Distraction Osteogenesis Research Articles

Influence of immunodeficiency on spring-assisted cranioplasty: A study in mice

BackgroundSpring-assisted cranioplasty has been widely used in craniomaxillofacial surgery in recent years, but the molecular mechanisms that regulate the process of spring-assisted distraction osteogenesis are still unclear. The study aimed to investigate the influence of immunodeficiency on spring-assisted distraction osteogenesis. MethodsThe experimental group consisted of Thirty-six 6-week-old male scid-beige mice and the control group consisted of Thirty-six wild-type mice. All mice conducted spring-assisted cranioplasty with a distraction force of 10 g. The sagittal suture tissue of mice was obtained at 6 time points: Immediately after surgery, 1, 3, 7, 14, and 28 days after surgery. The width of the sagittal suture was measured and osteogenesis was observed through HE staining and Masson staining. The expression levels of OPG, RANKL, and IL-6 were detected through immunohistochemistry and RT-PCR. ResultsThe control group had the widest sagittal suture gap on the 3rd postoperative day, and then the gap narrowed to exceed the preoperative level. The experimental group had the widest sagittal suture gap on the 7th postoperative day, and then the gap narrowed and reached the preoperative level. Histological staining showed that the experimental group showed slower growth of skull tissue. Immunohistochemistry showed that the percentage of positive cells for OPG, RANKL, and IL-6 in the experimental group increased and decreased later than that of the control group, and the magnitude of change was smaller. RT-PCR showed that the mRNA expression levels of OPG, RANKL, and IL-6 in the experimental group exhibited a smaller increase, lower peak levels, and a delayed time to reach peak expression. These differences were statistically significant (P<0.05). ConclusionsDuring the process of spring-assisted cranioplasty, immunodeficient mice had lagging bone reconstruction responses and poor osteogenic ability. Immunologic factors, especially lymphocytes, may play an important regulatory role in the distraction osteogenesis process.

Distraction Osteogenesis: Changing Lives

Background: A method of generating new bone following a corticotomy or an osteotomy and gradual distraction based on the tension-stress principle proposed by Ilizarov is called distraction osteogenesis. DO works in following phases: Osteotomy or surgical phase - Latency period - Distraction phase - Consolidation phase - Appliance removal - Remodeling period. Case report: A 21 years old female patient reported to the department of orthodontic with the chief complaint of forwardly placed upper front teeth. Her past medical, dental, post natal and family history did not show any relevant reporting. Material and method: The osteotomy was prepared by extending the line from medial aspect of posterior border of ramus till the buccal cortical plate between first and second molar and the intraoral bidirectional distractors (figure 3) were secured in place and the distraction was done twice a day at a rate of 1mm/day. The distraction was initiated five days after the surgery and then continued till 11 days. Conclusion: DO can effectively treat facial ............

PRECICE nail bending in femur lengthening

IntroIntramedullary nails (ILNs) are commonly used in orthopedic surgery for the fixation of long bone fractures and limb lengthening. Understanding the structural mechanics (i.e. nail bend) of an ILN device is crucial in determining its performance under various loading conditions. Furthermore, nail diameter was found to play a key role in an ILN's susceptibility to plastic deformity. This study aims to investigate the degree of nail bending and incidence of plastic deformity in patients receiving antegrade femoral ILNs (PRECICE, NuVasive, Inc.). MethodsRetrospectively evaluated 130 ILNs (PRECICE, NuVasive, Inc.) in 100 adult patients who underwent limb lengthening done in a single center. Patients who had concomitant osteotomies, tibial lengthening, malunion, non-union, mechanical failure, or revision surgery for any reason were excluded. All nails were inserted through the greater trochanter or piriformis. Patients’ age, weight, height, and body mass index (BMI)were extracted. Radiologic assessments involved analyzing long lower limb standing X-rays before, during, and at consolidation for total distraction and nail bend. Naildiameter and patient characteristics were directly sourced from medical records. ResultsNail bend at consolidation averaged 2.4° (SD 2.4), ranging from 0 to 9. Additionally, total femoral lengthening was assessed, with a mean value of 5.3 cm (SD 2.1). A significant positive association was observed in the nail bend and weight (weight in kg/nail diameter in mm) coefficient (P < 00.01). Bilateral limb lengthening was also correlated to increase nail bend (P < 00.05). ConclusionPatient's weight to nail diameter ratio and bilateral limb lengthening were found to be significant factors affecting nail bend. These findings advance our understanding of the interrelation between the nail biomechanical profile and the patient's physical attributes, offering important implications for limb lengthening. Level of evidenceIII.

