Complications Of Distraction Osteogenesis Research Articles

Is physeal distraction osteogenesis a good choice to treat CPT patients with tibial shortening?

The purpose of this study was to evaluate the healing index and complications of distraction osteogenesis through the physis in children with Congenital pseudarthrosis of the tibia (CPT) using Ilizarov external fixation device. Nine children with CPT who underwent distraction osteogenesis through the physis surgery with an Ilizarov external fixation device between June 2018 and August 2020 were included in the study. The average follow-up time was 36.1 months. X-ray examination was performed 1 month after physis lengthening, and the callus quality was evaluated using the Li classification. Any complications and the quality of the callus after tibial lengthening were followed up. The average age at the time of operation was 9.4 years, and the average follow-up time was 36.1 months. The average lengthening length of children with CPT was 6.6 cm. The incidence of good callus morphology was 100%, and the healing index was 51.1 d/cm. The average fixation time of the external fixation device was 316 days. Needle tract infection occurred in one case, ankle stiffness occurred in one case, ankle plantar flexion 20° deformity occurred in one case, angular deformity of the tibial lengthening segment occurred in one case (7°) and limited movement of knee joint occurred in one case (0-20°-70°). The osteogenic quality of the patients of distraction osteogenesis through the physis with tibial shortening and small diameter of the proximal tibia is good, which provides a choice of operation for the children with CPT.

Functional Outcome of Distraction Osteogenesis Using Linear Rail System (LRS) in Adults with Isolated Femoral Bone Gap

Background: The management of bone gap in the femoral shaft has remained difficult and challenging to the orthopaedic and trauma Surgeons. Distraction osteogenesis using the linear rail system (LRS) may be a useful tool in bridging such defects in our environment. Objective: To study the radiologic bone union, functional outcome and complications of distraction osteogenesis in the management of femoral bone gap using linear rail system (LRS). Methodology: A hospital based prospective interventional study conducted at National Orthopaedic Hospital, Dala and Albarka clinic, Dandishe, Kano, between March 2013 and March 2018. Sixty-eight cases were recruited. Every patient had LRS applied after adequate debridement when needed. Primary or interval corticotomy was done depending on the extent of soft tissue dissection in relation to the corticotomy site. Follow up was done until the regenerate had corticalized and LRS removed. Complications were noted and recorded. Radiologic union and functional outcome were assessed using the RUST and ASAMI outcome scores respectively. Data was analyzed using SPSS version 20. Results: Sixty-eight cases were recruited with M: F ratio of 16: 1. The mean age was 36.7 +/- 10.5years. The age range between 36-45years was more commonly treated representing 34(50.0%). Primary corticotomy was done in 52 (76.5%) while interval corticotomy was done in 16 (23.5%). The mean regenerate length achieved was 9.6 +/- 2.7cm. The mean duration of treatment was 20.3 +/- 6 months. Radiologic union was achieved in 66 (97.1%) patients. Sixty-four (94.1%) had excellent or good ASAMI functional outcome scores. Sixty-six (97.1%) were either very satisfied or satisfied with their treatment while 2 (2.9%) were indifferent. The common complications were intermittent pin tract infections recorded in 28 (41.2%), knee stiffness in 18 (26.5), proximal or distal varus deformity in 10 (14.7%) and non-union in 2 (2.9%) of cases. Conclusion: Distraction osteogenesis using LRS can achieve bone union and excellent outcome in the management of bone gap in the femur. However, intermittent pin tract infection, knee stiffness and varus deformities post significant challenges.

Functional Outcome of Distraction Osteogenesis Using Linear Rail System (LRS) in Adults with Isolated Femoral Bone Gap

