatory prerequisites for the desired therapeutic success.

[Possibilities of orthopedic technical care for extremity lengthening and reconstruction]. / Möglichkeiten der orthopädietechnischen Versorgung für die Extremitätenverlängerung und -rekonstruktion.

BACKGROUND: Orthopedic technical care plays a crucial role in improving function and mobility for patients undergoing limb lengthening and reconstruction. The treatment strategy is based on a precise classification of the defect, taking into account factors such as joint instability, muscle pathology and limb length discrepancy. CHOICE OF AIDS: The selection of orthopedic aids depends on the specific deformity, its classification and the individual needs of the patient. Through interdisciplinary decision-making and customized adaptations of prostheses and orthoses, optimal function and aesthetically pleasing outcomes can be achieved. The utilization of custom-made technical components, such as traction devices combined with elastic liners, is essential for long-term treatment success and can support surgical interventions. The treating physician's expertise is crucial in selecting the appropriate orthopedic technical device following limb lengthening and reconstruction.

[External fixation for the correction of complex deformities : From the classic Ilizarov ring fixator to modern software-driven hexapod fixators]. / Externe Fixateure zur Korrektur komplexer Deformitäten : Vom klassischen Ilizarov-Apparat zum modernen Software-unterstützten Hexapoden.

The history and development of circular fixation is closely aligned with the history of limb lengthening. Gavriil A. Ilizarov not only developed his circular fixator, but he also was the first to research and publish on distraction osteogenesis. Progress and dissemination of the method was initially based on individual pioneers; a standardized nomenclature and annual courses led to a wider dissemination. The introduction of the Taylor spatial frame in 1997 was a game changer. Although various groups had already developed Hexapod-fixators, it was the TSF that hit the market and achieved market presence. After the patent for TSF expired, many companies developed hexapod fixators with various modifications. A new version of the TSF, the Smart TSF, which included an intuitive planning software, was introduced in Baltimore in 2021. The introduction of intramedullary lengthening nails at the beginning of the 2000s and the wide dissemination starting approximately 2013 rendered external fixation obsolete for certain indications. However, ring fixators are still the method of choice for complex reconstruction of deformity in traumatology, as well as in pediatric orthopedics in the presence of open growth plates.

The effect of intermittent parathyroid hormone on bone lengthening: current evidence to inform future effective interventions.

PURPOSE: Recent studies have demonstrated the positive effects of parathyroid hormone (PTH) on bone healing, and findings support the use of PTH to accelerate bone healing following distraction osteogenesis. The goal of this review was to compile and discuss the mechanisms potentially underlying the effects of PTH on newly formed bone following a bone-lengthening procedure incorporating all relevant evidence in both animal and clinical studies. METHODS: This review summarized all evidence from in vivo to clinical studies regarding the effects of PTH administration on a bone-lengthening model. In addition, a comprehensive evaluation of what is currently known regarding the potential mechanisms underlying the potential benefits of PTH in bone lengthening was presented. Some controversial findings regarding the optimal dosage and timing of administration of PTH in this model were also discussed. RESULTS: The findings demonstrated that the potential mechanisms associated with the action of PTH on the acceleration of bone regeneration after distraction osteogenesis are involvement in mesenchymal cell proliferation and differentiation, endochondral bone formation, membranous bone formation, and callus remodeling. CONCLUSIONS: In the last 20 years, a number of animal and clinical studies have indicated that there is a prospective role for PTH treatment in human bone lengthening as an anabolic agent that accelerates the mineralization and strength of the regenerated bone. Therefore, PTH treatment can be viewed as a potential treatment to increase the amount of new calcified bone and the mechanical strength of the bone in order to shorten the consolidation stage after bone lengthening.

Biological reconstruction for massive bone defect following resection of tumor in Japan.

