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Classification of complications after progressive long bone lengthening: proposal for a new classification
P Lascombes1, D Popkov, H Huber
1Children Hospital, Nancy Teaching Hospital Center, 11, allée du Morvan, 54500 Vandœuvre-les-Nancy, France. pierre.lascombes@hcuge.ch
Orthopaedics & Traumatology, Surgery & Research : OTSR
|September 18, 2012
Summary
A new classification for long bone lengthening surgery complications ensures a triple contract is honored, improving patient outcomes. This objective system is reliable and reproducible for various surgical techniques.
Area of Science:
- Orthopedic Surgery
- Surgical Complications
- Bone Lengthening Techniques
Background:
- Long bone lengthening surgery frequently results in complications, necessitating improved classification systems.
- Existing classifications are often descriptive or severity-based, with the Caton classification introducing the concept of a treatment contract.
- Preoperative patient information can be enhanced by incorporating a maximum treatment duration into this contract.
Purpose of the Study:
- To propose a novel classification system for long bone lengthening complications.
- This classification aims to incorporate a "triple contract" encompassing bone length gain, treatment duration, and sequelae occurrence.
- To assess the reliability and reproducibility of the proposed classification.
Main Methods:
- A four-grade classification system was developed: Grade I (triple contract honored, minimal intervention), Grade II (contract fulfilled with unplanned general anesthesia), Grade III (contract not honored due to delayed union or interruption), and Grade IV (sequelae present).
- The classification was evaluated on 34 lengthening procedures across 43 bone segments in 32 patients.
- Complication grades were determined by multiple authors using the proposed system and compared against existing classifications (Caton, Paley, Popkov, Donnan).
Main Results:
- Ten of 34 procedures (approximately 30%) had no complications.
- The remaining 24 procedures experienced 30 complications.
- High inter-rater consensus was achieved for the proposed classification and the Caton classification, unlike more subjective systems.
Conclusions:
- The proposed classification emphasizes adherence to predetermined objectives in limb lengthening: gain, duration, and function.
- The system is reliable and reproducible due to its objective criteria.
- It is applicable to diverse surgical techniques, including external fixation and internal osteosynthesis.
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