Summary
Bone lengthening is a surgical method which requires meticulous technique, continuous attention, and satisfactory cooperation on the part of the patient. The absence of common criteria makes it difficult both to classify the complications which arise, and to compare them with those of other authors. We report the complications in a group of 61 patients who were studied prospectively. Disorders of the lengthening callus accounted for 45% of all complications, and a further 33% arose in the joints. The remainder occurred in the bone, the apparatus and the soft tissues, of which the most common were stiffness of the joints, axial deviations and loosening of the pins, while articular subluxation, fractures with angulation and delayed consolidation occurred less frequently. In our study, the overall number of complications per lengthening process was 2.1. In bilateral lengthening, the rate was 1 per segment, while in unilateral cases the mean was 2.7. Problems which we defined as severe, requiring that the lengthening had to be halted, occurred in 1.8% of the total complications. The aetiology of the length discrepancy has an important role in the complications which occur in each segment. Over twice as many problems occur in asymmetrical lengthening procedures as in patients where lengthening is symmetrical.
Résumé
L'allongement osseux est une intervention chirurgicale qui demande une technique méticuleuse, une surveillance médicale continue et une coopération satisfaisante du patient. En l'absence de critères communs il est difficile de classer les complications et de comparer avec les résultats d'autres auteurs. Si l'on analyse les complications selon leur localisation on constate que les problèmes concernant le cal représentent 45% du total et ceux des articulations 33%, soit un total d'environ 75% pour ces deux catégories. Les 25% restants se situent au niveau de l'os lui-même, du fixateur et des parties molles. Les incidents les plus fréquents sont les raideurs articulaires, les déviations axiales et l'ostéolyse autour des fiches, tandis que les subluxations, les fractures avec angulation et retard de consolidation s'observent moins souvent. Dans notre étude le total des complications est de 2.1 par allongement. Dans les allongements symétriques il est de 1 par segment, alors que dans les allongements asymétriques il s'élève à 2.7%. Les problèmes que nous considérons comme graves, c'est à dire ceux qui compromettent le processus d'allongement représentent 1.8% du total des complications. L'étiologie joue un rôle important dans les complications qui surviennent au niveau de chaque segment. Les complications des allongements asymétriques sont deux fois plus fréquentes que celles des allongements symétriques.
Similar content being viewed by others
References
Aguirre M (1990) Aspectos psicologicos de las personas de baja estatura. In: J de Pablos, J Canadell (eds) Elongacion osea. Estado actually y controversias. Servicio de Publicationes Universidad de Navarra, Pamplona
Canadell J, Pastor MA, Casado M, Artieda, J, Forriol F (1993) Quantitative EMG study in bone lengthening. 1st European Congress of Orthopaedics, Paris, 273
Canadell J, Aquerreta D, Forriol F (1993) Prospective study of bone lengthening. J Paediatr Orthop Part B 2: 1–7
Coleman SS, Scott SM (1991) The present attitude toward the biology and technology of limb lengthening. Clin Orthop 264: 76–83
Conejero JA, Florez MT, Salcedo J, Amaya J (1991) Elongaciones oseas en malformaciones congenitas de las extremidades inferiores. An Esp Pediatr 34: 293–298
Dutoit M, Rigault P, Padovani JP, Finidori G, Touzet P, Durand Y (1991) Le devenir des enfants opérés d'allongement pour hypoplasie congénitale des membres inférieurs. Rev Chir Orthop 76: 1–7
Faber FW, Keessen W, Van Roermund PM (1991) Complications of leg lengthening. 46 procedures in 28 patients. Acta Orthop Scand 62: 327–332
Fischer J, Dufek P, Stachel P (1992) Gliedmaßenverlängerung durch Epiphysen- und Kallusdistraktion mit dem Wiesbadener Ringfixateur. Orthopäde 21: 210–214
Franke J, Hein G, Simon M, Hauch S (1990) Comparison of distraction epiphyseolysis and partial metaphyseal corticotomy in leg lengthening. Int Orthop 14: 405–413
Franke J, Simon M, Hein G (1992) Ilizarov-Techniken zur Beinverlängerung. Orthopäde 21: 197–209
Galardi G, Comi G, Lozza L, Marchettini P (1990) Peripheral nerve damage during limb lengthening. J Bone Joint Surg 72: 121–124
Garcia E, Fernandez N, Olsen B, Ruiz M (1992) El metodo de Ilizarov en cirugia de alargamiento. Rev Ortop Traum 36-IB: 438–453
Grill F (1989) Correction of complicated extremety deformities by external fixation. Clin Orthop 241: 166–176
Guaniero R, Montenegro NB, Guanieri MV, Rossi J (1993) Comparative study of Ilizarov, Wagner, and Anderson methods for limb lengthening (100 lengthenings in 98 patients). J Paediatr Orthop Part B 2: 28–34
Herzog R, Hefti F (1992) Problematik und Komplikationen der Beinverlängerungen mit dem Wagner-Apparat. Orthopäde 21: 221–229
Hood RW, Riseborough EJ (1981) Lengthening of the lower extremity by the Wagner method. J Bone Joint Surg 63: 1122–1131
Hrutkay JM, Eilert RE (1990) Operative lengthening of lower extremity and associated psychological aspects: the children's hospital experience. J Paediatr Orthop 10: 373–377
Korzinek K, Tepic S, Perren SM (1990) Limb lengthening and three-dimensional deformity corrections. A retrospective clinical study. Arch Orthop Trauma Surg 109: 334–340
Monticelli G, Spinelli R, Iorio L, Forte R (1990) Complications in elongations using circular fixators. In: J de Pablos, J Canadell (eds) Bone lengthening. Current trends and controversies. Servicio Publicaciones Universidad de Navarra, Pamplona
Mosca V, Moseley CF (1986) Complications of Wagner leg lengthening and their avoidance. Orthop Trans 10: 462–468
Paley D (1990) Problems, obstacles and complications of limb lengthening by the Ilizarov technique. Clin Orthop 250: 81–104
Pfeil J, Niethard FU (1990) Unterschenkelverlängerung mit dem Ilisarov-System. Orthopäde 19: 263–272
Vade A, Eissenstat R (1990) Radiographic features of bone lengthening procedures. Radiology 174: 531–537
Wagner H (1978) Operative lengthening of the femur. Clin Orthop 136: 125–142
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Aquerreta, J.D., Forriol, F. & Cañadell, J. Complications of bone lengthening. International Orthopaedics 18, 299–303 (1994). https://doi.org/10.1007/BF00180230
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00180230