Lower limb-lengthening by coloptosis-unilateral [uniaxial] versus circular frames

The results of limb-lengthening by callotasis technique using unilateral frames [Wagner or Kazem Ill distractors] were compared with those by using circular frames [Ilizarov fixator]. The method of lengthening was selected on the basis of the availability of the device at the time of the surgery. Unilateral frames were used in fourteen patients [fourteen procedures], while circular frames were used in seventeen patients [nineteen procedures]. There were l8 female patients and 13 male patients. The average age at the time of surgery was 12.4 years [range 9-28 years]. The rate of distraction in both systems was about one mm. per day divided on four increments after a latent period ranged from 5-15 days. The average gain in length was 5.8 centimeters in callotasis with the use of unilateral frames and 5.5 centimeters with the use of circular frames. The percentage of achievement from intended length was 94% in unilateral frames callotasis and 102% in circular frames callotasis. A total of 40 complications [24 mild, 12 moderate and 4 severe] were recorded in the fourteen patients managed by unilateral frames with an average 2.8 per case. For the seventeen patients managed by circular frames, the total complications were 14 [8 mild, 4 moderate and 2 severe] with an average 0.8 per case. From this study, it was found that although technically demanding, the circular fixation devices, being highly versatile system, provided a better grip for bone segments and allowed for correction of coexisting angulation or deformity with low complication rate. It was observed also that whatever the method of lengthening, there have been a significant complication rate. That necessitated great caution and consideration before embarking on the correction of limb discrepancy. This rat of complication declined as experience with the technique increased

Intertrochanteric osteotomy-a salvage procedure-in non-union of the femoral neck

A series of 22 patients with ununited femoral neck fractures were treated by a Pauwels intertrochanteric abduction osteotomy. All the patients were under 60 years of age, Bone scan was done for all patients before the surgery. Six of them showed radiological evidence of avascular femoral head necrosis before osteotomy, and 10 non-unions showd associated varus deformity. The average follow up was 3.6 years [range from 1.8 to 5.1 years]. Sixteen cases were consolidated without complications [72.7%] and six cases necessitated further surgical interference. We concluded that in young active patients under 60 years with ununited femoral neck fractures, intertrochanteric osteotomy provided a high proportion of good results even in the presence of avascular necrosis of the head provided that there has been no collapse. If osteotomy fails, prosthetic replacement is still possible