A comparison of two osteotomy techniques for tibial lengthening

Area of Science:

• Orthopedic Surgery
• Regenerative Medicine
• Biomechanical Engineering

Background:

• Effective long bone lengthening relies on stable external fixation, low-energy osteotomy, appropriate latency, optimal lengthening rate, and functional limb use.
• Percutaneous osteotomy with multiple drill holes is recognized for producing high-quality regenerated bone.
• The Afghan percutaneous osteotomy offers a low-energy alternative that preserves the periosteum.

Purpose of the Study:

• To compare the efficacy of percutaneous multiple drill hole osteotomy versus Gigli saw osteotomy in terms of healing index (HI) for limb lengthening.
• To evaluate the bone regeneration quality influenced by different osteotomy techniques.

Main Methods:

• A retrospective study of 44 tibias in 41 patients undergoing limb lengthening using the Ilizarov device between 1995 and 2000.
• Patients with various etiologies for limb length discrepancy (poliomyelitis, idiopathic hypoplasia, posttraumatic) were included, excluding those with metabolic bone diseases.
• Comparison of healing index between percutaneous multiple drill hole osteotomy and Gigli saw osteotomy groups.

Main Results:

• The overall mean healing index (HI) for the entire cohort was 1.65 month/cm.
• The percutaneous multiple drill hole group had a mean HI of 1.98 month/cm, while the Gigli saw group achieved a significantly better mean HI of 1.37 month/cm (p=0.022).
• Patients with poliomyelitis who underwent Gigli saw osteotomy showed a significantly better HI (1.1 month/cm) compared to other osteotomy methods (1.9 month/cm; p=0.027).

Conclusions:

• The Gigli saw technique demonstrates biologic superiority in bone healing for limb lengthening procedures.
• This study supports the Gigli saw osteotomy as a preferred method for achieving better bone regeneration quality.
• The findings have implications for optimizing surgical techniques in limb lengthening to improve patient outcomes.