Sciatic nerve injury and its effect on bone regeneration in distraction osteogenesis zone in rat / 中华显微外科杂志

Objective:To evaluate the effect and mechanism of bone regeneration in distraction osteogenesis zone after the repair of sciatic nerve in rats.Methods:Between January 2021 and August 2021, 60 healthy adult male Sprague-Dawley rats were divided randomly into 3 groups: Group A, B, and C. In groups B and C, right sciatic nerve transection and anastomosis were performed. Then after 8 and 12 weeks, the 3 groups were treated with extension external fixation (Ilizarov technique) of right femur osteotomy to make distraction osteogenesis model. Electrophysiological changes of peripheral nerves were monitored by electromyography (EMG) pre-and postoperatively in all the femoral lengthening rats. The formation of callus was examined by X-ray every week after operation. The rats were sacrificed on 2nd, 4th, 6th weeks after the bone transport operation. Four-point bending test and histological staining examination were carried out to determine the osteogenesis in the distracted area. SPSS 21.0 was used for statistical analysis. Data of measurement were expressed as (Mean±SD). A non-parametric test was used to assess the statistical difference between groups. Graphs were plotted by GraphPad Prism 8.0 and considered statistically significant when P<0.05. Results:The results of Sciatic nerve function index (SFI), Compound muscle action potential (CMAP) and Motor nerve conduction velocity (MNCV) in group A were better than the group B and group C in both of before and after the surgery. At the 2nd and 4th weeks of the consolidation stage, X-ray showed that bone formation in group B was superior to groups A and C; HE and Safranin O staining showed that local capillary and cartilage formation in group B was significantly more than in groups A and C; Immunohistochemical staining showed that the expression levels of Osteopontin(Opn) and Osteocalcin(Ocn) in the distraction area of group B were higher than that of groups A and C. At the 6th week of the consolidation stage, the four-point bending test showed that the bone quality of group B was better than groups A and C. The differences of the results between groups shown above had statistical significance ( P<0.05). Conclusion:Bone regeneration in the distraction area of the bone lengthening group with sciatic nerve injury was better than that of the bone lengthening group without a never injury. This might be in relation to the fact that a distractive osteogenesis caused the secondary injury to the repaired nerve. The electrophysiological results showed that periodic changes took place in the repaired sciatic nerve caused by the stretch of femoral lengthening, and the injurious changes of sciatic nerve would be gradually relieved in 6th week after surgery.

Application of shortened replantation combined with limb lengthening in treatment of severe amputation of middle and distal lower leg / 中国修复重建外科杂志

Results: All 12 patients recovered the same lengths of both lower extremities after shortened replantation and limb lengthening. The lengthened segments gained good bone mineralization, bony union was achieved at lengthened segments and broken end of fracture at 7-16 months (mean, 11.3 months). All patients were followed up 6 months to 5 years (mean, 2 years and 5 months). The range of motion of the knee joint were 0-5° (mean, 3°) in hyperextension and 110-140° (mean, 120°) in flexion. Except for 2 cases of ankle arthrodesis, plantar flexion angles were 15-45° (mean, 26°) and dorsiflexion angles were 10-25° (mean, 15°) in the other cases. The plantar sensation was restored to the S 3 + level in 4 cases, S 3 level in 6 cases, and S 2 level in 2 cases. At last follow-up, the affected limb function were excellent in 7 cases, good in 3 cases, fair in 2 cases according to Kofoed functional evaluation criteria.

