ABSTRACT
BACKGROUND: There has been a lot of research done on Ilizarov's limb lengthening; however, very few publications focus on the quantitative assessment of the distractional bone regeneration in tibial and femur lengthening. Data regarding quality of the bone after lengthening are needed to consider the time of frame removal and develop a rehabilitation program. MATERIALS AND METHODS: Computed tomography (CT) assessment of a parent bone was performed on 136 patients with limb length discrepancy and bone deformity of various etiologies before and after lengthening. Transosseous osteosynthesis technique with the Ilizarov's external fixation was used for limb lengthening and deformity correction in all the cases. A 64-slice scanner was used for CT assessments. Specific Roentgen-negative units of the Ilizarov apparatus and techniques for interpreting CT findings were employed for artifact-free densitometric assessment. RESULTS: Cortical density of the femur and tibia in patients with limb length discrepancy and bone deformity of various etiologies was shown to have differences as compared to the contralateral limb. The lengthening process was accompanied by decreased cortical density of the segment being lengthened, and the decrease in the density was greater in the areas adjacent to the distractional bone regeneration. The cortical structure underwent characteristic changes. Osteonal density of the cortical bone was higher in the norm and at long term followup as compared to the density of external and internal plates. CONCLUSION: Cortical bone of the femur and tibia in patients with limb length discrepancy and bone deformity of various etiologies showed various preoperative local densities of external, internal, and osteon layers. The cortical bone demonstrated heterogenic structures with resorption areas of various magnitude and density, with minimal values at the boundary with regenerate bone during distraction and fixation with frame on and at short-term followup. Complete organotypical restructuring of the bone was shown to occur at a 1-to-3-year followup depending on the etiology of the disease and amount of lengthening performed.
ABSTRACT
PURPOSE: To assess age related manifestations of the femur and tibia in patients with vitamin D-resistant rickets (VDR) and explore causes for recurrent deformity using imaging modalities. METHODS: Computed tomography (CT), magnetic resonance imaging (MRI) and dual energy X-ray densitometry (DEXA) were used to assess conditions of long bones of lower limbs in patients with vitamin D-resistant rickets aged from 4 years to 30 years preoperatively and after limb lengthening. RESULTS: Age related MRI findings showed specific structure of the femur and tibia in patients with VDR preoperatively and after operative treatment. Abundant irregular osteoid formed in femoral and tibial physes was shown to reveal complicated nature of bone deformity causing recurrence in patients with VDR at childhood. CT findings allowed us to detect early cortical injury, measure its length with forming Looser's zones, examine significant differences in density measurements of Looser's zones preoperatively and after deformity correction using transosseous osteosynthesis. CONCLUSION: Recurrent deformity can develop in patients with VDR due to progression of the disease, irregular osteoid deposited in the medial and lateral metaepiphysis, osteoid area measuring over 50% of epiphyseal cross section, insufficient regenerate mineralization, and formation of Looser's zones.
ABSTRACT
Limb lengthening by Ilizarov lengthens not just the long bone, but also the soft tissues too. Damage of the muscles during corticotomy and their stretching during distraction play a crucial role in occurrence of complications and final limb function. We present here a systematic codified nomenclature system of each muscle summarising all the influence that corticotomy and distraction have the particular muscle and demonstrate the same in the setting of tibial lengthening. This scheme helps the surgeon easily recollect what all muscles are involved in what all ways in each level of corticotomy thus enabling him to watch out for complications thereof and monitor and accordingly modify the limb lengthening process.
ABSTRACT
Ilizarov is an accepted technique for lengthening short amputation stumps to improve prosthetic function and rehabilitation. The relation of stump lengthening and phantom limb pain (PLP) has not been reported in literature. We present here a case report of a transfemoral amputee who had a flare up of PLP following stump lengthening. He responded well to a combination of pharmacological therapy and soft tissue manipulative techniques and desired length was achieved. This report alerts the possibility of aggravation of PLP following stump lengthening and discusses its management.
