Bone Defects In Children Research Articles

Mineralized Collagen/Polylactic Acid Composite Scaffolds for Load-Bearing Bone Regeneration in a Developmental Model.

Repairing load-bearing bone defects in children remains a big clinical challenge. Mineralized collagen (MC) can effectively simulate natural bone composition and hierarchical structure and has a good biocompatibility and bone conductivity. Polylactic acid (PLA) is regarded as a gold material because of its mechanical properties and degradability. In this study, we prepare MC/PLA composite scaffolds via in situ mineralization and freeze-drying. Cell, characterization, and animal experiments compare and evaluate the biomimetic properties and repair effects of the MC/PLA scaffolds. Phalloidin and DAPI staining results show that the MC/PLA scaffolds are not cytotoxic. CCK-8 and scratch experiments prove that the scaffolds are superior to MC and hydroxyapatite (HA)/PLA scaffolds in promoting cell proliferation and migration. The surface and interior of the MC/PLA scaffolds exhibit rich interconnected pore structures with a porosity of ≥70%. The XRD patterns are typical HA waveforms. X-ray, micro-CT, and H&E staining reveal that the defect boundary disappears, new bone tissue grows into MC/PLA scaffolds in a large area, and the scaffolds are degraded after six months of implantation. The MC/PLA composite scaffold has a pore structure and composition similar to cancellous bone, with a good biocompatibility and bone regeneration ability.

Microsurgical autologous ffbula transfer as an optimal method for closure of extensive bone defects in children with neuroffbromatosis

Introduction Pseudarthrosis and bone defects are the most common consequence of neurofibromatosis type I in children, a rare hereditary disease. Destruction of bone tissue leads to severe deformities and impaired function of the limbs. Disability in such patients may reach 70 %. Surgical treatment of children with this pathology is long, laborious and multi-stage. Traditional orthopaedic methods for managing bone defects are often ineffective. The development of microsurgical methods enables to perform bone transfer of blood-supplied bone autografts.Purpose To prove the effectiveness of using microsurgical autologous transfer of the vascularized fibula for plastic surgery of bone defects in children with neurofibromatosis type I.Materials and methods A retrospective monocenter study included 27 pediatric patients who underwent reconstruction of bone defects with a vascularized fibular autograft from 2011 to 2021. The etiology of the bone defect in all patients was neurofibromatosis type I. A fibula graft was used to reconstruct 8 tibiae and 19 forearms. Bone defects averaged 12 cm. Median follow-up was 60 months.Results The fibula graft survival rate was 100 %. In 5 cases, nonunion of the proximal part of the fibula and the recipient zone was obtained which required iliac crest grafting. The overall rate of good and excellent results was 74 %. The average time to consolidation was 3 months. Discussion According to the literature, the use of autografting of vascularized bone fragments is a ather limited procedure in children with neurofibromatosis type I as it is associated with an increased risk of complications. Due to the restoration of blood flow in the transferred vascularized autograft, it retains its viability and the possibility of bone tissue remodeling.Conclusion Microsurgical autologous transfer of a vascularised fragment of the fibula is an effective and at times indispensable method of bone plasty in long bone defects in children with type 1 neurofibromatosis. Bone defects larger than 5 cm are an indication for free autologous transfer of a vascularized fragment of the fibula. This method, used in combination with traditional orthopedic methods for the treatment of children, allows obtaining good anatomical and functional results.

Treatment of long bone defects in children: Microsurgical transplantation of a fibular fragment for replacement of long bone defects: A systematic review

