Wagner Technique Research Articles

Femoral Lengthening by the Wagner Method

Lengthening procedures can yield excellent results, but are associated with potentially serious complications that require multiple operations and prolonged hospitalization. Femoral lengthening by the Wagner technique was performed from 1981 to 1987. The various complications and technical problems of 38 procedures in 37 patients were studied. Only 18 of the 38 procedures were uncomplicated. The main complication was related to the osteosynthesis with plates and screws in the second stage of the method, i.e., six broken plates, six minor pin-tract infections, two deep infections. The results were good in 28 procedures. To treat a leg length inequality, the physician must consider several treatment modalities, such as a lift for the short side. Each patient must be individually evaluated to select the adequate modality of surgical treatment including shortening or epiphysiodesis of the sound limb or lengthening of the shortened limb, procedures with relatively low morbidity.

Limb lengthening and three-dimensional deformity corrections

Different methods of limb lengthening as used at the Orthopedic Surgery Clinic of the Medical School, University of Zagreb, are compared. The results of operations performed between 1979 and 1989 on 111 patients are presented. These patients were subjected to surgery aimed at length equalization of limbs and/or correction of three-dimensional deformities. Lengthening was performed in 104 patients at one level, and in 7 patients at two levels of the same limb for a total of 118 procedures. In order to compare limb lengthening techniques the patients were divided into four groups: group I, original Wagner technique (45 patients); group II, Wagner technique using corticotomy (33 patients); group III, original Ilizarov technique (35 patients); group IV, continuous lengthening (2 patients). The evaluation covered radiological aspects of regenerated bone, complications and basic lengthening parameters. The results indicate that corticotomy has considerable advantages over osteotomy, provided bone circulation is maintained. These advantages manifest themselves in a reduced number of operations, lower incidence of infection and improved bone regeneration. It is preferable to perform corticotomy at the metaphysis site because of its optimum blood supply and its higher potential for osteogenesis. With corticotomy performed at the diaphysis site, satisfactory results were observed in only one-third of the cases.

Lower Limb Lengthening by a Modified Wagner Technique

The journal highlights important recent developments from the world's leading clinical and research institutions. The journal publishes peer-reviewed papers on the diagnosis and treatment of pediatric orthopedic disorders. It is the official journal of IFPOS (International Federation of Paediatric Orthopaedic Societies).

Lower Limb Lengthening by a Modified Wagner Technique

A series of 50 patients who underwent femoral and tibial lengthenings using the Wagner apparatus is reviewed. Satisfactory gains in leg length with an acceptably low complication rate were achieved. Both substitution of cortical osteotomy for complete osteotomy and delaying of distraction increased callus formation. The particular problems of lengthening the congenital short femur and tibia are discussed.

64 THE IMPORTANCE OF BODY IMAGE TESTING IN SHORT STATURE CHILDREN UNDERGOING CHANGE IN HEIGHT

It is well known that the basis of positive self-esteem is a healthy body image. Treatment, with now available growth hormone, may also have psychological implications. We studied children with extreme short stature, 6 achondroplastic children and adolescents (ACH-I) (mean height±SEM 119.8±3.7 before and 128±4.5 cm after operation), who were hospitalized for leg-lengthening precedure (modification of Wagner's technique) and 6 (ACH-II) who were operated years before (mean height 138±4.2 cm), as well as a control group with normal height and growth rate (mean 139.3±6 cm). All patients and parents were interviewed. Body image was assessed using Fisher's draw-a-person test and Jourard-Secord's body cathexis test. The figure height in draw-a-person test was 7.7±3.3 cm before and 11.3±2.4 after the operation for ACH-I, 17.8±2.9 for ACH-II, and 23.9±2.2 for the control group. The mean body disturbance score was 4±0.86 in the ACH-I and 2.2±0.58 in the ACH-II. The lowest score was observed in the control group. The total body cathexis score was not different in the three groups. However, negative body cathexis was seen for some body parts in ACH-I. Conclusion: ACH children show a certain improvement of their disturbed body image after the operation. The tests used are simple to perform, with no language limitation and give important information on the success of the treatment.

