Ilizarov technique for correction of the Shepherd's crook deformity: a report of two cases.

We report 2 patients with fibrous dysplasia who underwent correction, using the Ilizarov technique, of Shepherd's crook deformities and pathological fractures of the left femurs. A 12-year-old boy underwent an opening wedge osteotomy and a 48-degree gradual correction, whereas a 43-year-old woman underwent a 34-degree acute correction without osteotomy at the fracture site. Both patients could initiate early weight bearing. Final leg function was excellent and alignment was maintained. No complications were encountered. Both patients had no difficulty sleeping and no major complaints about the Ilizarov technique. It is more important to achieve accurate alignment than resection of the lesion. The Ilizarov technique is effective for treating the Shepherd's crook deformity in patients with fibrous dysplasia.

Bone transport using hydroxyapatite loaded with bone morphogenetic protein in rabbits.

The feasibility of bone transport with bone substitute and the factors which are essential for a successful bone transport are unknown. We studied six groups of 12 Japanese white rabbits. Groups A to D received cylindrical autologous bone segments and groups E and F hydroxyapatite prostheses. The periosteum was preserved in group A so that its segments had a blood supply, cells, proteins and scaffold. Group B had no blood supply. Group C had proteins and scaffold and group D had only scaffold. Group E received hydroxyapatite loaded with recombinant human bone morphogenetic protein-2 and group F had hydroxyapatite alone. Distraction osteogenesis occurred in groups A to C and E which had osteo-conductive transport segments loaded with osteo-inductive proteins. We conclude that scaffold and proteins are essential for successful bone transport, and that bone substitute can be used to regenerate bone.

Osteosarcoma around the knee. Intraepiphyseal excision and biological reconstruction with distraction osteogenesis.

In 11 patients juxta-articular osteosarcoma around the knee was treated by intraepiphyseal excision of the tumour and reconstruction of the bone defect by distraction osteogenesis. Preoperative and postoperative chemotherapy was given to eight patients with high-grade tumours. The articular cartilage of the epiphysis and a maximum of healthy soft tissues were preserved. Distraction osteogenesis was then carried out. The mean gain in length was 9.7 cm. Full function of the limb was preserved in all except one patient, with a mean follow-up of 53.8 months. Treatment of juxta-articular osteosarcomas around the knee with joint preservation and biological reconstruction using distraction osteogenesis can give excellent functional results.

Ankle arthrodesis and tibial lengthening for congenital sensory neuropathy with anhidrosis.

This report describes a patient with congenital sensory neuropathy with anhidrosis (CSNA) with destructive arthropathy of the left ankle joint that was treated with ankle arthrodesis and tibial lengthening, using an Ilizarov external fixator. The fusion at the ankle joint was successful, but, at the lengthening site, loosening of the apparatus occurred and formation and maturation of the distracted callus were delayed. Intramedullary nailing was used after the removal of the external fixator, and a low-intensity ultrasound device was employed, after which the distracted callus matured gradually. During the maturation period, the patient's dysplastic right hip joint was destroyed, without the occurrence of any severe symptoms. Distraction osteogenesis in patients with CSNA may lead to good results if rigid fixation, nonweight-bearing (i.e., adequate rest), and appropriate biological stimulation can be employed.