BACKGROUND: The use of a vascularized fibular graft during reconstructive interventions on the limbs in children is a promising direction in the replacement of extensive bone defects in children.
 AIM: This study aimed to conduct a systematic review of the literature on microsurgical transplantation of a fragment of the fibula in the replacement of long bone defects in children.
 MATERIALS AND METHODS: Articles were searched in systems such as eLibrary, PubMed, and Google Scholar, with a search time range of 10 years (from 20122022, last query 11/08/2022). The following keywords were used for searching in Russian-language search engines: replacement of bone defects in children and fibula transplantation in children, and in the English-language search engines, microsurgical and fibula, microvascular and fibula, and bone and defect were used. After sorting the published studies, 17 publications were analyzed.
 RESULTS: The study analyzed a total of 690 patients (mean age 12 2.6 years). The predominant cause of the defects was malignant tumors in 647 patients (93.7% of all patients). Benign processes were also noted, which accounted for 0.87% of all patients: osteomyelitis, 2.0%; congenital pathology, 2.17%, and trauma, 1.45%. The mean follow-up period was 4.8 2.4 years. The survival rate of patients with cancer was 78.4%. Donor-side complications accounted for 14.7% of all complications. Recipient-zone complications were frequent and accounted for 85.3% of all complications (n = 457 cases). The main type of complications reported in the studies was graft fracture or fracture at the graft-bone level (35.7% of all complications).
 CONCLUSIONS: The use of a fragment of the vascularized fibula in the replacement of extensive bone defects enables a one-stage reconstruction of the limb with good long-term results in large segmental defects of various features. Despite the complications, this technique is one of the few that enables simultaneous limb reconstruction. The decision to use microsurgical fibula autotransplantation is based on the preference and surgical experience of the surgeon.

Bone Transport in the Management of Post-Osteomyelitis Tibial Defects in Pediatric Population. A Long Term Follow-up Study in Uganda

Background: This study was designed to evaluate the long-term results and complications of using the bone transport technique in the management of post-osteomyelitis tibial defects in a low income country. Design: Retrospective study in a cohort of pediatric patients. Methods: Twenty-two patients were included in the study; all patients were treated between 2005 and 2014. The mean age at time of surgery was 9.5 years. The mean bone defect was 8.2 cm. Transport was done using both ring and monolateral external fixators; the fixator stayed in place for 290 days on average. Clinical and radiological evaluations were performed after a minimum follow-up period of 7 years. Patients were interviewed by social workers with focus on the psychosocial and economic costs of the procedure. Results: The bone and soft tissues management required a total of ninety-one surgeries, with an average of four surgeries per child. Eradication of infection was obtained in all patients. Bone results were graded as excellent in 10, good in 7, fair in 2 and poor in 3. Functional results were graded as excellent in 8, good in 6, fair in 7 and poor in 1. Major and minor complications were numerous during the bone transport procedure. Three cases of non-union at the docking point were observed. Twelve patients had a limb length discrepancy, four had slight angular deformities. Reduced range of motion was observed both in the ankle (n=4) and knee (n=2). Seven joint fusions were noted, two knees and five ankles. Conclusion: Bone transport is a valid option in the management of bone defects in children, providing satisfactory long-term outcomes. Bone gaps, soft tissue defects, limb discrepancy and joint disorders can be managed concurrently. The procedure is lengthy and prone to complications.

Bone transport in the management of post-osteomyelitis femoral defects in children: A case series with a minimum of 10-year follow-up in Uganda.

Purpose:The aim of this study was to evaluate the long-term outcomes of the bone transport technique in the management of post-infectious segmental femoral bone defects in children in a low-income country.Methods:Eleven children were included in this case series. All had a femoral defect secondary to osteomyelitis managed with the internal bone transport technique using an external fixator alone. Bone and functional results were evaluated and complications recorded after a minimum follow-up period of 10 years (range: 10–16).Results:The mean age of the patients was 7.8 years, and the average size of the bone defect was 10.8 cm. At the latest follow-up, bone results were excellent in three, good in five, and fair in three, while the functional results were excellent in three, good in four, fair in three, and poor in one. Limb length discrepancy was observed in 10 cases while hip and/or knee joint disorder was recorded in six cases. At the last follow-up, only one patient had a recurrence of infection.Conclusion:The bone transport technique has proven to be a valid option for eradicating infection and filling large bone defects in children. However, it is a technically difficult and lengthy procedure that is prone to unique complications.Level of Evidence:IV-Case series

Use of Vascularized Periosteal Flaps in Upper Extremity Pathology

AbstractMassive bone defects represent a challenge in orthopedics. The structural and biological contribution of vascularized bone flaps has significantly improved their treatment. Similarly, free vascularized periosteal flaps (VPF) have been used to treat bone defects in children, with higher flexibility, adaptability to the recipient's bed and good osteogenic and osteoinductive capacity. However, these are complex techniques related to donor area morbidity. We have started anatomical and clinical studies on the application of pediculated VPF in recalcitrant massive defects to reduce this morbidity. This article summarizes the fundamental aspects of the surgical technique, the main anatomical findings from cadaveric dissections and the applicability of pediculated VPF to treat biologically unfavorable bone defects at the upper limb. The authors review the vascularized humeral periosteal flap (VHPF), the dorso-ulnar and volar-radial forearm periosteal flaps and the vascularized first metacarpal periosteal flap, all described in previous papers. As a novelty, the dorsal wrist and hand VPF (4-5 radial periosteal flap and dorsum of the second metacarpal bone periosteal flap) are presented. In addition, clinical cases with recent VPF applications in common upper limb conditions are described.

