Ultrasonography of postosteotomy "cysts"

Area of Science:

• Orthopedics
• Radiology

Background:

• Limb-lengthening procedures involve distraction osteotomy, which can be complicated by delayed bone consolidation.
• Postosteotomy "cysts" are an under-recognized complication that impedes new bone formation at the osteotomy site.

Observation:

• Serial radiographs in three patients did not reveal the cause of delayed consolidation.
• Ultrasonography (US) identified well-defined fluid collections as the primary factor responsible for delayed healing.
• One patient experienced recurrence of the fluid collection despite US-guided aspiration.

Findings:

• Compression and redistraction techniques were unsuccessful in promoting new bone formation.
• Two patients required bone grafting to achieve consolidation at the osteotomy site.
• Postosteotomy "cysts" are not true cysts but represent an avoidable complication of improper distraction techniques.

Implications:

• Ultrasonography is the preferred imaging modality for the early detection of postosteotomy fluid collections.
• Careful supervision and controlled distraction rates are crucial to prevent this complication.
• Prompt diagnosis and management can potentially improve outcomes in limb-lengthening surgeries.