RESEARCH PROGRESS IN LOWER LIMB LENGTHENING BY INTRAMEDULLARY NAIL / 中国修复重建外科杂志

OBJECTIVE: To summarize the research progress in the lower limb lengthening by intramedullary nail. METHODS: The domestic and foreign related literature about the lower limb lengthening by intramedullary nail was reviewed, summarized, and analyzed. RESULTS: The intramedullary nail lengthening systems can be divided into 3 types:distraction by mechanical strength, by motorized electronic power, or by motorized magnetic force. The new technology has obvious advantages in complication incidence, limb function, bone healing rate, comfortable and cosmetic degree of the patients, and hospitalization days compared with the external fixation, but it also has the disadvantages including lengthening failure of system breakdown, intramedullary infection, injuries of vessel and nerve, limited distraction length, and expensive price of the apparatus. And the method also has several contraindications:narrow medulla, multiple curves of medulla, osteomyelitis, skin infection, and unclosed epiphyseal plate. CONCLUSIONS: The lower limb lengthening by intramedullary nail is a major improvement of Ilizarov technology. Although the method has been used in limited cases, the preliminary clinical results are excellent, and it can be regarded as a new trend of the limb lengthening, bone reconstruction, and deformity correction.

Alargamiento de extremidades: actualización y revisión del tema / Limb lengthening: review and update

El alargamiento de extremidades trata las discrepancias de longitud de extremidades superiores e inferiores. Lograr un adecuado tratamiento temprano evita secuelas irreversibles como la artrosis. El estudio de las discrepancias se realiza con una telerradiografía estandarizada, la cual entrega la información de cuál es el segmento óseo comprometido y cuál es el largo total a corregir. Menos de 15mm de discrepancia se ha demostrado que no tiene influencia sobre la mecánica de la marcha ni de las articulaciones. Más de 15mm produce una alteración en las cargas articulares, rangos de movimiento articular, compensaciones musculares, compensaciones de columna (escoliosis compensatoria), entre otras, que producen secuelas a largo plazo. Los métodos de tratamiento existentes son conservadores y quirúrgicos. Dentro de estos últimos están los fijadores externos e internos. Los fijadores externos tienen una alta frecuencia de infecciones superficiales a través de las agujas, sin embargo, son versátiles y capaces de corregir prácticamente cualquier deformidad. Los fijadores internos (por ejemplo, clavos intramedulares) no pueden corregir grandes deformidades, así como tampoco realizar grandes alargamientos, sin embargo, su frecuencia de complicaciones es mucho menor y son mucho mejor tolerados por el paciente. Estos métodos de tratamiento logran resultados muy precisos. Tienen un margen de error de 3,5 mm de longitud, lo cual no tiene consecuencias mecánicas para una extremidad. La tasa de satisfacción es de alrededor del 90 por ciento y logran un alivio del dolor significativo...

Limb lengthening can be used to correct upper and lower limb length discrepancies. To obtain an appropriate treatment early in life prevents irreversible consequences, such as arthritis. The limb length discrepancies study is performed with a standardised leg length X-ray. This X-ray shows the compromised bone segment and what the total limb length discrepancy is. A limb length discrepancy of less than 15mm has no influence on factors such as, gait mechanics, joint range of motion, or long term joint degeneration. Over 1.5cm, several consequences appear such as: joint overload, decreased joint range of motion, muscle compensations and compensatory spine malalignment. Existing treatment includes non-surgical and surgical methods. Among the latter are internal and external fixations. External fixations have a high frequency of superficial infections, but are highly versatile, being able to correct virtually any deformity. The internal fixation (e.g. intramedullary nails) cannot correct large deformities, or make big lengthenings, but its complication rate is much lower and is much better tolerated by the patient. These treatment methods achieve very accurate results. They have an error of 3.5mm in length, which has no mechanical consequences to an extremity. The satisfaction rate is high, with around 90 percent achieving a significant pain relief...

Lenthening of Tibia in CPT by Ilizarov’s Method.

A case of Congenital Pseudarthrosis of Tibia (CPT) with 24 centimetres shortening in a young boy of eighteen years treated by Ilizarov’s method is presented. No features of neurofibromatosis like café-aulait spots or skin nodules were seen. Excision of Pseudarthrosis site, deformity correction and the lengthening was done by Ilizarov’s apparatus, through upper tibial metaphysis. The follow up of two years showed sound union. It gives credence to Ilizarov’s as being one of the best methods for treatment of CPT and large shortening.