Material based on bioactive glass to replace bone defects in children after removal of tumors

Searchable abstracts of presentations at key conferences on calcified tissues ISSN 2052-1219 (online)

Repair of Cranial Bone Defects in Children Using Synthetic Hydroxyapatite Cranioplasty (CustomBone)

In pediatric cases, the use of autologous bone tissue to repair cranial bone defects is often impossible. The synthetic hydroxyapatite bone substitute (CustomBone) can be a good alternative, especially in case of a large bone defect that has to be repaired. This study focuses on a pediatric series of 30 children who underwent cranioplasty with a CustomBone implant. Patient age ranged from 8 months to 16 years, with a mean age of 7 years and 8 months. The most common indication for cranioplasty was posttraumatic decompressive craniectomy. No complications were reported. Cosmetic results were satisfactory in every patient. Only 1 implant had to be changed after severe head trauma because of an epileptic seizure in the early postoperative period. In all patients, cerebral blood flow improved during the postoperative phase. Complete implant osteointegration is a long process because mean time to begin was 13 months (range, 3-22 months). Mean patient follow-up was 6.7 years. Successful prosthesis integration depends on the accuracy of the preoperative model. The minimum thickness of the implant (4 mm) represents a challenge in very young children, but we used it with success in this series. Moreover, high costs represent another limitation for its use. The CustomBone implant meets all necessary conditions for good clinical outcome: excellent protective properties, restoration of normal intracranial physiology, satisfactory cosmetic results, good integration in the autologous bone, and good resistance in case of trauma.

“Fibula plus Ilizarov”: a Simpler Strategy Than Bone Transport for Major Bone Defects in Children

Bone infection in children can cause extensive diaphyseal defects that are challenging to reconstruct. We report a modified technique of ours in 2 of our patients. One was a 10-year-old boy with 8 cm tibial defect and the other was 13-year-old boy with 7 cm femoral defect. The first stage of treatment involved radical debridement, sequestrectomy, antibiotic spacer application, stabilization with conventional external fixation, and 6 weeks of antibiotic therapy. The second stage of treatment consisted of intramedullary autologous fibular strut grafting stabilized with intramedullary K-wire supplemented with corticocancellous graft and stabilized with simple Ilizarov fixator. Patients began full weight bearing walking with fixator at three months of application. Fibular graft incorporated at 4 and 8 months for the femoral and tibial defects respectively. At follow-up of 3 years both patients are independent ambulators with preserved joint range of motion. We present this simple, cost-effective, and replicable technique.

Assessment of Bioabsorbable Hydroxyapatite for Cranial Defect in Children.

To evaluate the utility and efficacy of bioabsorbable hydroxyapatite and collagen complex (HA/Col) for cranioplasty repair of cranial bone defects in children. Two patients (a 6-year-old male and 11-year-old female) with Treacher Collins syndrome received zygoma and orbital floor reconstruction using a full thickness of parietal bone. The bone grafts were taken from each patient's parietal cranium. The right parietal cranial defect was repaired with autologous bone dust, and the left side was repaired with HA/Col in each patient. Computed tomography scans were taken immediately after and at 12 months following surgery. The osteosynthesis areas and thicknesses were measured using computer-aided engineering. Both patients experienced no complications, including infection. In the 6- and 11-year-old patients, the extent of osteosynthesis for HA/Col was 92.2% and 89.4%, respectively; and for the autologous bone dust was 78.5% and 53.2%, respectively. Because of the small sample size, a significant difference could not be calculated; however, the percentage of osteosynthesis for HA/Col was higher than for the autologous bone dust. This study showed that HA/Col can be effectively used in cranial defects and can be considered an alternative graft material for cranial reconstruction.

Managing large bone defects in children: a systematic review of the 'induced membrane technique'.

IV.

Preliminary Results of the Induced Membrane Technique for the Reconstruction of Large Bone Defects.