BACKGROUND: Several procedures of biological reconstruction for massive bone defect are available following tumor resection. Since the 1980s, allografting has been advanced mainly in the United States. However, allogeneic bone grafting has not been sufficiently developed in Japan for socioreligious reasons, and many other biological reconstructive methods have been developed. STATUS OF BIOLOGICAL RECONSTRUCTION: Bone lengthening, recycled and vascularized bone grafting have yielded favorable outcomes. Once bone union is achieved, reoperation is scarcely performed, with lower rate of infection than that observed with a prosthesis. However, there are disadvantages, such as complicated surgical procedures and relatively common postoperative complications. However, if sufficient donors are available, allogeneic bone grafting can be a good alternative. PROSPECTS OF THE JAPANESE ORTHOPAEDIC ASSOCIATION: Regenerative medicine with iPS cells, etc., which is under investigation, is expected to be employed for defect reconstruction. However, several biological reconstructive procedures should be further developed. These procedures are not inferior to prosthetic and allograft reconstructions in the short term, but rather are superior in the long term. Favorable outcomes are being obtained by combining recycled bone reconstruction and vascularized bone grafting, suggesting possible improvement in the future. Data should be accumulated to develop biological reconstruction in Japan. Although Japan has the challenge in terms of the ability to convey its message, the disadvantages of the procedures should be minimized. CONCLUSION: The construction of an allogeneic bone grafting system should be promoted, while biological reconstruction methods developed in Japan should be further developed and convey our message clearly and logically.

Re-implantation of foot and ankle following crush injury of the distal leg with 22 cm bone deficit: A case report.

INTRODUCTION/IMPORTANCE: Crush injury with extensive soft tissue damage to an extremity is generally considered a contraindication to re-implantation and the extremity best managed by prosthesis. However good prosthesis is not easily available especially in resource constrained environment, the overall long term quality of life is also considered better with re-implantation. CASE PRESENTATION: We report a 24 year old tourist patient who presented with post-traumatic amputation of the left leg following a road traffic accident. The patient had no other injuries. Clinical examination revealed extensive soft tissue damage to the involved leg. Radiograph done demonstrated segmental fracture of the distal tibia. The foot was successfully re-implanted after a lengthy surgery of 10 h. The patient was then subjected to an Illizarov bony lengthening procedure to correct the limb discrepancy length of about 20 cm. CLINICAL DISCUSSION: Our patient through multidisciplinary approach and after a combination of many procedures had his foot salvaged with good functional outcome. Though the injury had both bony and soft tissue loss, limb shortening necessitated by the segmental fracture followed by Illizarov technique were able to ensure adequate length. CONCLUSION: Post-traumatic crush amputation of the foot previously considered a contraindication for re-implantation could be salvaged by re-implantation in combination with bone lengthening procedure with good functional outcome.

A modified pixel value ratio based on contralateral normal bone: a novel reliable indicator for distraction osteogenesis.

BACKGROUND: The traditional pixel value ratio (tPVR) is subject to disuse osteopenia of the adjacent bone in distraction osteogenesis (DO). Therefore, a modified PVR (mPVR) based on the contralateral normal bone was developed and validated to address this issue. METHODS: A total of 79 bone lengthening subjects were recruited in this retrospective study. The difference between the mPVR and tPVR of early callus was identified in the first three months after osteotomy. Moreover, we further investigated the relationship between mPVR and healing index (HI), lengthening index (LI) and external fixator index (EFI). Finally, the potential influencing factors for mPVR of the early callus were analyzed. RESULTS: The mPVR was significantly lower than the tPVR in the first three months after osteotomy, and the difference gradually increased. Interestingly, the mPVR of the early callus in the first two months was negatively correlated with the HI, LI and EFI. Moreover, the age, lengthening site, total bilirubin and mean hemoglobin content were associated with the mPVR of early callus during DO. CONCLUSION: The mPVR based on contralateral normal bone is a novel reliable indicator for DO, which may be helpful for the clinical management of DO. However, the findings of this study need to be confirmed further by larger prospective research.

[Plate-assisted bone segment transport for bone defects of the lower extremities : Possibilities and limitations of treatment]. / "Plate-assisted bone segment transport" bei Knochendefekten an der unteren Extremität : Möglichkeiten und Grenzen der Behandlung.