Effect of low-intensity pulsed ultrasound stimulation on maturation of regenerate bone / 中南大学学报(医学版)

Objective To explore the effect of low intensity pulsed ultrasound stimulation (LI-PUS) on the maturation of regenerate bone in a rabbit limb lengthening model. Methods Sixty skeletal mature female New Zealand white rabbits were randomly divided into an LIPUS treatment group and a control group. All rabbits were underwent mid-diaphyseal tibial osteotomy and immobilized in an Orthofix M103 Mini lengther. Gradual distraction at 0. 5 mm every 12 h for 10 d was performed at day 7 postoperatively. A 4-week course of LIPUS treatment group was applied over the distraction site for 20 min daily starting immediately after the completion of the distraction only for the treatment group. Rabbits were euthanized and the mid-diaphyseal tibia was harvested for evaluation at 4, 8, and 12 wk after the completion of the bone lengthening protocol. Radiographic analysis was performed to study the formation of bone callus using the ImageJ software at 12 wk after the completion of the bone lengthening protocol. Bone mineral density (BMD) of regenerate bone was measured by Dual energy X-ray absorptiometry (DEXA) . Torsional testing to failure was performed on the tibia specimens at 8 and 12 wk after the completion of the bone lengthening protocol. Results Radio-graphic measurement showed higher relative gray scale of bone callus in the LIPUS group than that in the control group at 12 wk (P ＜ 0. 05) . BMD in the LIPUS group was significantly higher than that in control group at 8 and 12 wk (P ＜ 0. 05). Biomechanical testing showed that the ultimate torque, ultimate torsional stiffness, and energy absorption at failure of regenerated bone at 8 and 12 wk in the LIPUS treatment group were better than those in the control group (P ＜ 0. 05) Conclusion LIPUS as a biophysical stimulation may accelerate the formation and maturation of regenerate bone in rabbit tibia lengthening model.

Lymphangiomatosis of Bone and Visceral Parenchyma : Report of Two Cases / 대한정형외과학회잡지

Lymphangiomatosis is a rare disorder that occurs mainly in children or during the first two decades of life. It is characterized by a diffuse proliferation of lymphatic channels involving the bones, visceral parenchyma, and soft tissue. Most cases of lymphangiomatosis have bone and visceral involvement and usually present with chylothorax, chylous ascites, chylous pericardial effusion, or acute symptoms that are related to the affected organs. The authors experienced two cases that presented with chylothorax and multiple lytic bone lesions. Chest drainage and chemical pleurodesis were performed for treatment of the chylothorax. In one case, lytic bone lesions were found only in the right scapula and bone lengthening with an Ilizarov frame was performed for growth arrest in the right humerus. In the other case, lytic bone lesions were found in both femurs and both humeri, the right tibia, and the right scapula; and were particularly severe in the right tibia and femur. The lytic bone lesion, osteosclerosis, pathologic fracture, and pseudoarthrosis were so severe that weight-bearing was impossible. Internal fixation was performed with an intramedullary nail in the left femur.

Study on the distraction-resisting force contributed by gastrocnemius / 中国矫形外科杂志

[Objective]To evaluated the distraction-resisting force contributed by gastrocnemius during tibial lengthening.The force contributed by gastrocnemius during both the distraction and consolidation phases in a rabbit model of tibial lengthening were measured by an in-line strain gauged bilateral fixator.[Method]Sixteen immature New Zealand White rabbits underwent 30% (left) tibial diaphyseal lengthening at a rate of two 0.4 mm increments per day.[Result]The contribution of the gastrocnemius distraction-resisting force at the end of lengthening (11?5N,25%?7%) was statistically higher than that of 5 weeks later (3?1 N,13%?5%)(P

Effect of diaphyseal lengthening of tibia on knee joint reactive force / 中国矫形外科杂志

