mehmet kocaoğlu

We performed bone lengthening surgery on 12 metacarpals and 14 metatarsals of 15 patients. The mean age for metacarpal and metatarsal lengthening was 14.5 (10–21) and 17.5 (10–25) years, respectively. We used a unilateral or a circular external fixator. The mean healing index of the metacarpals and metatarsals was 1.6 (1.1–2.3) and 1.6 (1.0–2.0) months/cm, respectively. The mean increase in metacarpal and metatarsal length was 17.6 (13–26) and 24.3 (20–30) mm, respectively. The functional scores of the metatarso-phalangial (MTP) joint of lengthened metatarsals for the lesser toe were excellent in 12 and good in two cases based on the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system. Complications were seen in six of the metatarsal lengthening cases including four angulations, one subluxation and one non-union. We conclude that the periosteum must be protected with percutaneous osteotomy and lengthening should be performed at a rate of 0.25 mm twice a day and should not exceed 40% of the original bone length (or >20 mm). Nous avons réalisé une chirurgie d’allongement sur 12 métacarpiens et 14 métatarsiens chez 15 patients. L’âge moyen était respectivement de 14.5 ans pour les métacarpiens (10 à 21) et 17.5 ans pour les métatarsiens (10 à 25). Nous avons utilisé un fixateur unilatéral ou circulaire. L’index moyen de consolidation a été de 1.6 mois/cm d’allongement, de 1.1 à 2.3 pour les métacarpiens et de 1.0 à 2.0 pour les métatarsiens. L’allongement moyen a été de 17.6 mm (13 à 26) pour les métacarpiens et de 23 mm (20 à 30) pour les métatarsiens. Le score fonctionnel de l’articulation métatarso-phalangienne a été excellent chez 12 patients, et bon chez 2 patients (score de l’AOFAS). Les complications ont été constituées par 4 angulations, 1 subluxation et 1 pseudarthrose parmi 6 allongements métatarsiens. Nous pouvons conclure que le périoste doit être protégé lors de l’ostéotomie percutanée mais la vitesse d’allongement doit être de 0.25 mm deux fois par jour. L’allongement ne doit pas excéder 40% de la longueur originale de l’os (plus de 20 mm).

Introduction There are various methods of long bone lengthening. The quality of the regenerated bone depends on stable external fixation, low energy corticotomy, latency period, optimum lengthening rate and rhythm, and functional use of the limb. Percutaneous corticotomy and ostetomy with multiple drill holes yield the best results for the quality of the regenerated bone. An alternative low energy osteotomy, which respects the periosteum, is the Afghan percutaneous osteotomy. The purpose of the current study was to compare a percutaneous multiple drill hole osteotomy with a Gigli saw osteotomy in terms of the healing index (HI). Materials and methods Forty-four tibias of 41 patients were lengthened at our institution between 1995 and 2000. All patients underwent limb lengthening without any deformity correction by the Ilizarov device. The etiology of the limb length discrepancy was sequelae to poliomyelitis in 16 tibias, idiopathic hypoplasia in 17 tibias, posttraumatic discrepancy in 5 tibias, bilateral tibial lengthening in achondroplastic dwarfism in 3 patients. Patients with metabolic bone diseases were not included in this series. Results The mean amount of length discrepancy was 5.7 cm (range 2–12 cm). The mean HI of the whole group was 1.65 month/cm (range 1.1–2.4 month/cm). When comparing the osteotomy methods without taking the etiology into consideration, the percutaneous, multiple drill hole group yielded a mean HI of 1.98 month/cm (range 1.4–2.4 month/cm), while the Gigli saw group yielded a mean HI of 1.37 month/cm (range 1.1–1.8 month/cm). There was a statistically significant difference between the two groups (p=0.022). The Gigli saw patients with poliomyelitis had a significantly better HI compared with patients who underwent lengthening by the other form of osteotomy (1.1 vs 1.9 month/cm; p=0.027). Conclusion Our results confirm the biologic superiority of the Gigli saw technique.

Thirty-five humeral shaft non-unions treated by the Ilizarov external fixator were studied after an average of 39 months. Bone union was achieved in all but one. The mean time to union was 5.5 months (range: 3–10 months). Major pin tract problems leading to removal of the Schanz screws occurred in three patients. A radial nerve palsy developed in three patients, two recovered spontaneously and one was treated with a triple tendon transfer. Nous avons suivi 35 pseudarthroses de la diaphyse humérale traitées par fixateur d'Ilizarov avec un suivi moyen de 39.2 mois. La consolidation a été obtenue dans tout les cas sauf un. Le temps moyen de consolidation était de 5.5 mois (3–10 mois). Dans trois cas ont été observés des problèmes majeurs nécessitant l'ablation des vis de Schanz. Une paralysie du nerf radial a été noté dans trois cas, avec une récupération spontanée deux fois et traitement par un triple transfert tendineux dans l'autre cas.