During past decades, gradual bone transplant using external fixators and vascularized fibular or rib transplants widely contributed to solve difficult problems related to the reconstruction of large bone defects in children. However, these surgeries are time consuming and require specialized surgical skills, not always available in a general hospital setting, mainly in rural areas. To report the preliminary results of the more recently described induced membrane technique in a consecutive series of 8 children and to identify some factors related to the procedure's success. Nine consecutive children with bone defects ranging from 5 to 14 cm were included in the study. The age at surgery ranged from 3 to 16 years. There were 3 congenital pseudarthrosis (CP) of the fibula, 1 CP of the tibia, 1 Ewing sarcoma of the tibia, 1 Ewing sarcoma of the ulna, 1 tibial osteosarcoma, 1 fibular osteosarcoma, and 1 chronic diffuse tibial osteomyelitis. The procedure was performed according to the original Masquelet's description in 2 stages. Follow-up ranged from 1 to 7 years. The child with tibial osteosarcoma died 3 months after the surgery from complications related to chemotherapy. Among the 8 remaining children, 6 healed uneventfully, and 2 required revision with additional grafting and/or better internal fixation, one with Ewing sarcoma of the tibia and a 13-cm bone defect and the second with CP of the fibula. Both of them had suboptimal internal stabilization. The induced membrane technique is a useful, efficient, and simple alternative to highly specialized surgical procedures used for the reconstruction of large bone defects in children. Risk factors for failure include chemotherapy, suboptimal bone fixation, and persistent axial malalignment. Level IV.

Facial bone reconstruction with prefabricated vascularized calvarium flaps in children and young adults: Advantages and long-term results

Reconstruction of facial bone defects in children is challenging. The use of well-vascularized bone is mandatory to obtain stable lasting results. This study reports our experience of facial bone reconstruction using prefabricated vascularized calvarium flaps. Retrospective case series of 50 patients who underwent 52 maxillary, malar, and mandibular reconstructions between 1988 and 2014 using prefabricated vascularized calvarium flaps. Forty-nine patients suffered from noma sequels; one patient had craniofacial cleft Tessier 3-11. Surgery consisted of a two-step procedure beginning with flap delay and prelamination with skin grafting on the galea. Flap harvest followed at least 2 weeks later (range, 2-16 weeks), including a full-thickness calvarium fragment, which was set into the facial defect. Early complications concerned wound healing and infections requiring surgical revision in six patients at the recipient and six at the donor site. There was one flap loss. Clinical long-term assessment at 15-year median follow-up (range, 1-27 years) showed good results, assuring facial height and contour. Radiological long-term results demonstrated excellent integration of the flap to the adjacent facial skeleton of the growing child. Prefabricated vascularized calvarium flaps are an effective, safe and lasting method for reconstruction of facial bone defects in children.

Segmental bone loss in pediatric lower extremity fractures: indications and results of bone transport.

In this study, we evaluated the results of external bone transport, which was applied to 11 patients with traumatic bone loss who had not completed their bone development. The average age of the 9 male and 2 female patients was 10.6 (range, 8 to 16) years. Eight of the defects were located in the tibia, whereas the other 3 were in the femur. The average defect was 5.4 (range, 4.5 to 8.5) cm. External bone transport was applied in the early period in 7 patients, whereas in 4 patients it was performed due to nonunion. Bifocal osteosynthesis and single osteotomy were performed in 2 patients with type B2 nonunion. Compression to the nonunion region and lengthening in the osteotomy region were applied. In 2 patients with type B1 nonunion, and the other 9 patients who had external bone transport, the gap was eliminated by bifocal osteosynthesis, single osteotomy, and bone transport to the osteotomy line. The mean follow-up period was 21 (range, 13 to 48) months. Complete union was achieved in all patients without any bone operation or graft application. No refracture was observed after the removal of the external fixator, and the average hospitalization time was 16 (range, 7 to 65) days. The average external fixation time was 4.2 (range, 3.5 to 5.5) months, and the mean external fixator index was 0.8 months (23 d/cm). The mean bone healing time was 5.1 (range, 4.6 to 6) months. To initially consider the open fractures with true or in situ bone loss in children as "anticipated nonunion," and determine the treatment strategies regarding this fact, may prevent nonunion and shorten the healing period. Bone transport in the treatment of traumatic bone defects in children is an easy biological procedure, with lower complications but higher success ratios. Level IV-therapeutic.