Large bone defects of the lower extremities are challenging for both patients and the treating orthopedic surgeons. The treatment is determined by the size and location of the defect; however, patient-specific factors, such as the soft tissue situation and the presence of systemic comorbidities must be taken into consideration in the treatment strategy. Osteodistraction is an excellent technique especially for large bone defects exceeding 3 cm; however, it is time-consuming and required external fixation prior to the development of motorized distraction nails. This article describes the procedure for the treatment of large bone defects of the lower extremities, with its possibilities and limitations, using the novel plate-assisted bone segment transport (PABST) procedure.

Acute shortening and double-level lengthening versus bone transport for the management of large tibial bone defects after trauma and infection.

OBJECTIVE: The aim of this study was to present our experience with a new modified Ilizarov technique of acute shortening and double-level lengthening (ASDL) for the management of large tibial bone defects after trauma and infection and compare it with bone transport (BT). METHODS: A retrospective comparative study was performed on 47 patients with large tibial defects after trauma and infection from June 2014 to June 2018. Depending on different Ilizarov methods, these patients were divided into ASDL group (n = 21) and BT group (n = 26). The difference in bone lengthening time, time in frame, external fixation index, docking site healing time were recorded and compared between the two groups. Bone and functional results were evaluated according to the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. Complications encountered in both groups were categorized according to the classification of Paley, including problems (treated nonoperatively), obstacles (treated operatively), and sequelae (unresolved at last). RESULTS: All patients were followed for at least two years since the lengthening frame was removed. All cases achieved complete union at the docking site and consolidation of the regenerate callus. The mean bone loss was 8.9 cm (range 6.5-16.0 cm) in ASDL group vs. 10.3 cm (range 5.2-18.5 cm) in BT group. The mean bone lengthening time was 2.4 ± 0.7 months in ASDL group vs. 4.1 ± 1.4 months in BT group (p<0.001); time in frame was 9.1 months (range 7.0-14.5 months) in ASDL group vs. 17.7 months (range 13.5-23.0 months) in BT group (p<0.001); and external fixation index was 1.04 months/cm (range 0.83-1.38 months/cm) in ASDL group vs. 1.91 months/cm (range 1.28-2.70 months/cm) in BT group (p<0.001). The incidence of obstacles occurred in ASDL group was significantly lower than that in BT group (p<0.001). There was no significant difference in the bone (p = 0.635) and functional results (p = 0.293) between the two groups. CONCLUSION: Compared with bone transport, our modified technique of acute shortening and double-level lengthening could reduce bone lengthening time, time in frame, external fixation index and postoperative complications. It showed better clinical effects in patients with large tibial bone defects after trauma and infection.

Simultaneous multisegmental and multifocal corrections of complex lower limb deformities with a hexapod external fixator.

INTRODUCTION: External fixators are a part of the therapeutic arsenal used in the correction of complex pediatric lower limb deformities. These long iterative procedures, which are commonly performed over several months, strongly impact the lives of these children and their families. To reduce these drawbacks, we perform, whenever possible, a simultaneous multisegmental and/or multifocal correction of these deformities. HYPOTHESIS: Simultaneous multilevel correction of complex pediatric deformities using external fixators does not result in more complications than sequential corrections. MATERIALS AND METHODS: Sixteen patients were treated with this hexapod external fixator correction procedure. The mean age was 13.9 years. The corrections involved 12 femurs and 20 tibias, representing 53 osteotomies on 23 limbs. The quality of the correction was assessed by measuring the mechanical axis deviation (MAD), residual limb length discrepancy (RLLD) and a new, specifically defined, criterion called the "angular healing index" (AHI). Complications were assessed according to Lascombes' classification. RESULTS: The mean MAD went from 30 to 13.5 mm (P<.05) and the mean RLLD from 33.2 to 6.9 mm (P<.05). The mean AHI was 74.1 days/cm (16.7 to 319). The overall complication rate was 13/23 operated limbs or 56.5% (4.3% grade 1, 43.3% grade 2, 9.3% grade 3, and no grade 4). DISCUSSION: One-stage multilevel corrections of complex pediatric lower limb deformities represent a difficult technical challenge, and any reduction in treatment time must not adversely impact the quality of the results. The rate and severity of complications compared to monofocal/segmental procedures were no higher than that reported in the literature. This study demonstrated the feasibility of multisegmental and multifocal corrections, which reduced the total treatment duration compared to successive corrections, without adversely affecting the result or increasing the complication rate. LEVEL OF EVIDENCE: IV; retrospective study.