[Objective]To measure the in vivo knee joint reaction force in a rabbit model of tibial diaphyseal lengthening.[Method]Sixteen immature (8 weeks old) New Zealand White rabbits were underwent 30% (left) tibial diaphyseal lengthening at a rate of two 0.4 mm incremental lengthenings per day.The knee joint reaction force was measured at the end of lengthening (8 rabbits,13 weeks old) and 5 weeks later (8 rabbits,18 weeks old).An instrumented bilateral distractor and an extensometer were fixed cross the knee joint.The joint distraction force and distraction displacement were measured immediately after each incremental distraction of the joint.[Result]The joint reaction force on the lengthened side was significantly higher than that of the control side at both time points (44.4?7.8 N v.27.2?4.0 N at 13 weeks of age,44.3?6.5 N v.31.3?3.0 N at 18 weeks of age).[Conclusion]The knee joint reactive force could be increased in 30% tibial disphyseal lengthening which potentially could lead to the risk of damage to artic ular cartilage.

Effect of tibial diaphyseal lengthening on the longitudinal growth of the tibia / 中国矫形外科杂志

[Objective]To study the effect of tibial diaphyseal lengthening on the longitudinal growth of the tibia.[Method]Rabbit models of tibial diaphyseal lengthening and tibial osteotomy were established.Standard radiography of the tibia was taken and the length of the tibia was measured.Histology of the proximal and distal tibia was made and the thickness of the growth plate was measured.[Result]Tibial osteotomy alone stimulated the longitudinal growth of the tibia and increased the thickness of the growth plate.However,tibial diaphyseal lengthening suppressed this stimulation resulting in natural longitudinal growth and normal thickness of the growth plate that matched the normal side.[Conclusion]Diaphyseal lengthening of tibia does not inhibit the longitudinal growth of the tibia.

Lower Limb Lengthening in Turner Dwarfism / 대한정형외과학회잡지

PURPOSE: The aim of this study was to review our cases of lower limb lengthening to treat Turner dwarfism, and to speculate whether or not effective limb lengthening can be achieved in this rare condition. MATERIALS AND METHODS: 12 tibiae and 2 femora were lengthened in 6 patients using the Ilizarov method for tibia and a gradual elongation nail for the femur. Mean age at the time of surgery was 19 years. RESULTS: The average gain in tibial and femoral lengths were 6.2 cm and 6.0 cm, respectively. The average healing indices of tibia and femur were 1.9 and 1.7 months. The average tibia-to-femur ratio improved from 0.68 to 0.81 and leg-trunk ratios improved from 0.88 to 0.99. Two segment (14.3%) had intractable pin site infection, and four segments (35.7%) had twelve complications. The patients showing a nonunion at the distraction site had a reduced bone mass, which was less than 65% of that of the age-matched normal population. CONCLUSION: Despite complications, all patients were satisfied with this results, and lower limb lengthening in Turner Dwarfism is believed to be a valid option. However, it may require careful managment in a specialist unit in order to prevent complications.

Effects of limb lengthening on metabolism of articular cartilage in experimental rabbits / 第三军医大学学报

Objective To investigate the adaptation of metabolism of the arthrodial cartilage for limb lengthening. Methods Thirty New Zealand rabbits were divided into two groups: limb lengthening group (A) and delayed observation group (B). Each group was further divided into three sub groups ( n =10) according to the distraction ranges: 10%, 20%, and 40%. Upper tibia metaphysis lengthening was adopted at 1 mm/d rate of distraction and iconography changes of the knee joint were observed with X ray. The contents of glycosaminoglycan (GAG), hydroxylysine (HYL), and hydroxyproline (HYP) were determined by biochemical techniques. Results ① There was no obvious imaging change of knee articular cartilage at every time point in each group. ② The content of GAG was normal in group A 10 , and B 10 , and B 20 , but the content of galactosamine decreased obviously in group A 20 ( P 0.05). The content of GAG recovered obviously in group B 40 as compared with that in group A 40 . ③ The ratio of HYL to HYP was 0.18 and 0.17, respectively in group A 40 and group B 40 , but it was normal in other groups, nearly 0.24. Conclusion Metabolism of the arthrodial cartilage during low distraction range can adapt the stimulation of distraction, but great distraction range may result in transitory disorder in metabolic function of the arthrodial cartilage.

