1 / 9

Factors Affecting Distraction Osteogenesis at the Proximal Tibial Metaphysis in Congenital Pseudoarthrosis of the Tibi

Background. Tibial shortening is the most frequently encountered problem remaining after osteosynthesis in congenital pseudoarthrosis of the tibia (CPT). Ilizarov method enables comprehensive approach by concomitant limb lengthening. We experienced good healing of distraction osteogenesis in some patients, but poor healing in others.The purposes of the current study were to investigate the outcome of distraction osteogenesis at the proximal metaphysis using Ilizarov metho33298

alcina
Download Presentation

Factors Affecting Distraction Osteogenesis at the Proximal Tibial Metaphysis in Congenital Pseudoarthrosis of the Tibi

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. Factors Affecting Distraction Osteogenesis at the Proximal Tibial Metaphysis in Congenital Pseudoarthrosis of the Tibia Patients Tae-Joon Cho, In Ho Choi, Ki Seok Lee, Won Joon Yoo, Chin Youb Chung, Sang Min Lee Seoul National University Childrens Hospital, Seoul, Korea All presentations will be six (6) minutes in length. Podium sessions will consist of 15 presentations, after every third paper there will be a 5-minute floor discussion conducted by two invited moderators. All presentations will be six (6) minutes in length. Podium sessions will consist of 15 presentations, after every third paper there will be a 5-minute floor discussion conducted by two invited moderators.

    2. Background Tibial shortening is the most frequently encountered problem remaining after osteosynthesis in congenital pseudoarthrosis of the tibia (CPT). Ilizarov method enables comprehensive approach by concomitant limb lengthening. We experienced good healing of distraction osteogenesis in some patients, but poor healing in others. The purposes of the current study were to investigate the outcome of distraction osteogenesis at the proximal metaphysis using Ilizarov method in CPT patients, and to find out the risk factors for poor or delayed bone formation.

    3. Patients Retrospective review D.O. at the proximal metaphysis 27 procedures in 22 CPT pts NF1 in 19/22 pts Age at surgery: avg. 7.0 yrs ( 1.7 ~ 20 )

    4. Surgical Protocol 5 ~ 7 days of latency period Initial rate 0.5 mm/day then adjusted Removal of frame when bridging callus at more than 3 cortices Indication: No regenerate bone formed or No maturation of regenerate bone 17 additional procedures in 12 cases Auto BG: 12 in 9 cases BM inj.: 4 in 4 cases DBM insertion: 1 in 1 case Case A: 3 BGs + 1 BM inj Case B: 2 BGs Case C: BM inj. + DBM

    5. Results Length gain: 3.7 cm ( 1.0 ~ 9.1) Healing index: Avg. 89 day/cm (22 ~ 280)

    6. Length Gain Overall distraction rate and length gain were significantly larger in Group I.

    7. Age at surgery 0.821 Ilizarov construct 0.251 NF 1 0.349 Intramedullary rod 0.402 Proximal tibial dysplasia .. 0.001 Repeated lengthening 0.042 Parameters Compared between Group I vs. II

    9. A representative case in Group I. A 7-year-old girl with untreated CPT associated with NF1 had a normal-looking proximal tibial segment. DO at the proximal tibia resulted in active new bone formation at 2 months postoperatively. A length gain of 5.3cm was achieved with a HI of 29 day/cm.

    10. Summary Distraction osteogenesis (DO) through corticotomy at the proximal metaphysis provides a safe and effective means of limb lengthening, even in CPT patients, if the proximal metaphysis has a normal morphology and it has not been previously lengthened. If the proximal tibial metaphysis is dysplastic or has been previously lengthened, DO is likely to result in unacceptably delayed bone healing or the development of nonunion. Physeal distraction or DO through subphyseal corticotomy may be a safer option in such high risk cases.

More Related