An analysis of referrals to a regional leg-lengthening service with special reference to achondroplasia.

For a number of years, in Sheffield, we have practised leg lengthening according to the Wagner technique (5). This technique requires a minimum of three operations per segment (Fig. 1) and extensive incisions. We have experienced many complications including malunion, non union and late fracture. Wagner himself reported 15 complications in a series of 58 femoral lengthenings and 11 patients required a further operation for plate exchange (6). For these reasons our service was limited to patients with asymmetry of over 4 cm and lengthenings were not performed for disproportionate short stature.

Subluxation of the knee as a complication of femoral lengthening by the wagner technique: D.C. Jones and C.F. Moseley. J Bone Joint Surg 67B:33–35, (January), 1985

Subluxation of the knee as a complication of femoral lengthening by the wagner technique: D.C. Jones and C.F. Moseley. J Bone Joint Surg 67B:33–35, (January), 1985

Femur lengthening using the Wagner technique.

Seventeen femoral lengthenings with an observation period of 1 year or more are reviewed. The mean leg length discrepancy was 6.9 cm, ranging from 3.8 to 14.8 cm. Mean lengthening was 5.8 cm, ranging from 3.6 to 10 cm. Osteosynthesis and bone grafting was done in all cases. Nonunion occurred in one lengthening, and five bones refractured. All failures, however, healed after reosteosynthesis. Transient peroneal paresis occurred in two cases, while in one case knee flexion was reduced to 55 degrees. In spite of minor pin-track drainage, no infections complicated the osteosynthesis. It is concluded that the Wagner procedure is an effective and fairly safe method for leg lengthening. Complications, however, are frequent and great caution is essential.

Leg Lengthening in Achondroplastic Children

Bilateral simultaneous elongation of the lower limbs was performed in 3 achondroplastic children. A total of 10 bones were elongated with Wagner's distraction apparatus, mainly by a modified Wagner technique. Maximal elongation of 34 to 44% of the original bone length resulted in relatively minor complications. Elongation of the lower limbs in achondroplastic children improves trunk-to-lower-limb proportions.

Methods for Computing Wagner Trees

Abstract Farris, J. S. (Biol. Sci., State Univ., Stony Brook, N. Y.) 1970. Methods for computing Wagner Trees. Syst. Zool., 19:8342.-The article derives some properties of Wagner Trees and Networks and describes computational procedures for Prim Networks, the Wagner Method, Rootless Wagner Method and optimization of hypothetical intermediates ( HTUs). The Wagner Ground Plan Analysis method for estimating evolutionary trees has been widely employed in botanical studies (see references in Wagner, 1961) and has more recently been employed in zoological evolutionary taxonomy (Kluge, 1966; Kluge and Farris, 1969). Wagner Trees are one possible generalization of the most parsimonious trees of Camin and Sokal (1965). The Wagner technique is of con-siderable interest for quantitative evolution- ary taxonomists because it is readily pro- grammable and because the type of tree produced can tractably be extended to ap- plications in a variety of novel quantitative phyletic techniques. In this paper I shall formalize the concept of a Wagner Network and discuss a number of algorithms for calculating such networks. The rationale for the methods described will not be treated extensively here, as it is published elsewhere (Kluge and Farris, 1969).

An evaluation of a test using 14C labelled triglyceride in the diagnosis of steatorrhoea.

Intestinal fat absorption has been studied in fifty-six patients by a simplified Kaihara and Wagner technique using14C labelled triglycerides. The peak radioactivity in the expired air is attained in the majority of patients between five and seven hours after administration of the dose. The highest of these three one hourly readings of14CO2 below 30×10−4 per cent of the14C−T.G. dose per m.mol of exhaled CO2 is consistent with steatorrhoea provided there is no disturbance of lipid or general metabolism. The test is well tolerated and easy to carry out but is not reliable in the presence of obesity and uncontrolled thyrotoxicosis.