New limb-lengthening technique is less cumbersome for patients
A highly specialised procedure that lengthens bones can avoid the need for amputations in selected patients who have suffered severe fractures. A new study has found that an alternative limb-lengthening technique makes the long recovery process less cumbersome, while providing good-to-excellent outcomes. Loyola University Medical Center orthopaedic surgeon Mitchell Bernstein is first author of the study, published in Clinical Orthopaedics and Related Research.
The standard limb-lengthening technique requires patients to be fitted with a circular external fixator. The device consists of a rigid frame made of stainless steel and aluminium. Three rings surround the lower leg and are secured to the bone in order to manipulate bone fragments with stainless-steel pins.
The study examined an alternative technique used on trauma patients who underwent lengthening of the tibia to prevent amputation. The technique significantly reduced the amount of time patients had to spend in the external fixator (from 11 months to seven months).
Limb lengthening works on a principle known as distraction osteogenesis. Four times a day, the external fixator pulls apart two bone segments, and new bone tissue fills in the gap. As a result, the bone lengthens at a rate of about 1mm per day. Bones can be lengthened by between 15 per cent and 25 per cent of their original length at a time.
Once the new bone tissue is formed, it takes several more months until it fully regenerates. In the standard limb-lengthening technique, the patient wears the external fixator until the bone completely matures, in order to support the weight of the limb. In the alternative technique, the surgeon implants a titanium rod inside the bone, in order to reduce the amount of time the patient must spend in the external fixator.
The study included 58 trauma patients who underwent limb lengthening. Thirty patients were treated with the standard technique. Twenty-eight patients were treated with the alternative technique, which combined the external fixator with the titanium rod implantation. In both groups, the average limb lengthening was 2.1 inches.
There was no statistically significant difference in the severity or number of complications between both groups, and good-to-excellent results were found in all patients.
Source: Loyola Medicine
Does Integrated Fixation Provide Benefit in the Reconstruction of Posttraumatic Tibial Bone Defects? M Bernstein MD, Fragomen AT, Sabharwal S, et al. Symposium: 2014 Annual Meeting of the Limb Lengthening and Reconstruction Society