Ipsilateral medial fibular transport using a circular external fixator for reconstruction of massive tibial bone defects in children and adolescents

BackgroundIpsilateral fibular transport is a novel option in limb salvage surgery for patients with large tibial defects. A less common application of the Ilizarov technique is transverse bone transport. The frame allows for gradual transport of the fibula into the adjacent tibial defect site, with precise proximal and distal alignment of the fibula, and compression at tibial contact sites. Here, we outline a method of limb salvage for large tibial bone loss using ipsilateral medial fibular transport using the Ilizarov apparatus in a group of children and adolescents.Patients and methodsWe retrospectively reviewed six consecutive patients, average age 8 years (range 3-18 years), with infection or trauma-related large tibial bone loss. All patients were treated using gradual medial transport of the ipsilateral fibula using the Ilizarov technique. The follow-up of the patients averaged 4 years, with a range of 4-7 years after removal of the circular external fixator. We reviewed patients' medical records and radiographs. We recorded the fracture type in trauma cases, length of the tibial segment replaced, time to union, additional procedures, knee and ankle range of motion, limb length, satisfaction with the reconstructive surgery compared with amputation, and possible complications.ResultThe Ilizarov ring fixation time to achieve fibular transport and bone union averaged 11 months (range from 7-17 months). The amount of tibial bone loss replaced using the Ilizarov frame with fibular transport averaged 9.8 cm, with a range of 8-11 cm. Hypertrophy of the transported fibula accompanied full weight bearing and satisfactory lower extremity joints motion occurred in all patients. Four of the six patients had a superficial pin-site infection. All patients and or parents were satisfied with the results, and none of them reported that amputation would have been a better option.ConclusionThe Ilizarov technique of ipsilateral medial fibular transport to address massive tibial bone loss led to limb salvage for our six patients, with satisfactory functional results. Adolescent patients may require iliac crest bone grafting at the docking sites if the healing response is poor. Our work shows that ipsilateral fibular gradual transport in children and adolescents provides a reasonable alternative for surgeons addressing limb salvage in patients with large tibial bone loss. Patients should be treated by surgeons familiar and experienced with the Ilizarov method.

Treatment of Benign Bone Defects in Children with Silicate-Substituted Calcium Phosphate (SiCaP)

In children with benign bone defects, various treatment options are recommended. Whether these defects should be curetted, osteosynthetically stabilized and/or filled with allogenic or synthetic bone material is still a matter of controversy. The reported study presents preliminary results of five children with benign bone lesions of the lower extremity. Curettage and filling of the defect with a commercially available silicate-substituted calcium phosphate (SiCaP) (Actifuse® by ApaTech Ltd., Elstree, United Kingdom) was performed. Patients were followed-up in the outpatient clinic. The healing process was assessed according to the clinical and radiological criteria. Clinical and radiological follow-up showed uneventful healing without intraoperative and short-term complications. All patients were capable of full weight bearing after a few weeks and currently did not experience any decreased range of movement among adjacent joints. Growth disturbances did not occur. In all patients increasing cancellous bone reconstruction of the defect, without signs of osteolysis could be shown radiologically. SiCaP represents a good and safe alternative to hitherto existing therapies in the management of defined symptomatic benign bone defects in the pediatric age group.

Traumatic diaphyseal bone defects in children

Traumatic bone defects (BD) are rare in children. There are no pediatric series in the literature on this topic. The aim of this first pediatric series was to determine the epidemiological characteristics and evaluate the results of different treatments in this entity. This retrospective multicenter study evaluated diaphyseal bone defects in cases in which bone reconstruction was performed. BD was either initial and associated with trauma or secondary, resulting from infected non-union. The series included 27 patients (17 boys and 10 girls), mean age 11.4 years old (3-16) (20 traffic accidents). At the outset of all patients' history was an open fracture (one stage 1, seven stage 2, 11 stage 3A and seven stage 3B, 1 NR). BD involved 13 tibias, 9 femurs, three humerus, one radius and one ulna. Bone defects were initial in 20 cases and secondary in seven cases. They were less than 2 cm in two cases, between 2 and 5 cm in 9 cases, between 5 and 10 cm in 10 cases and more than 10 cm in six cases. Treatment of BD was immediate in one case and delayed in 26 cases. Techniques used included: induced membrane in 10 cases, bone transport in seven cases, bone autograft in eight cases, vascularized fibular transfer in one case, no bone reconstruction in one case. Union was obtained in 27 patients. Union was obtained within a mean 12.3 months BD (3-62). Fifteen patients presented with sequellae. Traumatic bone defects have a better prognosis in children than in adults. The thicker, more active and richly vascularized periosteum in children is an important prognostic factor. Treatment of BD requires good initial bone stabilization. Reconstruction depends on the integrity of the periosteum. In case of an intact periosteum, bone reconstruction does not seem necessary in young children. If one part of the periosteum is intact, a simple autograft seems sufficient even with extensive bone defects. In the absence of the periosteum or especially in case of infection, the induced membrane technique seems preferable, with bone transport or a vascularized bone transfer. IV: retrospective study.