Background: The management of bone gap in the femoral shaft has remained difficult and challenging to the orthopaedic and trauma Surgeons. Distraction osteogenesis using the linear rail system (LRS) may be a useful tool in bridging such defects in our environment. Objective: To study the radiologic bone union, functional outcome and complications of distraction osteogenesis in the management of femoral bone gap using linear rail system (LRS). Methodology: A hospital based prospective interventional study conducted at National Orthopaedic Hospital, Dala and Albarka clinic, Dandishe, Kano, between March 2013 and March 2018. Sixty-eight cases were recruited. Every patient had LRS applied after adequate debridement when needed. Primary or interval corticotomy was done depending on the extent of soft tissue dissection in relation to the corticotomy site. Follow up was done until the regenerate had corticalized and LRS removed. Complications were noted and recorded. Radiologic union and functional outcome were assessed using the RUST and ASAMI outcome scores respectively. Data was analyzed using SPSS version 20. Results: Sixty-eight cases were recruited with M: F ratio of 16: 1. The mean age was 36.7 +/- 10.5years. The age range between 36-45years was more commonly treated representing 34(50.0%). Primary corticotomy was done in 52 (76.5%) while interval corticotomy was done in 16 (23.5%). The mean regenerate length achieved was 9.6 +/- 2.7cm. The mean duration of treatment was 20.3 +/- 6 months. Radiologic union was achieved in 66 (97.1%) patients. Sixty-four (94.1%) had excellent or good ASAMI functional outcome scores. Sixty-six (97.1%) were either very satisfied or satisfied with their treatment while 2 (2.9%) were indifferent. The common complications were intermittent pin tract infections recorded in 28 (41.2%), knee stiffness in 18 (26.5), proximal or distal varus deformity in 10 (14.7%) and non-union in 2 (2.9%) of cases. Conclusion: Distraction osteogenesis using LRS can achieve bone union and excellent outcome in the management of bone gap in the femur. However, intermittent pin tract infection, knee stiffness and varus deformities post significant challenges.

Complications of distraction osteogenesis in brachymetatarsia: Comparison between the first and fourth brachymetatarsia

BackgroundRecently, distraction osteogenesis has been widely used to treat brachymetatarsia. However, few papers have compared complications associated with this treatment. The purpose of the present study was to compare the complications between the first and fourth brachymetatarsia treated by distraction osteogenesis.MethodsWe performed distraction osteogenesis to 83 metatarsals in 41 patients between 1999 and 2012. A total of 30 metatarsals received treatment for the first metatarsal (Group A) while 53 metatarsals received treatment with the fourth metatarsal (Group B).ResultsThe complication rate in Group A (40%) was higher than that in Group B (18.9%). Those who had high percentage of lengthening gain were more likely to have complications. A cut-off value for lengthening gain developing complication was 41.3%.ConclusionComplication incidence after distraction osteogenesis was increased when lengthening gain was more than 41.3% for brachymetatarsia. In the 1st metatarsal lengthening, the most common complication was stiffness. In contrast, complications of the 4th metatarsal lengthening were pin-track infection and angular deformity.

A Rare Complication Associated with Distraction Osteogenesis in Correction of Maxillary Hypoplasia

Aim: Distraction osteogenesis (DO) is an alternative to orthognathic surgery that appears to have some advantages for advancement in the maxilla and mandible, but relatively high complication rates have been reported in the maxillofacial region.
 Methodology: A 22-year-old female with the chief complaint of maxillary hypoplasia was referred to our clinic. A two-stage procedure combining maxillary advancement by distraction technique with mandibular setback surgery was performed to correct jaw deformity. At the sixth day of the distraction breakage of the device occurred. The distractors were removed and the patient was treated using conventional osteotomy techniques to achieve good occlusion and improve the facial profile
 Results: Besides there are a number of studies about complications of DO, breakage of distractor has been really rare reported. In our case this unexpected and a very rarely reported complication occurred.
 Conclusions: The purpose of the present case report is to present an undesirable and very rare complication associated with the maxillary distraction device and an alternative treatment method for managing this undesirable failure.
 How to cite this article: Apaydın A, Yenigün S, Can T. A Rare Complication Associated with Distraction Osteogenesis in Correction of Maxillary Hypoplasia. Int Dent Res 2012;2:23-26.
 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Cranial distraction osteogenesis: a proposal of minimal consolidation period.