Lower Limb Lengthening in Turner Dwarfism

The aim of this study was to review our cases of lower limb lengthening to treat Turner dwarfism, and to speculate whether or not effective limb lengthening can be achieved in this rare condition. Twelve tibiae and 2 femora were lengthened in 6 patients using the Ilizarov method for the tibia and a gradual elongation nail for the femur. The mean age at the time of surgery was 19 years, and the patients were followed up for a minimum of 2 years. The average gain in the tibial and femoral length was 6.2 cm and 6.0 cm, respectively. The average healing index of tibia and femur was 1.9 and 1.7 months. The average tibia-to-femur ratio improved from 0.68 preoperatively to 0.81 postoperatively, and leg-trunk ratios improved from 0.88 to 0.99. Seven segments (50.0 percent) had completed the lengthening protocol without complications. Two segments (14.3 percent) had an intractable pin site infection requiring a pin exchange, and four segments (35.7 percent) had twelve complications (a nonunion at the distraction site, premature consolidation, Achilles tendon contractures and planovalgus). The overall rate of complications was 100 percent for each bone lengthened. All the patients showing a nonunion at the distraction site had a reduced bone mass, which was less than 65 percent of those of the age-matched normal population. Despite the complications, all patients were satisfied with the results, and lower limb lengthening in Turner Dwarfism believed to be a valid option. However, it may require careful management in a specialist unit in order to prevent complications during the lengthening procedure. In addition, the osteopenia associated with an estrogen deficiency leading to problems in consolidation is a difficult issue to address.

Re-application of External Fixators for Complications of Limb Lengthening and Deformity Correction / 中国矫形外科杂志

Objective: To treat limb length discrepancy or deformity using external fixation,and Correct potential complications. The authors present their figures for reapplication of external fixator frames in the same bone segment following complications during or after the treatment phase. Methods: Two hundred and sixty-one patients (297 limbs) underwent this type of treatment in our unit between Feb. 1991 and July 1999 with either Orthofix or Ilizarov fixators.228 in children and 69 limb segments in adults. Results: Reapplication of 22 fixators in children (9.65%), and 4 fixators in adults (5.8%) was performed. This gives an overall reapplication rate of 8.75%. The reason for reapplication was fracture and / or deformity of the regenerate (15 segments). Four patients eventually came to amputation. Conclusion: The authors recommended the continue use of this technique for the treatment of severe deformity particularly in congenital disorders.

Limb Lengthening by Gradual Elongation Intramedullary Nail (Albizzia ) / 대한정형외과학회잡지

Leg length discrepancy or short stature is a significant problem to patient psychosocially, cosmetically, and there has been many efforts for limb lengthening. There are many report about lower limb lengthening since the first description of femoral lengthening by Codivilla in 1905. Although limb lengthening using external fixator was popularized by Anderson, the result was poor because of many difficulties in techniques and complications. Recently, a great progress in lower limb lengthening was made by distraction osteogenesis by llizarov and callotasis by De Bastiani. But as such exter- nal fixator has some problem in technique, cosmesis or complications. Therefore gradual elongation intrameduilary nailing(Albizzia) developed by Guichet in 1986 has gained attention for more stability and relatively less discomfort. We reviewed 18 cases in 11 patients(5 males and 6 females) who visited the department of Orthopedic Surgery of Severance Hospital at Yonsei University with limb leg length discrepancy due to sequeale of poliomyelitis, familial short stature and Turner syndrome. They all underwent lower limb lengthening using Albizzia technique between December 1995 and January l997. The average age at the time of the operation was 22.7 year. Famiiial short stature was in 12 cases(67%), Turner syndrome in 2 cases(11%), and leg length discrepancy due to the sequelae of poliomyelitis in 4 cases(22%). The site of lengthening were 5 cases of femur(28%) and l3 cases of tibia(72%). The latency period was average of 7 days. During the distraction period, 15 ratchetings per day(1 mm/day) were performed. In case of bilaterai femoral lengthenings, average length of gain(LG) was 6.0cm and percentage of increase(PI) l6.8%(16.2-17.4), lengthening index(LI) 1.2 month/cm(0.75-2.2). In case of unilateral femoral lengthening, LG was 3.8cm, Pl 7.8 %, Ll 1.3 month/ cm. In case of bilateral tibial lengthening, average LG was 5.5cm(3.5-6.0~) and Pl 18.8%(12.0-22.9), LI 1.3month/cm(0.67-2.3). In case of unilateral tibial lengthening, LG was 2.9cm(2.3-3.5), P1 9.4 %(7.7-11.7), LI 2.8 month/cm(2.2-3.1). Lengthening index in poliomyelitis by llizarov was 3.l month/cm, but it was 1.3 in femur and 2.8 in tibia hy Albizzia method. There are some advantages and disadvantages or contraindications and indications of the Albizzia technique. We suggest that the Albizzia technique is more stahle, more comfortable and no longer lengthening time compared to external fixator such as Ilizarov.