Radial Osteotomy With Callus Distraction for the Correction of Severe Madelung Deformity.

We report a case of an 11-year-old girl with bilateral severe Madelung deformity who underwent radial osteotomy with callus distraction. The distal radial articulation was corrected at surgery, and a unilateral fixator was subsequently used for callus distraction. No postoperative complication was noted. The patient did not need any additional surgeries for correction of the deformity. Forty-three months after surgery, the patient had a nearly full range of motion without any pain. Forearm deformity was not noticeable, except for surgical scar on both wrists.

Ilizarov bone transport assisted by a 3D printed patient-specific guide plate for treatment of tibial bone defects / 中华创伤骨科杂志

Objective:To evaluate the efficacy of 3D printed patients-specific guide plates in assisting Ilizarov bone transport in the treatment of tibial bone defects.Methods:A retrospective study was conducted to analyze the clinical data of 24 patients with tibial bone defects who had been admitted to Institute of Trauma Orthopedics, The 80th Army Group Hospital of PLA from January 2018 to March 2022. There were 9 males and 15 females with an age of (49.8±6.5) years, and 4 upper tibial defects, 5 middle tibial defects, and 15 lower tibial defects. According to the methods of repairing bone defects, the patients were divided into 2 groups: a 3D printing group of 10 cases where a 3D printed patient-specific guide plate was used to assist Ilizarov bone transport in the treatment of tibial bone defects, and a traditional group of 14 cases where Ilizarov bone transport was performed in a traditional manner. The 2 groups were compared in terms of operation time, frequency of intraoperative fluoroscopy, axial angulation of the tibia at postoperation and the last follow-up, external fixation time (EFT) and external fixation index (EFI). At the last follow-up, healing of bone defects was evaluated according to the criteria of The Association for the Study and Application of the Method of Ilizarov (ASAMI), functional outcomes were evaluated according to the Paley criteria, and needle infection was recorded according to the Paley classification for complications.Results:There was no statistically significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). All patients were followed up for (11.3±2.0) months on average after operation. The 3D printing group had significantly shorter operation time [(19.9±2.6) min] and significantly lower frequency of intraoperative fluoroscopy [(3.0±0.8) times] than the traditional group [(38.1±2.2) min and (8.9±1.3) times] (P<0.05), and had significantly better axial angulation of the tibia at postoperation and the last follow-up than the traditional group ( P<0.05). There was no significant difference in EFT or EFI between the 2 groups ( P>0.05), and the last follow-up revealed no significant difference either in bone healing, functional outcomes, or needle infection between the 2 groups ( P>0.05). Conclusion:In the treatment of tibial bone defects, compared with conventional Ilizarov bone transport, the Ilizarov bone transport assisted by a 3D printed patient-specific guide plate demonstrates advantages of shorter operation time, lower intraoperative fluoroscopy, and higher reduction accuracy.

Comparison of bone transport technique combined with bone grafting plus internal fixation versus simple bone transport technique for large segmental bone defects at lower limbs after trauma / 中华创伤骨科杂志