Cranial distraction osteogenesis (DO) has many advantages for correcting skull deformities: Thus, DO is extensively used for the treatment of skull deformities. However, diverse, unexpected complications are associated with this procedure. In this study, we present the surgical outcomes and complications of DO. Moreover, we propose a modified protocol for DO to reduce complications. This is a retrospective study on managed patients that underwent DO between March 2008 and May 2013. Their clinical courses were reviewed. Distraction protocols were individually inspected, and the final surgical outcomes, including complications, were evaluated. During the study period, a total of ten patients (seven boys and three girls) were treated at our institute. The median distraction period was 20.5days (ranging from 17 to 50days). The range of total distraction length was 19-22mm. The median consolidation period was 96days (ranging from 0 to 343days). All patients achieved the goals of distraction. At follow-up evaluations, all patients, except one, showed good surgical outcomes in both head shape and neurologic symptoms. There were six patients with wound complications during the treatment period. Among them, the distractors were removed early in three patients. Interestingly, even these three patients, without a sufficient consolidation period, showed good outcomes. Although DO has many merits for correcting skull deformities, it frequently causes severe wound complications. To reduce these complications, we propose a modified protocol with a minimal or even no consolidation period.

Risk factors for and complications of distraction osteogenesis

Distraction osteogenesis is commonly used for limb deformities and reconstruction of bone defects with satisfactory outcome for the patients. However, it is associated with a risk of complications. The present study aims to assess the incidence of complications and to identify the risk factors that may predict distraction osteogenesis-related complications. We retrospectively studied 63 patients (mean age 13.5 years; range 3-57 years) who had 74 distraction osteogenesis procedures from 2004 to 2009. A circular external fixator was used in 58 procedures, and a monolateral in 16 procedures. Fixator's time, days of treatment, lengthening percentage, bone healing index, distraction regenerate length and index, risk factors and complications were evaluated. The mean follow-up was 5 years (range 2-7 years). Complications occurred in 57 of the 74 procedures (77%); 70% were major complications and 30% were minor. Complications were more common in adults. Bone healing index, days of treatment and fixator's time were univariate predictors of complications. Bone healing index and adult age were the only multivariate predictors of complications. Adult age and bone healing index are the most important multivariate predictors of distraction osteogenesis-related complications. Routine follow-up after implant removal, selection of younger patients with minor risk factors and shorter fixator's time are necessary to reduce the rate of distraction osteogenesis-related complications.

Histomorphometrical and radiological comparison of low-level laser therapy effects on distraction osteogenesis: experimental study

Distraction osteogenesis (DO) is the application of traction to the callus formed between bone segments and stimulation of bone formation by creating stress on the callus with this traction. Shorten the duration of DO and increasing the capacity of bone formation is important to prevent the possible complications of DO. For this reason, it was considered that low-level laser therapy (LLLT) may affect positively DO and it can decrease the complication range by shortening the period. Unilateral mandibular distractors were applied on 16 female white New Zealand rabbit to prove this hypothesis with micro CT, plain radiograph and histomorphometric analyses. Eight rabbits were applied LLLT with GaAlAs laser on the distraction area during the distraction period. On the post-distraction 28th day, four rabbits from study group and four rabbits from control groups were sacrificed. The rest of the rabbits were sacrificed on post-distraction 56th day. As a result of this study, significant positive effects of LLLT on post-distraction 28th day were revealed with all analyses. In histomorphometrical analyses, new bone formation was significantly higher in short-term laser applied group comparing to that of short-term control group (p = 0.029). In both microCT and plain radiograph, the highest radioopacity values were observed in short-term laser group when compared with that of the controls (p = 0.043 and p = 0.025, respectively). Even though LLLT increased the healing capacity on short-term, it was not sufficient on long-term (post-distraction 56th day) healing. LLLT application on distraction period, activate healing on bone so it may decrease DO period. The result of this study should be supported with clinical studies and the most effective laser source, dose and application time should be revealed with experimental and clinical studies.

Can bone healing in distraction osteogenesis be accelerated by local application of IGF‐1 and TGF‐β1?

Because complications of distraction osteogenesis are largely related to the long duration of therapy, increasing efforts were reached to shorten treatment by using osteoconductive replacement materials incorporating bioactive molecules such as IGF-1 and TGF-beta1. The controlled release of IGF-1 and TGF-beta1 from coated biodegradable poly(D,L-lactide) implants could stimulate fracture healing locally. We investigated the effect of locally applied IGF-1 and TGF-beta1 from IGF-1/TGF-beta1-enriched polylactide membranes on fracture healing in a sheep model of delayed callus formation. Twenty-eight sheep were used for this study. Callus distraction of 1 mm/day by means of a unilateral fixator was continued for 30 days. At the beginning of the subsequent consolidation phase, either growth factors were applied locally or the defect was packed with cancellous bone, or both. The groups treated with growth factors were compared to a control group. The consolidation phase lasted for 60 days and both tibiae were dissected for histological and histomorphometric analyses. This investigation found a reduced absolute callus area in the lengthening zone in all treatment groups. The two treatment groups that received a membrane coated with growth factors showed distinctly higher relative bone areas than the groups treated with an uncoated membrane or packing of the osteotomy defect with cancellous bone. The differences in bone areas were not statistically significant. Application of the growth factors accelerated bone healing and achieved results comparable with those of established treatment methods (packing with autologous cancellous bone). The best results were achieved with a combination of both methods.