Classification and Evaluation of the Callus in Limb Lengthening / 대한정형외과학회잡지

Recent advances in surgical techniques and equipment have made bone lengthening by callotasis both easier and safer, and many successful clinical cases have been reported. The callus formation, however, has often been very poor, and prolonged applied of the external jixator increases the risk of serious complications, such as pin tract infection. We reviewed 68 cases of limb lengthenings performed with callus distraction in 48 patients at Kang Nam St. Mary' s Hospital between January 1989 and May 1994. There were 29 female and 19 male patients, with an average age of 19 (6-50) years. Causes of limb shortening were short stature (14), poliomyelitis (8), fracture and physeal damage (6), osteomyelitis (6), Legg-Calve-Perthe's disease (4), bone tumor (3), congenital dislocation of the hip (3), leg length discrepancy (3), achondroplasia (2) and hip dysplasia (1). Sixty eight calluses were classified radiographically into 6 types: external, straight, attenuated, opposite, pillar, and scattered. The healing indexes and complications following the procedure were evaluated. The mean femoral lengthening was 6.2 (2-10) cm, the tibial 6.5 (3.3-15.7) cm, the forearm 1.8 (1.6- 2.2) cm and the humerus 10 cm. Fifteen cases classified as external type, 5 femur, 7 tibiae, 2 forearm and 1 humerus, with healing index of 34 days/cm and no major complications. Thirty one cases classified as straight type, 7 femur, 22 tibiae, 1 forearm and 1 humerus with healing index of 38 days/cm and 2 obstacles. Fourteen cases classified as attenuated type, 4 femur and 10 tibiae with healing index of 47 days/cm and 2 obstacles. Six cases classified as opposite type, 4 femur and 2 tibiae with healing index of 65 days/cm and 3 obstacles and 1 residual complications. Two cases classified as scattered type, 2 tibiae with healing index of 116 days/cm and 5 obstacles. The scattered type of the callus in two cases was suspected to be a result of poor callus formation due to K-wire breakage conditions that autogenous bone marrow transplantations were performed. This classification enabled us to estimate the intrinsic conditions, predict the healing index, incidence of complications, and decide to apply early bone marrow injection to the callus.

Regenerate Bone Healing According to Osteotomy Methods in Ilizarov lengthening / 대한정형외과학회잡지