Objective:To compare the clinical efficacy between bone transport technique combined with bone grafting plus internal fixation and simple bone transport technique in the treatment of large segmental bone defects at lower limbs after trauma.Methods:A retrospective study was conducted to analyze the clinical data of 42 patients with large segmental bone defects at lower limbs after trauma who had been treated at Department of Trauma Orthopaedics, Honghui Hospital Affiliated to Medicine College, Xi'an Jiaotong University from September 2015 to September 2019. The patients were divided into 2 groups according to the different methods of repairing bone defects. In group A of 18 patients subjected to bone transport combined with bone grafting plus internal fixation, there were 11 males and 7 females with an age of (35.2±10.3) years, and 12 tibial defects and 6 femoral defects; in group B of 24 patients subjected to simple bone transport, there were 15 males and 9 females with an age of (37.3±9.4) years, and 17 tibial defects and 7 femoral defects. The external fixation time (EFT), external fixation index (EFI), total cure time and complications were recorded and compared between the 2 groups. At the last follow-up, the Ennecking score for limb functional recovery (score/total score 30) and Self-rating Anxiety Scale (SAS) were used to evaluate respectively the functional recovery of the limbs and postoperative anxiety.Results:The 2 groups were comparable because there was no significant difference between them in preoperative general data or follow-up time ( P>0.05). There was no statistically significant difference in the number of surgeries between the 2 groups ( P>0.05). The EFT [(5.9±1.5) months], EFI [(0.45±0.09) months/cm], total treatment time [(16.2±2.4) months], Ennecking score for limb functional recovery (87.0%±8.6%), SAS score [(43.2±9.0) points], and complications per capita [(0.4±0.2) times/case] in group A were significantly better than those in group B [(15.3±4.2) months, (1.19±0.28) months/cm, (19.7±3.5) months, (77.3%±9.2%), (58.2±9.3) points, and (1.2±0.5) times/case] (all P<0.05). Conclusion:In the treatment of large segmental bone defects at lower limbs, compared with simple bone transport technique, bone transport technique combined with bone grafting plus internal fixation has advantages of shorter external fixation time and overall cure time, a lower rate of complications, and better functional recovery of the limbs.

"Accordion" technique to promote bony union at the docking site in the treatment of tibial bone defects by Ilizarov technique / 中华创伤骨科杂志

Objective:To evaluate the effect of "accordion" technique on promoting bony union at the docking site in the treatment of tibial bone defects by bone transport.Methods:A retrospective study was conducted to analyze the data of 11 patients with tibial bone infection who had been admitted to Department of Orthopedics, The Second Hospital of Shanxi Medical University from November 2017 to February 2019. There were 10 males and 1 female with an age of (47.0±9.7) years. Seven patients were infected after internal/external fixation for open fractures and 4 cases after internal fixation for closed fractures. After surgical debridement, sensitive antibiotic bone cement was implanted, and dead or infected bone segments were radically resected. In all patients, the resulting bone defects of (6.6±2.9) cm were fixated by an Ilizarov ring external fixator and filled by bone transport. The "accordion" technique was used after the bone segments touched the docking site. The closure time, "accordion" time, bony union time and complications during bone transport were recorded.Results:None of the patients underwent bone grafting. This case series was followed up for (2.7±0.5) years. The closure time was (30.8±6.8) weeks, the "accordion" time (43.1±8.4) days, and the bony union time (31.6±9.0) weeks. None of the patients had obvious pain. Ankle stiffness was observed in 3 patients and traumatic equinus deformity in 1 patient.Conclusions:The "accordion" technique based on the Illizarov technique can accelerate mineralization of the bone segments transported, promote the bony union at the docking site, and effectively solve the problem of tibial bone defects without surgical bone grafting.

Comparison of acute shortening-lengthening and antibiotic calcium sulfate-loaded bone transport for the treatment of segmental tibial defects after trauma / 国际外科学杂志

Objective:To compare the clinical effects of acute shortening-lengthening technique with antibiotic calcium sulfate-loaded bone transport technique for the treatment of segmental tibial defects after trauma.Methods:The clinical data of 58 patients with large tibial defects treated by Ilizarov technique in Xi′an Honghui Hospital Affiliated to Xi′an Jiaotong University from May 2014 to December 2019 were retrospectively analyzed. Thirty patients were treated by acute shortening-lengthening (group A), and they were divided into those who were successful in one-time shortening during operation (group A1) and those who needed gradual shortening after operation (group A2) according to different shortening conditions. And 28 patients by antibiotic calcium sulfate-loaded bone transport (group B). The external fixation time (EFT) and external fixation index (EFI) of the two groups were compared. Bone defect healing and limb functions were evaluated according to the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. Complications were compared by Paley classification. The measurement data of normal distribution were expressed as ± s, and t-test was used for comparison between groups; the count data were expressed as n(%), and the chi-square test, Fisher exact probability method or Mann-Whitney U test were used for comparison between groups. Results:Patients were followed for(27.5±5.1)months. There was no significant difference in EFT, EFI, bone defect healing and limb functions between the two groups( P>0.05). The incidence of Grade-Ⅱ[41.2% (7/17)], Grade-Ⅲ [47.1% (8/17)] pin-tract infection in group A1 and Grade-Ⅱ[46.2% (6/13)], Grade-Ⅲ pin-tract [53.8% (7/13)] in group A2 was significantly higher than those in group B[14.3% (4/28)], [17.9% (5/28)] ( P<0.05). The number of complications per capita in group A1 [(1.4±0.3) times/case] and in group A2 [(1.5±0.3) times/case]was significantly higher than that in group B [(1.1±0.5) times/case]. Conclusions:Patients can be cured successfully by both acute shortening-lengthening and bone transport techniques. Compared with acute shortening-lengthening group, the complication incidence in antibiotic calcium sulfate-loaded bone transport group was lower, especially, the infection-related complications. Therefore, antibiotic calcium sulfate-loaded bone transport technique has a greater application prospect in patients with large segmental bone defects caused by infection or osteomyelitis.