Complications of Distraction Osteogenesis in Short First Metatarsals

The authors analyzed the results and complications of metatarsal lengthening in short first metatarsals by distraction osteogenesis. There were 13 first metatarsal lengthenings in eight patients. Mean age was 18.8 years and the average percentage of lengthening was 49.2%. The average healing index was 72.4 days/cm. The major complication was cavus foot, which was noticed in four feet. All great toes showed some loss of motion at metatarsophalangeal (MP) joint. Other complications were hallux valgus, angulation of the metatarsals, and pin tract infection each in two feet. The functional score according to the American Orthopedic Foot and Ankle Society (AOFAS) hallux MP joint, interphalangeal joint scale was excellent in 11 and good in 2. All patients were satisfied with the procedure. To avoid potential complications such as MP joint subluxation, cavus foot, and hallux valgus, the first metatarsal lengthening should not exceed 50% of the original length.

Complications of Distraction Osteogenesis in Short First Metatarsals

The authors analyzed the results and complications of metatarsal lengthening in short first metatarsals by distraction osteogenesis. There were 13 first metatarsal lengthenings in eight patients. Mean age was 18.8 years and the average percentage of lengthening was 49.2%. The average healing index was 72.4 days/cm. The major complication was cavus foot, which was noticed in four feet. All great toes showed some loss of motion at metatarsophalangeal (MP) joint. Other complications were hallux valgus, angulation of the metatarsals, and pin tract infection each in two feet. The functional score according to the American Orthopedic Foot and Ankle Society (AOFAS) hallux MP joint, interphalangeal joint scale was excellent in 11 and good in 2. All patients were satisfied with the procedure. To avoid potential complications such as MP joint subluxation, cavus foot, and hallux valgus, the first metatarsal lengthening should not exceed 50% of the original length.

Complications of Distraction Osteogenesis in Short Fourth Metatarsals

This study investigated 47 callus distractions performed in 31 patients who had only shortening of the fourth metatarsals (20 feet in 13 children and 27 feet in 18 adults). The average percentage of lengthening was 35% in children and 30% in adults. The average healing index was 69 days/cm in children and 75 days/cm in adults. In both groups, major complications were stiffness or subluxation of the metatarsophalangeal (MP) joint and minor complications were varus angulation at the distraction site and pin tract infection. The incidence of major complications was 30% (6/20) in children and 48% (13/27) in adults. The results in children were 14 excellent and 6 good; results in adults were 14 excellent, 8 good, 3 fair, and 2 poor, according to American Orthopaedic Foot and Ankle Society (AOFAS) score. The unfavorable results occurred in patients with combined short proximal phalanx who required extra lengthening and led to subluxation of the MP joint. Distraction lengthening is an effective treatment method for short fourth metatarsals, but subluxation or stiffness of the MP joint must be avoided for satisfactory results.

Intracranial Migration of Halo Fixation Pins: A Complication of Using an Extraoral Distraction Device

Abstract Objective: Distraction osteogenesis is a well-accepted technique in the treatment of patients with hypoplastic craniofacial components. Complications of distraction osteogenesis are well described in the literature. We describe a complication of using an external distraction device in a 9-year-old girl with Pfeiffer. Intervention and Results: A modified Lefort III osteotomy was performed for maxillary hypoplasia with application of an external distraction halo device by a pediatric neurosurgeon. A postoperative computed tomography (CT) scan showed 0.5-cm skull penetration of the cranial pins. The pins were repositioned and the patient was followed up on a regular basis until discharge from the hospital. At 3-week follow-up, a CT scan of the head showed migration of the pins 1.5 cm intracranially. The halo was removed and repositioned at a different site. No detectable neurological sequelae from the pin penetration were noted. The patient developed cellulitis at the site of the penetration and was...