The Ilizarov technique for gradual distraction osteogenesis was developed in the 1950s. A correctly performed osteotomy is essential to the success of distraction osteogenesis and prepares for limb lengthening. Between Sept. of 1991 and 1994, thirty-four patients were treated by Ilizarov technique at St. Benedict Hosp. and Gang-Dong Hosp.. And then assigned to two separate groups : a corticotomy group (group A) and osteotomy group (group B; osteotomy with Gigli saw or osteotomy with multiple drill holes and osteotome). The regenerate segments were evaluated weekly for the first six weeks after operation. After the initial six-week evaluation period, observations of these segments were continued through a series of monthly radiographs. Distraction began on postoperative day seven in group A and on day eleven in group B; and continued at a rate of 1 mm/day and a frequency of 4 times/day. Group A displayed new bone formation earlier than group B: group A's mean was 16.5 ± 4.9 days, while B's mean was 25.3 ± 4.6 days. The first bridging callus occurred earlier in group A than it did in group B: A's mean was time of 36.7 ± 9.9 days, while B's mean was 44.0 ± 7.9 days. There was no significant difference between groups A & B in terms of first cortical formation : A's mean was 86.9 ± 24.0 days, and B's mean was 100.6 ± 25.2 days. There was no significant difference between groups A & B in terms of the bone healing index : A's mean was 41.6 ± 13.5 days and B's mean was 41.15 ± 8.10 days.

Detection of the Proliferation of Muscle Fibers During Limb Lengthening by Monoclonal Antibody to Bromodeoxyuridine / 대한정형외과학회잡지

Soft tissue related complications are quite frequent in limb lengthening. Muscle fibers may proliferate or regenerate after stretching injury over 10-20% of their original length. However, the cells which are engaged in this phenomenon are not confirmed yet. We chased the S-phase cells (phase for DNA replication) in the posterior leg muscle during limb lengthening by immunohistochemical technique. We lengthened the tibiae of fifteen New Zealand white rabbits. We divided them into three groups and each group is consisted of five rabbits. In group 1, we lengthened the left tibiae by 10% of their original length, in Group 2, 20%, and in group, 3, 25%, respectively, At the end of lengthening posterior muscles of lengthened left side and of controlled right side were fixed and processed for Immunohistochemical staining which could detect the incorporation of bromodeoxyuridine(BDU). Labelling index(LI:% of positively stained S-phase nuclei) of group 1 was zero. LI of groups for more than 20% lengthening (sum of group 2 and 3) was statistically significant. In conclusion, nuclei around or within the muscle tissue are in S-phase during limb lengthening which means proliferation of the muscle fivers or of the certain cells that abut muscle fibers.

Distraction Epiphysiolysis as a Method of Limb Lengthening / 대한정형외과학회잡지

We, at Department of Orthopedic Surgery, College of Medicine, Pusan National University, applied epiphyseal distraction as a method of limb lengthening, using unilateral one-plane pin fixator(ORTHOFIX) and bilateral multi-plane ring fixator(SEQUOIA) to three children with limb length discrepancies and angulation deformity due to injury of epiphyseal plate, and obtained following results. l. At first case, on whose distal femoral physis, bone bridge occupied about 20% of total epiphyseal plate and distributed mainly on the lateral side. At 10 days of distraction, epiphysiolysis occurred from the lateral side at first and angulation deformity was corrected. Epiphysiolysis on the medial side of physis appeared apparently after 60mm distraction. Bone lengthening of 4.2cm and correction of 25 valgus deformity were achieved after 72mm distraction for about 10 weeks. The percentage of increase in the initial length achieved was 11.67% and healing index was 27.86. 7 months later, loss of lengthening of 2.7cm was observed and it was considered that this was due to relatively short corticalization phase. 2. At second case, on whose distal tibial physis, bone bridge occupied about 40% of total epiphyseal plate and distributed on the medial side. At 10 days of distraction, epiphysiolysis occurred on the medial side of the epiphyseal plate, but not on the lateral side and instead of further lengthening, valgus deformity of the ankle appeared. It was thought that asymmetric distraction was attributed to the difference between the force applied on the medial side and that applied on the lateral side of the epiphyseal plate by unilateral one-plane pin fixation. 3. At third case, on whose distal tibial physis, bone bridge occupied about 75% of total epiphyseal plate. No epiphysiolysis occurred. there was a difficulty in observation of epiphysiolysis because ring fixator was overlapped with the epiphyseal plate on radiographs.