Motorized Intramedullary Nail Lengthening in the Older Population.

Limb lengthening has not been widely employed in the elderly population due to concerns that outcomes will be inferior. The purpose of this multicenter, retrospective case-control series was to report the bone healing outcomes and complications of lower limb lengthening in older patients (≥60 years) using magnetic intramedullary lengthening nail (MILN). Our hypothesis was that healing parameters including consolidation days, the consolidation index, maturation days, and the maturation index, as well as the number of adverse events reported in the older population, would be no different to those of the general adult population. We retrospectively reviewed charts and radiographs from patients ≥60 years of age with limb-length discrepancies who underwent femoral or tibial lengthening using a MILN. Parameters were compared among the age categories "≤19 years," "20-39 years," "40-59 years," or "≥60 years" and propensity-matched cohorts for the age groups 20-59 years and ≥60 years. Complications were reported as percentages for each age category. In the study period, 354 MILN were placed in 257 patients. Sixteen nails were placed in patients 60 years of age or older (mean 65 ± 5 years; range 60-72 years). Comparisons of healing parameters showed no difference between those aged 60+ and the younger cohort. Complication percentages were not statistically significant (p = 0.816). Limb lengthening with MILN may therefore be considered a safe and feasible option for a generally healthy elderly population.

Feasibility of Computer-Aided Design in Limb Lengthening Surgery: Surgical Simulation and Guide Plates.

OBJECTIVE: To evaluate the feasibility and utility of computer-aided design (CAD) in surgical treatment of leg length discrepancy (LLD) using monorail external fixators. METHODS: In the present case series, we retrospectively analyzed seven patients diagnosed with LLD who were surgically treated using a monorail external fixator between June 2018 and August 2020. A personalized surgical emulation of each patient was designed using CAD based on preoperative CT scans to measure limb parameters. Through reverse engineering, a surgical guide plate was then designed to assist with correcting the limb deformity. Patient general information and clinical history, leg length, mechanical lateral distal femoral angle (mLDFA), anatomical anterior distal tibial angle (aADTA), and surgical parameters were recorded during the perioperative period. Three months after external fixator removal, distraction-consolidation time (DCT), healing index (HI), and lower extremity function score (LEFS) were calculated, and statistically analyzed by paired T-test. RESULTS: The mean limb lengthening achieved was 6.41 ± 2.54 (range, 3.30-10.54) cm with either varus or valgus correction. The mean operative duration was 151 ± 41.87 (84-217) minutes and mean blood loss was 53.58 ± 22.51(25-87) ml. The mean distraction-consolidation time was 3.67 ± 1.13 (range, 2.5-6.0) months and mean external fixator duration was 11 ± 2.45 (range, 8-14) months. The mean healing index (HI) was 18.11 ± 3.58 (range, 12.8-22.7) days/cm. Mean LEFS scores improved postoperatively from 32.17 ± 8.57 (range, 24-45) to 61.17 ± 6.68 (range, 50-67) with a significant difference (T = -14.26,P < 0.001). CONCLUSIONS: Simultaneous length and angular correction can be achieved by incorporating CAD into the surgical treatment of patients with LLD, without compromising postoperative lower limb function. CAD demonstrates utility in the surgical treatment of LLD by improving the functionality of monorail external fixators.