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Does lengthening and then plating (LAP) shorten duration of external fixation?
Ryhor Harbacheuski1, Austin T Fragomen, S Robert Rozbruch
1Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA.
Background:
Classic bone lengthening requires patients wear external fixation for the distraction and consolidation phases and there is fracture risk after frame removal. Our technique of lengthening with the Taylor Spatial Frame(TM) and then insertion of a locked plate allows earlier removal of the external fixator during consolidation. Plate insertion is accomplished through a clean pin-free zone avoiding contamination and before frame removal maintaining bone position.
Questions/Purposes:
We asked (1) whether lengthening and then plating (LAP) decrease the time for external fixation (2) how alignment and complications compare with those of the classic method.
Methods:
We performed a retrospective case-matched comparison between LAP and the classic technique with 27 extremities in each group. We compared time wearing the frame, bone healing index, external fixation index, joint ROM, alignment, and complications.
Results:
The time wearing the frame and external fixation index were lower in the LAP group (4.5 versus 6.2 months and 1.5 versus 2 months/cm). Deviation from normal alignment was observed in seven and six patients in the LAP and classic group, respectively. Varus malalignment in two patients in the LAP group was associated with plate breakage. The incidence of pin-tract infection was greater in the classic group (12 versus two). No deep infections occurred in the LAP group.
Conclusions:
The LAP technique shortened the time patients wore the external fixator but was associated with a high incidence of varus deformity. Stronger plates may help prevent deformity and allow earlier removal of the frame.
Level Of Evidence:
Level III, therapeutic study (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.
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