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Extreme bone lengthening using distraction osteogenesis after trauma: a case report
Alexander Lerner1, Lucian Fodor, Haim Stein
1Department of Orthopedic Surgery, Rambam Medical Center & Bruce Rapaport Faculty of Medicine, Haifa, Israel.
Journal of Orthopaedic Trauma
|July 9, 2005
Summary
This study details a 22 cm tibial lengthening using acute shortening and angulation for severe post-traumatic lower limb injury. The technique successfully restored limb length and function, achieving good aesthetic and functional outcomes.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Limb Reconstruction
Background:
- Severe post-traumatic lower limb injuries often involve significant bone and soft-tissue defects.
- Limb lengthening techniques are crucial for reconstructing extensive post-traumatic defects.
Observation:
- A 22 cm tibial gap and a large soft-tissue defect were present after a Gustilo IIIB open complex injury.
- An Ilizarov frame was used for acute tibial shortening with temporary posterior angulation to manage the defect.
Findings:
- Progressive angulation correction and bilevel tibial distraction (1.75 mm/day) achieved 22 cm of lengthening (17 cm proximal, 5 cm distal).
- Fracture consolidation occurred in 371 days with complete wound healing and no osteomyelitis.
- The patient achieved symmetrical limb length and returned to work and sports.
Implications:
- This case demonstrates the feasibility of substantial tibial lengthening (22 cm) in a salvage setting for complex post-traumatic defects.
- The described technique offers a viable option for limb length restoration in challenging trauma cases.
- This represents a significant advancement in managing extensive post-traumatic lower limb deformities.