混合式单臂外固定架骨延长术治疗感染性骨不连

目的评价混合式单臂外固定架骨延长术治疗长骨干骺端感染性骨不连的初步临床结果。方法2003年1月至2006年2月采用混合式单臂外固定架固定、局部清创和截骨延长法治疗感染性骨不连21例,男17例,女4例;年龄18～48岁,平均31.5岁。16例为开放骨折内固定术后感染,5例为闭合骨折内固定术后感染。胫骨近端12例,胫骨远端6例,股骨远端3例。12例行骨折端植骨,其中2例二次植骨。结果21例术后随访10～36个月,平均18个月。18例骨折获得初期愈合,3例骨折愈合时仍有局部窦道和渗液,2例骨折尚未完全愈合,1例行截肢术,20例感染得到控制。改良ASAMI骨评定结果为优良13例,中4例,差4例;功能评定结果为优良11例,中6例,差4例。平均骨延长5.6cm,平均愈合时间为11个月。15例发生钉道感染。结论对长骨干骺端感染性骨不连可使用混合式单臂外固定架骨延长术、骨折端开放换药的方法。该方法控制感染好,可自体修复骨缺损,供区畸形发生率低。但固定需采用HA涂层螺钉,严格控制延长速度,一般在1mm/d以内,分次进行延长,手术风险小。     

削骨痂植骨治疗胫骨骨搬运后期对合端骨不连的经验

目的探讨削骨痂植骨治疗胫骨骨搬运后期骨不连的疗效和经验。方法回顾性分析2012年1月至2016年6月应用骨搬运技术治疗的胫骨骨缺损患者,选取在骨搬运后期对合端未能顺利愈合的患者22例,行切开手术,清除骨端软组织卡压、清理硬化骨,削取对合端或延长段骨痂回植于胫骨对合端,使对合端最终骨性愈合。结果 22例患者术后获5~18个月(平均8个月)随访,其中18例削痂植骨术后顺利愈合,2例术后发生伤口感染,经清抗感染治疗,最终愈合;1例患者植骨吸收,经历再次植骨后愈合;1例患者途中外固定松动,导致骨折,更改为内固定+植骨,最终愈合;其余21例根据Paley等骨不连愈合评分标准评定结果:优18例,良1例,中1例,差1例,优良率为86.36%。结论胫骨骨搬运后期胫骨骨不连通过非手术方法不能愈合的患者,可尝试削取骨痂植骨的方治疗使对合端愈合。     

单臂骨外固定架并植骨治疗胫骨骨折骨不连23例

目的探讨单臂骨外固定架并植骨治疗胫骨骨折骨不连疗效。方法自2001年3月至2005年3月应用单臂骨外固定架并植骨治疗胫骨骨折骨不连23例并观察疗效。结果术后骨折经2.5~5个月骨折愈合,平均3.6个月。结论骨外固定架并植骨治疗胫骨骨折骨不连是一种简便又实用的治疗方法。     

胫骨成角短缩畸形数字化三维精准矫形研究

目的探讨三维数字化骨科技术和Ilizarov环形外固定架辅助胫骨成角短缩畸形精准矫形的效果。方法 2012年6月—2016年8月收治胫骨成角伴短缩畸形患者26例,其中男12例,女14例;年龄1~19岁,平均16.5岁。先天性胫骨假关节患者6例,胫骨、股骨纤维结构不良1例,小儿麻痹后遗症导致肢体短缩畸形3例,骨折畸形愈合16例。术前患侧肢体短缩1.5~9.5 cm,平均6.2 cm。采取数字化骨科技术分析患肢三维空间存在的畸形,模拟截骨矫形和延长的手术过程,计算机辅助设计(computer aided design,CAD)、3D打印个性化辅助截骨矫形导航模板,借助外固定架辅助胫骨延长。术后定期复查X线片,随访观察新生骨塑形情况、肢体延长长度、下肢力线、成角畸形有无复发。结果术后患者均获随访,随访时间14~48个月,平均18.8个月。1例发生针孔浅表感染,经清洁换药和口服抗生素治疗后愈合。无骨不连、足部马蹄状畸形、血管神经损伤等并发症发生。术后1周复查X线片示胫骨畸形完全矫正,下肢负重力线恢复正常。所有患者按照术前计划完成骨延长长度,牵移骨痂矿化时间为12~20周,平均11.6周;外固定架拆除时间为18~26周,平均14.9周;愈合指数为21~78 d/cm,平均63.4 d/cm。延长过程中1例患儿膝关节屈曲活动较健侧减少15°,经理疗锻炼后好转,并完成肢体延长达到预期矫正效果。结论采用三维数字化技术辅助胫骨畸形实施精准矫形,借助外固定架辅助矫形术后肢体延长,可获得较好疗效,保证了手术的安全性、微创性和精准性。     

