Method Of Distraction Osteogenesis Research Articles

Multidirectional Cranial Distraction Osteogenesis for the Treatment of Craniosynostosis

Although many operative methods for the treatment of craniosynostosis exist, whether any difference in outcome could be associated with either the child's age at surgery or the extent of the operation remains to be elucidated. The authors have developed a method of distraction osteogenesis for craniosynostosis that uses a new multidirectional cranial distraction osteogenesis system. From 2003 to 2008, 26 selected patients with syndromic and nonsyndromic craniosynostosis were treated with this method. The ages of the patients ranged from 9 to 139 months (median, 27 months). The follow-up period ranged from 13 to 81 months (median, 49 months). The postoperative course was uneventful in all cases. The mean blood transfusion was 20.9 ml/kg. The mean postoperative hospital stay was 12 days. Sixteen of 49 (32.7 percent) anchor pins used in the first eight patients loosened because of bone absorption during the consolidation period. After the authors altered the screw shape, loosening occurred in seven of 81 pins (8.6 percent) in the last 18 patients. Loosening occurred in 28 of 204 traction pins (13.7 percent) among all patients. The phase of activation ranged from 8 to 14 days (mean, 10.5 days) and the consolidation period ranged from 21 to 42 days (mean, 29 days). Overall, distraction osteogenesis with the multidirectional cranial distraction osteogenesis method is safe and effective. The authors conclude that the multidirectional cranial distraction osteogenesis method constitutes an excellent alternative for all phenotypes of syndromic or nonsyndromic craniosynostosis.

Soft Tissue Assessment in Midface Advancement

Classically, soft tissue repair when indicated is done before or after the skeletal mobilization especially in those cases that present midface deficiency with severe midline soft tissue restriction by scars or congenital affectation. The distraction osteogenesis method has contributed to improve substantially this problem elongating bones, muscles, and ligaments, but some situations need specific and more precise reconstruction of the subunits to gain in aesthetics. The labial-columella junction, the tip of the nose, and the more projecting point of the cheeks are one of these exigent anatomic areas, where only sophisticated reconstruction by flaps can improve facial proportions and projections.

Results of using Ilizarov distraction osteogenesis technique for the treatment of cubitus varus deformities in adults

Five adult patients, with posttraumatic cubitus varus deformity underwent corrective surgery by the Ilizarov method of distraction osteogenesis. A standard technique was applied in all patients. The average follow-up was 28 (range, 24-38) months. Preoperative carrying angle ranged from 12 degrees to 22 degrees of varus (average 16.6 degrees ) and postoperative carrying angle ranged from 10 degrees to 14 degrees of valgus (average, 11.6 degrees ) equalized to the contralateral side. The outcome was rated as excellent in all patients. No complication was observed, except a grade-2 pin-tract infection in two patients. Rigid fixation, early rehabilitation, precise correction, satisfactory cosmetic scars and functionally excellent results can be obtained with this method.

Distraction Lengthening of the Ulna in Children With Radial Longitudinal Deficiency

Children with radial longitudinal deficiency have very short forearms. The Ilizarov method of distraction osteogenesis has been used to increase extremity length, but results differ with the underlying condition and the limb being lengthened. The purpose of this study is to examine retrospectively the outcomes of Ilizarov lengthening of the ulna in children with radial longitudinal deficiency. Nine children with radial longitudinal deficiency had 13 ulnar lengthenings using the Ilizarov method; 8 with unilateral deficiency had 9 lengthenings to improve appearance, and 1 child with bilateral radial longitudinal deficiency had 4 lengthenings to improve function. All had previous wrist centralization surgery, and all but 1 had a carpal osteotomy at the time of lengthening to reduce residual wrist angulation. The average gain for each lengthening was 4.4 cm (range 1.8-8.0 cm) with an average lengthening index of 9 weeks per cm (range 4-24 weeks per cm). All patients at each lengthening experienced at least 1 pin site infection that required antibiotic treatment. Other complications included delayed union requiring internal fixation and bone grafting in 3 lengthenings and recurrence of radial deviation requiring shortening and wrist arthrodesis in 1 case. The Ilizarov technique is an effective method for lengthening the ulna in children with radial longitudinal deficiency. The process of lengthening is prolonged and arduous with frequent complications. In successful cases, however, patients are pleased with the function and appearance of their lengthened forearms.

Traumatic Segmental Bone Loss in a Pediatric Patient Treated With Bifocal Bone Transport

Bone transport is a method of distraction osteogenesis that allows the creation of regenerate bone using a dynamic external fixator. We report on the use of bifocal bone transport to treat a skeletally immature patient with 15 cm of post-traumatic segmental bone loss from the distal tibia.

Lengthening of congenital forearm stumps

The Ilizarov device and distraction osteogenesis method became very useful in correction and elongation of forearm defects. Two cases of forearm elongation with congenital transverse defect are described. The construction of the device is provided. During follow-up examination, 2 and 7 years after the treatment, good clinical results were achieved in both patients with the use of upper limb prosthesis employing the patient's own elbow joint. Presented application of the Ilizarov method can significantly improve possibilities for the use of prosthesis in patients with congenital upper limb defects and result in better cosmetic and functional outcome.

