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Biology of Limb Lengthening

Biology of Limb Lengthening. Distraction Phase. End Distraction. Consolidation Phase. Remodelling Phase. Interzone Pluripotential cells. Intramembranous. Ossification. 2 Phases of lengthening:. Distraction phase (1mm/day) Consolidation phase. Normotrophic: Stable.

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Biology of Limb Lengthening

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  1. Biology of Limb Lengthening

  2. Distraction Phase End Distraction Consolidation Phase Remodelling Phase

  3. Interzone Pluripotential cells

  4. Intramembranous Ossification

  5. 2 Phases of lengthening: Distraction phase(1mm/day) Consolidation phase

  6. Normotrophic: Stable

  7. Atrophic-Unstable

  8. Low Energy Osteotomy • Metaphyseal better than Diaphyseal • Stable Fixation • No Initial Separation between bone ends • Latency Period before distraction • Rate of distraction </= 1mm/day • Rhythm of distraction ¼ mm 4X/day or greater

  9. CONSOLIDATION TIME vs DISTRACTION GAP

  10. OSTEOTOME GIGLI SAW

  11. osteotome Gigli saw

  12. IIizarov (canines) 1mm , 1 X/day (worst) ¼ mm, 4 X/day (better) 1/60mm, 60 X/day (best) CORR Vol. 239, 1989

  13. Birch (goats) No difference manual versus motorized ASAMI MTG, 1994.

  14. motorized manual

  15. Materials Manual: 43 tibiae in 40 pts. Motorized: 27 tibiae in 26 pts.

  16. Surgical Technique • Percutaneous prox. tibia osteotomy • Ilizarov ex.fix. • Bone lengthened at 1mm/day:Manual: ¼ mm, 4 X/dayMotorized: 1/1, 440mm, 1,440 X/day

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