Acute correction and distraction osteogenesis for the malaligned and shortened lower extremity

Area of Science:

• Orthopedic surgery
• Limb reconstruction surgery
• Pediatric orthopedics

Background:

• Limb deformities often present with combined shortening and angulation or malrotation.
• Correction techniques include acute or gradual methods, often preceding limb lengthening.
• External fixation is a common modality for these procedures.

Purpose of the Study:

• To evaluate the efficacy of acute deformity correction followed by gradual lengthening in pediatric and adolescent patients.
• To assess the impact of deformity magnitude on bone healing and complication rates.
• To compare outcomes between skeletally immature and mature patients undergoing limb deformity correction and lengthening.

Main Methods:

• Retrospective analysis of 35 patients (40 limbs) undergoing acute deformity correction and subsequent gradual lengthening.
• Measurement of average deformity correction (degrees) and lengthening (cm).
• Radiographic assessment of callus formation and evaluation of complications and healing index.

Main Results:

• Average deformity correction was 19 degrees, with an average lengthening of 4.1 cm.
• Good radiographic callus formation was observed in 34 of 40 segments.
• Magnitude of deformity correction did not affect bone quality, complications, or healing index.
• Skeletally mature patients showed significantly decreased bone formation, increased callus complications, and a higher healing index.

Conclusions:

• Immediate correction and lengthening is a suitable technique for children and adolescents with malaligned, shortened lower extremities.
• Poorer outcomes in older patients suggest alternative surgical techniques should be considered for adults.
• The study highlights age-related differences in bone healing and complication rates following limb reconstruction.