Prevalence of Upper Limb Length Discrepancy among Asymptomatic Population of Medical Students in Nepal: A Descriptive Cross Sectional Study

INTRODUCTIONUpper limb length discrepancy are frequently documented in various anatomical orthopedics and anthropometric journals. Proper idea about discrepancy is pivotal prior to any limb lengthening surgery. The aim of the study is to find out the prevalence of upper limb length discrepancy among asymptomatic population in medical students of Nepal. MATERIAL AND METHODSA descriptive cross-sectional study was carried out at the department of anatomy in Universal College of Medical Sciences, Bhairahawa, Nepal from September 2021 to November 2022 after ethical clearance from the same institution (IRC UCMS, Ref: UCMS/IRC/079/21). Full and segmental length of upper limb was taken, recorded with help of flexible tape. Reference points for these measurements were bony landmarks as approved in the Integrative Measurement Protocol Morphological and Behavioral Research in Human and non-human primates version 1.0 were used. Convenient sampling method was used Data was analyzed using Microsoft Excel 2016. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage. RESULTSOut of two hundred fifty seven participants 141 were male and 116 were female. Total upper limb length of male is 74.17± 4.79 cm and female is 71.92 ± 4.81cm. Total upper limb length discrepancy maximum was observed 3 cm. In our study it was observed that wrist has maximum discrepancy between right and left limb followed by arm and fore arm. CONCLUSIONThe present study shows the prevalence of upper limb length discrepancy in asymptomatic Nepalese population.

Alternated activation with relaxation of periosteum stimulates bone modeling and remodeling

Gradual elevation of the periosteum from the original bone surface, based on the principle of distraction osteogenesis, induces endogenous hard and soft tissue formation. This study aimed to assess the impact of alternating protocols of activation with relaxation (periosteal pumping) on bone modeling and remodeling. One hundred and sixty-two adult male Wistar rats were used in this study. Four test groups with different pumping protocols were created based on the relaxation applied. Two control groups underwent an activation period without relaxation or only a single activation. One group was sham-operated. Periosteal pumping without period of activation induced gene expression in bone and bone remodeling, and following activation period enhanced bone modeling. Four test groups and control group with activation period equaled the values of bone modeling at the end-consolidation period, showing significant downregulation of Sost in the bone and periosteum compared to that in the sham group (p < 0.001 and p < 0.001, respectively). When all test groups were pooled together, plate elevation from the bony surface increased bone remodeling on day 45 of the observation period (p = 0.003). Furthermore, bone modeling was significantly affected by plate elevation on days 17 and 45 (p = 0.047 and p = 0.005, respectively) and by pumping protocol on day 31 (p = 0.042). Periosteal pumping was beneficial for increasing bone repair when the periosteum remained in contact with the underlaying bony surface during the manipulation period. Following periosteal elevation, periosteal pumping accelerated bone formation from the bony surface by the modeling process.

Computerized Surgical Planning for Mandibular Distraction Osteogenesis.

Mandibular distraction osteogenesis is a technically challenging procedure due to complex mandibular anatomy, especially in the treatment of Pierre-Robin Sequence due to variable bone thickness in the infant mandible and the presence of tooth buds. Computerized surgical planning (CSP) simplifies the procedure by preoperatively visualizing critical structures, producing cutting guides, and planning distractor placement. This paper describes the process of using CSP to plan mandibular distraction osteogenesis, including discussion of recent advances in the use of custom distractors.

Distraction Osteogenesis Reconstruction Following Resection of Bone Sarcomas: Surgical, Functional, and Oncological Outcomes from a Prospective Trial Analysis.