Forearm Elongation After Hand Replantation

T he cases of a considerable number of patients who have had successful hand and forearm replantation have been reported1-6. Success depends primarily on the surgical technique and the type of injury. Amputations with a narrow area of injury have the best expectations for a successful recovery7,8. Amputations with extensive areas of injury of the forearm, wrist, and hand, such as crush and avulsion injuries, reduce the chances of survival and functional recovery9,10. The objective of this case report was to demonstrate the possibility of restoring a functional upper extremity in a patient with a complete amputation of the hand at the level of the wrist with extensive damage to all of the tissues at the amputation level. I n October 2001, a thirty-four-year-old right-hand-dominant man was working with an agricultural machine that separates corn grains from corncobs (a corn sheller) when the machine stopped working. In order to remove the obstruction, he put his hand into the machine without turning it off. The rollers of the machine caught the left hand and forearm and completely amputated the hand at the level of the wrist. It took twenty minutes to turn off and dismantle the machine to release the injured man. He arrived at our hospital three hours after being injured. In preparation for the surgery, intravenous fluids and tetanus immunoglobulin were administered. As the accident had happened in the farmyard and the wound was characterized by extensive soft-tissue damage and contamination with parts of plants, soil, clothes, and machine oil, a combination of imipenem and cilastatin sodium was administered, by intravenous infusion, starting at the time of admission to the hospital. The amputated hand (Fig. 1) sustained considerable damage in the area of the wrist and the …

Use of the Ilizarov method of distraction osteogenesis for the treatment of radial hemimelia in a dog

A 6-month-old female crossbred dog with unilateral radial hemimelia was treated with a circular external fixator. During the first surgery, the dog underwent transverse osteotomy through the distal ulnar physis and rotation of the distal ulnar fragment (epiphysis) together with the forepaw in a lateral direction to achieve contact with the end of the proximal ulnar segment (shaft of the ulna); a circular external fixator was then applied. After removal of the fixator, a cast was applied. The initial intent was to preserve mobility of the ulnocarpal joint; however, the joint fused naturally. A second surgery was performed to lengthen the ulna by use of distraction osteogenesis. An Ilizarov external fixator was used, and the ulna was lengthened 25 mm. During the third surgery, osteotomy of the distal portion of the ulna was performed to treat residual deviation of the forepaw. The surgical treatment resulted in satisfactory use of the limb and a better quality of life.

FOREARM ELONGATION AFTER HAND REPLANTATION

FOREARM ELONGATION AFTER HAND REPLANTATION

Effect of distraction rate on biomechanical, mineralization, and histologic properties of an ovine mandible model.

Craniofacial microsomia is a common congenital malformation. Ilizarov's method of distraction osteogenesis applied to the mandible has yielded promising results both experimentally and clinically. Because the technique is used predominantly in a pediatric population, length of treatment and compliance may be problematic. To date, the limits of distraction rate in the craniofacial skeleton have not been defined. This study was designed to investigate the effects of distraction rate, in a large animal model, on the mineralization, biomechanical, and histologic properties of lengthened mandibles. Clinically faster distraction rates would decrease the overall treatment time. Twenty-four animals were divided into four groups, with varying rates of distraction (1, 2, 3, and 4 mm/day). A uniaxial distractor at the angle of the mandible was used. The mandibles were lengthened to 24 mm and fixed for a period of 5 weeks, when the animals were killed. The specimens were analyzed with respect to mineralization using dual energy x-ray absorptiometry, biomechanical strength, through a modified three-point bending test, and histologic properties with hematoxylin and eosin stains. Biomechanical, mineralization, and histologic analyses of the samples indicated that group 1 (1 mm/day) samples were significantly superior (p<0.05) to those of group 4 (4 mm/day). Although bone formation was achieved in all groups, group 1 (1 mm/day) demonstrated the strongest biomechanical and histologic properties. Bone mineral density obtained using dual energy x-ray absorptiometry may be clinically useful as a reliable, noninvasive, and relatively cheap predictor for removal time of the fixator.

Distraction Osteogenesis

Distraction osteogenesis and the use of circular external skeletal fixation has increased the capacity of veterinary surgeons to manage difficult orthopedic conditions including limb-length discrepancies, angular deformity, distal and severely comminuted fractures, and bone defects. This article discusses the historical developments of the Ilizarov method of distraction osteogenesis in veterinary surgery, circular external skeletal instrumentation, and the biological principles. There is also discussion of use of this method for correction of angular deformity and bone transport and complications associated with this technique.

Multiple segmental gradual distraction of facial skeleton: an experimental study.

The method of distraction osteogenesis was used to move several facial segments in different directions with formation of new bone. On 3 young adult sheep a Le Fort II osteotomy, combined with circumferential orbital osteotomies, was performed. The periosteum over the osteotomies was preserved. Titanium bone screws were placed as bone markers. The segments were fixed with pins and plates to a combined distraction apparatus in order to advance the segments in different directions. By a gradual distraction, the midface was advanced forward by 30 mm. The left orbit was moved laterally 20 mm and the right orbit was moved forward 20 mm. In both orbits there was a concomitant globe movement. New bone formation in the distracted area was obvious radiographically, clinically, and histologically. In conclusion, multiple segmental distraction is possible in the adult sheep face and may offer three-dimensional (3D), controlled correction of complex face deformities.