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.

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.