While sustainable long-term function has been established for biological reconstruction with distraction osteogenesis (DO) following osseous resections, there is a paucity of published data informing surgeons and patients on important milestones in the reconstructive process. The objectives of this study were to determine when to expect complete bone healing and full weight-bearing as well as to quantify the influence of chemotherapy on the osseous regeneration process. Prospectively, pathological and clinical data were collected for 30 consecutive patients who underwent primary or secondary DO-based reconstruction following osseous resection from 2018 to 2021. Serial radiographs indicated the times to cortex formation and full union. An unpaired t test was used to compare the time required for full bone remodeling of segments transported with and without concurrent chemotherapy. The average resection length was 13.6 cm (range, 4 to 22 cm). Patients underwent an average of 6.1 procedures (range, 1 to 14 procedures). Half (50%) of all procedures were planned, while half were unplanned procedures. All patients achieved full, independent weight-bearing at a median of 12 months (interquartile range [IQR], 9 to 16 months). For the 34 segments transported concurrently with chemotherapy, the mean bone healing index (BHI) was 2.3 ± 0.7, and the mean BHI was 1.2 ± 0.4 for the 25 segments without chemotherapy at any point during their transport (p < 0.0001). All 30 patients achieved full bone healing and independent weight-bearing at a median of 1 year postoperatively and continued to show functional improvement afterward. Surgeons and patients can expect bone healing to be nearly twice as fast for segments transported after completion of systemic chemotherapy compared with segments transported concurrently with adjuvant chemotherapy. Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.

Mandibular Distraction in Patients With Pierre Robin Sequence: A Multisurgeon Experience.

Mandibular distraction osteogenesis (MDO) is rapidly becoming a standard of care for management of patients with severe Pierre Robin sequence. The tongue is brought forward to alleviate airway obstruction. This study will look at an institutional, multisurgeon experience with MDO over 10 years. A retrospective chart review was conducted. All patients who underwent MDO at the authors' institution from 2012 to 2022 were included. Three craniofacial surgeons performed all interventions. Demographics, preoperative and postoperative respiratory and feeding status, and distraction data were collected for 27 patients meeting inclusion criteria. Primary outcomes were avoidance of a gastrostomy tube, avoidance of a tracheostomy, discharge from hospital on room air, and complications. A significance value of 0.05 was utilized. The average age at MDO was 135 days, mean activation phase was 13.6 days, mean distraction length was 14.9 mm, and mean consolidation phase was 64.2 days. A longer activation phase was associated with discharge with a gastrostomy tube and a shorter activation phase was associated with discharge on full oral feeds. The ability to discharge on room air was associated with a shorter latency phase, shorter activation phase, and decreased distance of distraction. The goal of MDO is to achieve full oral feeds with no respiratory support. Several different latency periods were used in this study, and a short latency period was demonstrated to be safe.

Posterior Vault Distraction in the Acute Setting.

Posterior vault distraction osteogenesis (PVDO) has been shown to resolve acute intracranial hypertension (AIH) while carrying an acceptable perioperative morbidity profile. PVDO has been associated with symptomatic improvement and fewer surgeries in those requiring ventriculoperitoneal shunts. The authors' experience using PVDO as an acute intervention is presented, demonstrating its safety and efficacy for management of AIH. Four cases of children with craniosynostosis that underwent PVDO in the acute setting are outlined. All patients presented with papilledema and symptoms of AIH. One patient with slit ventricle syndrome (SVS) presented with a nonfunctioning shunt following multiple shunt revisions. No intraoperative complications during distractor placement or removal were reported. Distraction protocol for all patients began on postoperative day 1 at 1-2 mm per day, resulting in an average total distraction of 30.25 mm. For the 3 cases with no shunt, the average length of stay was 7 days. As part of the planned treatment course, the patient with SVS required externalization of the shunt during distraction followed by early distractor removal and planned shunt replacement. One case of surgical site infection (in an immunocompromised patient) required premature distractor removal during the consolidation period. Computed tomography (CT) in all patients indicated increased intracranial volume following distraction, and symptomatic improvement was reported. Six-month follow-up showed resolution of papilledema in all patients. The authors' experience using PVDO in the acute setting is reported, alongside a review of current literature, in order to provide supporting evidence for the efficacy of PVDO as a tool for resolving AIH.

