1/44. Spontaneous healing of an atrophic pseudoarthrosis during femoral lengthening. A case report with six-year follow-up.A seven-year old girl developed an atrophic pseudoarthrosis at the midshaft of the femur with 8.5 cm of femoral shortening after an open type II fracture. During a femoral lengthening procedure, the pseudoarthrosis filled with spontaneous callus formation and bone union was obtained.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
2/44. Ilizarov lengthening in centralized fibula.Tibial hemimelia often produces major limb length problems (1,6,9,15) as well as foot deformity. The decision to perform reconstructive surgery depends on the expected leg-length discrepancy, the anomalies of the foot, and the status of the knee (4,6,8,15). Congenital bone deficiencies usually have a constant rate of growth inhibition (8), and leg lengthening is often associated with more complications (5,13). The complication rate is also increased with the increased leg-length discrepancy (5). In tibial hemimelia with functioning quadriceps (types I and II) and a functional foot, centralization of the fibula onto the talus and synostosis with the proximal tibia is an accepted reconstructive procedure (1,4,6,7,9,15). However, when the transplanted fibula produces a functional limb for the patient, the correction of leg-length inequality would be a challenge. This is a report of such a case.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
3/44. Lengthening of replanted or revascularized lower limbs: is length discrepancy a contraindication for limb salvage?Some replantation cases require substantial bone shortening for primary closure. leg-length discrepancy can be restored by lengthening of the replanted or revascularized extremities. Between 1991 and 2000, four patients with four total and two subtotal below-knee amputations had replantation or revascularization for their severely damaged extremities. All of them had extensive debridement, vascular repair, bone shortening and nerve repair for sensibility of their soles. One of the replanted extremities failed and had to undergo below-knee amputation because of sepsis. No other infection or vascular complications were encountered following the replantations or revascularizations. After bony consolidation, four legs were lengthened; for elimination of length discrepancy in three cases, and for obtaining balanced body proportion in one case in which the other leg was also amputated. In all procedures, a unilateral dynamic axial external fixator was used. The lengthening was performed from the proximal tibial metaphysis, with a subperiosteal osteotomy. Evaluation of injury according to the Mangled Extremity Severity Score (MESS) would encourage the surgeon to avoid salvage surgery with a shortened extremity, because of the required debridement of soft tissue and bone. These authors think the amount of limb shortening is not a major criterion in evaluating a traumatic total or subtotal below-knee amputation for salvage replantation or revascularization. A knee that has stable joint motion and the possibility of preservation of sensibility of the sole broadens the scope of indications for limb salvage, even with deliberate shortening that can be restored by lengthening; length discrepancy is not a contraindication for limb salvage.- - - - - - - - - - ranking = 3keywords = bone (Clic here for more details about this article) |
4/44. Infantile myofibromatosis: a cause of leg length discrepancy.An infant with self-healing, multifocal cutaneous infantile myofibromatosis with leg-length discrepancy as a sequela is reported. This condition should be suspected in infants with one or more firm or hard nodules in the skin, subcutaneous tissue, bone, muscle, or viscera. The histopathologic picture is diagnostic. Treatment and prognosis depend on the extension and location of the tumors.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
5/44. Telescoping vascularized fibular graft: a new method.The authors describe a case of congenital pseudarthrosis of the tibia treated with a telescoping vascularized fibular graft. The advantages of this new method are that bone union and leg-length discrepancy may be corrected simultaneously.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
6/44. limb salvage after subtotal supramalleolar amputation by initial shortening followed by tibial lengthening.BACKGROUND: We present a patient with a subtotal traumatic supramalleolar amputation of the leg, which was initially treated by a vascular reconstruction with deliberate bone and soft-tissue shortening. methods: To correct the ensuing complex deformity, which consisted of a varus hindfoot, leg length discrepancy and equinus, a staged reconstruction was planned. Initially, the hindfoot varus, in presence of a stiff ankle, was corrected by a supramalleolar osteotomy, followed by a Wagner distraction and finally a correction of the equinus. RESULTS: After a relatively long period of normal functioning, she regained painful minimal ankle function, which necessitated ankle fusion and correction of a pronation deformity. At the most recent follow-up 13 years after the injury, the patient is fully functional and has near normal leg length. CONCLUSION: Although a mangled lower extremity is often a candidate for primary amputation allowing early rehabilitation, in certain cases a good result can be obtained by a creative strategy.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
7/44. Tibial shortening for correction of leg length discrepancy and deformity: a new technique.Where length discrepancy occurs in the skeletally mature lower leg, there may be a benefit in using the technique of tibial shortening. Existing techniques have not been widely adopted and are associated with a high incidence of soft tissue complications. We describe a technique of progressive shortening, which we believe is a safe method, having adapted this from techniques for dealing with traumatic bone loss.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
8/44. Linear scleroderma with severe leg deformity.Linear scleroderma is an unusual form of localised scleroderma, mainly affecting the legs and occurring primarily in children. Sometimes the linear lesions may extend to involve the underlying muscles and bones, with severe disturbances in growth and possibly flexion deformities of the legs. In this study, two cases suffering from linear scleroderma of the legs are presented.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
9/44. Atrophic femoral nonunion with bone loss: treatment with monorail transport: a case report.Nonunions are an uncommon outcome of femoral fractures. Atrophic nonunions with a leg length discrepancy secondary to bone loss are often the most difficult to treat, and the treatment options are limited. We present a case that uses concomitant monolateral external fixation and intramedullary nailing to heal a nonunion and perform a simultaneous 7-cm lengthening procedure in a 33-year-old female.- - - - - - - - - - ranking = 5keywords = bone (Clic here for more details about this article) |
10/44. Treatment for flexion contracture of the knee during Ilizarov reconstruction of tibia with passive knee extension splint.Joint stiffness is one of the complications of limb procedure. It developes as a result of failure of knee flexors to lengthen in tandem with the bone, especially when there is inadequate physical therapy to provide active and passive mobilization of the affected joint. We are reporting four patients who developed fixed flexion contracture of their knees during bone lengthening procedure for the tibia with Ilizarov external fixator. Three of them were treated for congenital pseudoarthrosis and one was for fibular hemimelia. None of them were able to visit the physiotherapist even on a weekly basis. A splint was constructed from components of Ilizarov external fixator and applied on to the existing frame to passively extend the affected knee. patients and their family members were taught to perform this exercise regularly and eventually near complete correction were achieved. With this result, we would like to recommend the use of this "Passive knee Extension Splint" to avoid knee flexion contracture during limb lengthening procedures with Ilizarov external fixators.- - - - - - - - - - ranking = 2keywords = bone (Clic here for more details about this article) |
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