Regeneration of the Fibula Using a Periosteum-preserving Technique in Children

Bone grafting is a commonly used surgical procedure, particularly in reconstructive orthopedic surgery. Bone grafts may be used to fill skeletal defects created by trauma, infection, tumors, or congenital malformation. Fibular graft is an ideal option and is widely used to treat massive segmental defects; however, it leads to various complications, especially in children. This article describes our experience with donor site bone grafts using a periosteum-preserving technique with respect to minimizing donor site complications and performing effective reconstruction of bone defects in children. Seventeen patients who were followed after fibula resection and bone grafting in the donor site using a periosteum-preserving technique were evaluated radiologically and clinically. The patients were divided into 2 groups: 1 group was filled with cancellous allograft (n=9), and the other group was filled with calcium sulfate (n=8) in the donor site. Mean patient age was 8.4 years (range, 2-13 years), and mean follow-up was 31 months (range, 7-65 months). Complete regeneration of the donor sites occurred in all patients; mean time to regeneration at donor sites was 12 weeks (range, 4-21 weeks). There were no significant donor site complications intraoperatively or immediately postoperatively. The average regeneration index was 0.5 (range, 0.2-1.1), and it was found to increase with age (r=0.75, P<.001), indicating that younger patients had faster regeneration. The periosteum-preserving technique was found to lead to the reconstruction of bone defects effectively in children with minimal donor site complications.

Bone Metabolism in Celiac Disease

To investigate the prevalence of both calcium metabolism alterations and bone defects in children with celiac disease (CD). We studied 54 untreated patients with CD (mean age, 7 years). We compared the serum concentration of calcium, magnesium, 25(OH)vitamin D3, alkaline phosphatase, and parathyroid hormone (PTH) of patients with CD with those of 60 healthy children. Children with CD with 2 laboratory alterations underwent DEXA examination, which was evaluated after 6 months of a gluten-free diet (GFD). The calcium and the 25(OH)vitamin D3 levels were lower in children with CD than in control subjects, and the PTH level was higher in children with CD than in control subjects (P < .001). Hyperparathyroidism was found in 29 children with CD. Twenty patients tested positive for 2 laboratory alterations, and 10 of them were osteopenic. After 6 months of GFD calcium, 25(OH)vit.D3 and PTH levels normalized, with the improvement of bone mineral density. Calcium metabolism defects are common in untreated children with CD, and they returned to normal after GFD. A detailed, time-consuming, and expensive study of bone metabolism is not necessary in children with CD shortly exposed to gluten who follow the GFD.

Spontaneous bone regeneration in surgically induced bone defects in young rabbits.

Defects of the femoral shaft (15%, 20%, 25%, and 30% of the femoral length) with intact periosteum were made in young rabbits to investigate differences in union time. The mean union time was 7.3, 7.1, 7.4, and 7.0 weeks, respectively and there was no significant difference ( >0.05) between the groups. The mean healing indices were 6.7, 4.6, 3.9, and 3.1 weeks/cm, respectively and these were significantly different ( <0.05) between the 15% bone defect group and the other bone defect groups. These results suggested that union time was not affected by the amount of bone defect. Femoral lengthening of 20% was performed to compare the quality of callus with those of the femoral defect of 20%. The mean healing indices of defect and lengthening were 4.6 and 5.7, respectively and the difference was significant ( = 0.004). The callus stiffness of femoral defect was higher ( = 0.02) than that after femoral lengthening whereas the bone mineral density of the callus showed no significant difference ( = 0.37) between two groups. The method of filling bone defect with callus generated from the intact periosteum may be a new therapeutic option for the reconstruction of large bone defects in children when other treatments are not available.