Determination of mandibular distraction osteogenesis most suitable parameters. An experimental study

Determination of mandibular distraction osteogenesis most suitable parameters. An experimental study

Long-term Follow-up of Implant Installation Following Multiple Distraction Osteogenesis in Maxillofacial Gunshot Wounds.

Distraction osteogenesis (DO) is a reconstruction technique developed in the fields of oral and maxillofacial surgery and plastic surgery, addressing both vertical and horizontal bone deficiencies and enhancing soft tissue volume to facilitate subsequent dental implant placement. In this treatment method, devices are placed to stretch the bone gradually to stimulate the formation of new bone, effectively filling the existing defect to treat maxillofacial deformities or repair posttraumatic injuries. This case report presents an almost 20-year long-term follow-up of jaw defect reconstruction resulting from a gunshot injury, using DO with multiple distractors. Details on the frequency, period of DO, and subsequent implant installation in the distracted anterior jaw area are outlined. This case exhibits DO treatments that reconstructed effectively severe bone defects in the jaws. The quality of bone generated during the DO process was both functionally and esthetically satisfactory for subsequent implant rehabilitation.

Pre-Operative Characteristics Helping to Avoid Gastrostomy Tube After Mandibular Distraction in Neonates With Pierre-Robin Sequence: A Institutional Case-Series and Review of the Literature.

to investigate the ability of mandibular distraction osteogenesis (MDO) to avoid gastrostomy tube (G-tube). PubMed, EBSCOhost, Cochrane, and Embase. We retrospectively reviewed the number of MDO cases performed at our institution for patients with Robin Sequence (RS) over the past 10 years. In our institutional review, patients were excluded if they had a G-tube already placed at the time of surgery. We also performed a systematic review of the literature. Articles were excluded if they did not detail feeding outcomes after MDO, or if MDO was performed on patients that did not have RS. In our systematic review, 12 articles were included that comprised a total of 209 neonates with RS that underwent MDO. A total of 174 (83.3%) patients avoided a G-tube once MDO was performed. A total of 14 patients met the inclusion criteria at our institution. Of the 14 RS patients, 9 (64%) avoided having a G-tube placed and all (14/14) avoided tracheostomy. The average birth weight of patients avoiding a G-tube was 3.11 kg compared to 2.25 kg (P = .045) in the group requiring a G-tube. In the group avoiding a G-tube, the average weight at time of operation was 3.46 kg compared to 2.83 kg (P = .037) in the group requiring a G-tube. MDO may be considered as a surgical option to prevent G-tube placement for neonates with non-syndromic RS who have difficulty with PO feeding but whose airway obstruction is not severe enough to require respiratory support. Based on our institutional experience, a minimum weight of 3.00 kg correlated with higher success rates of PO intake and avoiding a G-tube.

Fibular hemimelia: reconstruction of difficult cases with tibial lengthening and ankle arthrodesis.

Management of fibular hemimelia includes either prosthetic care with or without a suitable amputation or tibial lengthening. Many studies have documented the success of both procedures. Most parents of these children refuse an amputation or have no access to good prosthetic care. The author presents a limb-salvage procedure with tibial lengthening and ankle stabilization. Twelve children of fibular hemimelia with 14 extremities had been subjected to limb lengthening after lateral leg release. To correct the valgus procurvatum, double oblique diaphyseal osteotomy (DODO) of the tibia was performed in 11 extremities. The age of the patients ranged from two to 15years with the median of fiveyears. All were male. The proposed procedure included three stages of loosening, lengthening, and stabilization with ankle arthrodesis at a later stage. All patients returned for follow-up for the first fouryears and had been walking on their sensate feet. With DODO followed by fixator/traction could straighten and lengthen the tibia simultaneously and correct the valgus procurvatum. Ankle stabilization provided stability and a plantigrade foot. A follow-up of six to30years with a median of tenyears has been reported. A new procedure of loosening, lengthening, and stabilization of the leg with ankle arthrodesis has been proposed. A follow-up of 30years with a median of tenyears of the said procedure has been reported. The procedure provides a long-lasting plantigrade and painless foot that has sensation and proprioception. An amputation at any level has not been recommended.

Characterizing the Magnitude and Risk Factors of Functional and Anatomic Limb Lengthening in Patients Undergoing Revision Total Knee Arthroplasty

BackgroundIn revision total knee arthroplasty (TKA), there is little information on the magnitude of potential limb lengthening, risk factors for lengthening, or its impact on patient-reported outcome measures. We aimed to quantify limb length alteration during revision TKA and assess risk factors for lengthening. MethodsWe identified 150 patients over a 3-year period who underwent revision TKA and had preoperative and postoperative EOS hip-to-ankle standing radiographs. The average patient age was 64 years, 51% were women; 68% had a preoperative varus deformity and 21% had a preoperative valgus deformity. Outcomes assessed included change in functional and anatomic limb length, risk factors for lengthening, and clinical outcome scores, including the Knee Osteoarthritis Outcome Score Joint Replacement, and the Veterans RAND 12-item Physical and Mental Scores. ResultsThere were 124 patients (83%) who had functional limb lengthening, and 108 patients (72%) had anatomic limb lengthening. Patients had an average functional limb lengthening of 7 mm (range, −22 to 35) and an average anatomic limb lengthening of 5 mm (range, −16 to 31). Patients undergoing revision for instability experienced significantly greater anatomic lengthening (7.6 versus 4.6, P = .047). Patients who had ≥ 10° of deformity were more likely to be functionally lengthened (91 versus 79%) and had significantly greater average functional lengthening (12 versus 6 mm; P = .003). There was no significant change in clinical outcome scores at 6 weeks and 1 year for patients lengthened ≥ 5 or 10 mm compared to those not lengthened as substantially. ConclusionsThere is major potential for functional and anatomic limb lengthening following revision TKA, with greater preoperative deformity and revision for instability being risk factors for lengthening.

Apert syndrome: neurosurgical outcomes and complications following posterior vault distraction osteogenesis.

Posterior vault distraction osteogenesis (PVDO) has been utilized during the past 15 years to treat a variety of clinical features commonly presented by patients with Apert syndrome. The objective of this study is to determine the efficacy of PVDO in addressing both elevated intracranial pressure (ICP) and ectopia of the cerebellar tonsils (ECT) in young Apert patients. In addition, we aimed to determine the prevalence of hydrocephalus in Apert syndrome patients who underwent PVDO. A retrospective study was made with a cohort of 40 consecutive patients with syndromic craniosynostosis (SC), previously diagnosed with Apert syndrome, who underwent PVDO between 2012 and 2022, and thereafter received at least 1 year of follow-up care. Demographic data and diagnosis, along with surgical and outcome data, were verified using medical records, clinical photographs, radiologic examination, and interviews with the parents of all cohort patients. The average patient age when PVDO was performed was 12.91 ± 10 months. The average posterior advancement distance achieved per patient was 22.68 ± 5.26mm. The average hospital stay per patient was 3.56 ± 2.44 days. The average absolute and relative blood transfusion volumes were 98.47ml and 17.63ml/kg, respectively. Although five patients (14%) presented ECT preoperatively, this condition was completely resolved by PVDO in three of these five patients. One of the three patients whose ECT had completely resolved presented syringomyelia postoperatively, requiring subsequent extra dural foramen magnum decompression. All of the remaining four patients were asymptomatic for ECT for at least 1 year of follow-up, and none of these four patients required any additional treatments to address ECT. Two patients presented hydrocephalus requiring ventriculoperitoneal shunt placement. This study demonstrates that PVDO both reduces diagnosed elevated ICP symptoms and is partially effective in treating ECT in Apert syndrome patients. Hydrocephalus in Apert syndrome is an uncommon feature. The effectiveness of PVDO in addressing hydrocephalus is uncertain.

A novel approach in orthodontics: Archwise distraction osteogenesis

Distraction osteogenesis can be described as a procedure that is based on the principles of physiologic remodeling and indirect fracture healing. In dentoalveolar level, conventional appliances may present some difficulties such as the need for multiple stages of DO to achieve a good occlusion due to distraction on a straight vector; incompetency to reduce the oronasal fistula in cleft patients; and the difficulty in achieving complete hard and soft tissue reconstruction, especially in cases with large alveolar defects.ArchWise Distraction Appliance (AWDA) have been developed to overcome these limitations and obtain a regenerated bone curvilinear in shape, similar to the original alveolar bone configuration. This article aims to introduce and explain the AWDA method in detail so that every clinician will be able to perform the treatment. The reader can observe the application of the procedure on a variety of cases including cleft lip and palate, trauma, and bone pathology. Possible complications and their solutions are also explained on actual cases.

D36. Early Posterior Vault Distraction Osteogenesis is changing the Syndromic Craniosynostosis Treatment Paradigm: Outcomes of A 20-year Cohort Study

D36. Early Posterior Vault Distraction Osteogenesis is changing the Syndromic Craniosynostosis Treatment Paradigm: Outcomes of A 20-year Cohort Study

P35. Quantifying Type H Vasculature in Irradiated Distraction Osteogenesis as a Marker for Enhanced Bone Healing

P35. Quantifying Type H Vasculature in Irradiated Distraction Osteogenesis as a Marker for Enhanced Bone Healing

Impact of upper airway obstruction management in Robin Sequence on need for myringotomy tubes

ObjectiveInvestigate an association between upper airway obstruction (UAO) management in Robin Sequence (RS) and need for bilateral myringotomy and tubes (BMT). MethodsRetrospective chart review of RS patients treated at a tertiary free-standing pediatric hospital from 1995 to 2020 was performed. Patients were grouped based on airway management: conservative, tracheostomy, tongue-lip adhesion (TLA), and mandibular distraction osteogenesis (MDO). Demographic data, cleft palate (CP) association, numbers of BMT and ear infections, and audiogram data including tympanograms were collected. One-way ANOVA and Chi-square/Fisher's exact tests were used to compare continuous and categorical data, respectively. Multivariable regression analysis was used to compare BMT rates between treatment groups. ResultsOne hundred forty-eight patients were included, 70.3 % of which had CP. Most patients (67.6 %) had at least one BMT; 29.1 % required two or more BMT. The rate of BMT was higher in patients with CP compared to those with intact palates (p = 0.003; 95 % CI 1.30–3.57) and those treated with tracheostomy (p = 0.043; 95 % CI 1.01, 2.27). Surgically managed patients were more likely to have hearing loss (67.5 % vs. 35.3 %, p = 0.017) and ear infections (42.1 % vs. 20.0 %, p = 0.014) pre-compared to post-procedure for airway management. ConclusionMost RS patients require at least 1 set of BMT. Those with CP and/or treated with tracheostomy had a higher likelihood of needing BMT. Rate of hearing loss and ear infection was higher in surgically managed RS patients. Patients with RS and overt CP require a statistically higher number of BMTs compared to those with either submucous cleft palate or intact palate.

Analysis of remodeling and degenerative changes in the condylar process on the contralateral side in children with unilateral ankylosis post-mandibular ramus distraction

Relevance. Patients with a history of unilateral ankylosis of the temporomandibular joint (TMJ) exhibit significant functional and anatomical abnormalities, leading to diminished quality of life and social adaptation. This condition necessitates a complex, multi-stage rehabilitation process. The contralateral, non-operated joint often bears the brunt of functional loads for an extended period post-surgery. Frequently, due to ankylosis-related interventions such as distraction osteogenesis and osteoplasty using various biomaterials, as well as orthognathic surgery, the bone structure of the contralateral joint is subjected to loads exceeding their biological capacity, resulting in notable degenerative changes around the condylar process head.Materials and methods. An analysis was conducted on data from 55 patients who, within the age range of 7 to 18 years, had undergone multiple mandibular ramus distraction osteogenesis surgeries due to a history of unilateral ankylosis.Results. The application of the distraction apparatus led to rotational movements of the mandible within the coronal plane, thereby increasing compression around the TMJ on the contralateral side. Subsequent degenerative alterations in the area of the condylar head were observed in 61.8% of the patients.Conclusion. To mitigate the risk of degenerative changes in the contralateral condylar process head, it is advisable to utilize an orthopedic splint to separate the articular surfaces of the TMJ. This approach helps reduce pressure on the condylar process and prevents pathological remodeling.