骨折周围骨痂移植治疗骨不愈合

目的观察用骨痂移植对骨折不愈合作用的临床疗效。方法1995年1月～2003年12月共收治增生型骨折不愈合19例,采用骨痂移植加内固定或外固定治疗。其中男16例,女3例;年龄19～57岁。骨折部位：肱骨4例,尺桡骨2例,股骨8例,胫骨5例。均为增生型骨折端有大量骨痂形成,其中普通钢板固定松动变形10例,加压钢板松动2例,梅花针固定变形3例,带锁髓内钉断裂2例,普通钢板断裂2例。骨折不愈合时间8～24个月。结果19例均获6～18个月随访,平均15.6个月。骨折愈合时间为6～8个月,其中1例术后7个月外伤后再骨折,钢板弯曲,经手术及骨痂骨植骨后7个月愈合。钢板内固定及交锁髓内钉治疗者无伤口感染;外固定架固定者1例针道感染,经消炎、换药痊愈。上肢骨折6例功能恢复良好;下肢骨折13例除上述1例再骨折功能恢复稍差外,其余功能恢复良好。结论采用骨痂移植简便易行,骨折愈合率高,可作为一种治疗骨不愈合的骨移植材料。     

骨搬运治疗创伤早期Gustilo ⅢB型胫骨骨折伴骨缺损的疗效

目的 探讨应用单边可延长外固定架在创伤早期行骨搬运治疗GustiloⅢB型胫骨开放骨折伴骨缺损的临床疗效。方法 回顾性分析2016年6月至2021年6月收治的GustiloⅢB型胫骨开放骨折伴骨缺损患者20例,其中男12例,女8例;年龄21～56岁,平均(36.3±4.2)岁。手术方法：一期进行伤口清创,外固定架固定稳定骨折端,防治感染。二期于伤后14～35 d,平均(18.6±6.3)d更换单边延长外固定架,截骨、骨搬运,骨折愈合后拆除外固定架。结果 20例患者均获随访,随访时间18～36个月,平均(24.2±5.1)个月。骨折临床愈合时间平均(17.3±6.2)个月。末次随访时患肢采用Johner-Wruhs标准评价,优8例,良6例,差6例,优良率70%;Mazur踝关节功能评分,优7例,良6例,可4例,差3例,优良率65%。4例患者对接端不愈合,取髂骨植骨后愈合。3例针道感染,给予清创换药后愈合,无骨髓炎形成。结论 在创伤早期应用单边可延长外固定架行骨搬运治疗GustiloⅢB型胫骨骨折伴骨缺损,与传统采用清创内固定+植骨治疗方法相比,可以有效缩短治疗时间,减少手术次数,降低骨髓...     

成人胫骨缺损新分型与骨搬移治疗策略:附58例报告

背景:胫骨缺损常合并软组织损伤、肢体畸形、不等长等问题。目前的临床分型并不能涵盖一些复杂胫骨缺损情况。目的:从Ilizarov骨搬移技术角度探讨成人非感染性胫骨缺损临床新分型及治疗策略。方法:分析2000年4月至2017年1月应用Ilizarov骨搬移技术治疗的58例成人无感染性胫骨缺损。依据胫骨缺损的长度、部位、是否合并畸形以及相应的Ilizarov骨搬移手段分为5个类型。Ⅰ型:1 cm<中下/上段骨缺损≤6 cm,无明显成角畸形。采用胫骨单节段截骨,向缺损端搬移。Ⅱ型:6 cm<中下/上段骨缺损≤10 cm,无明显成角畸形。采用双节段截骨同步向缺损端骨搬移。Ⅲ型:6 cm<中段骨缺损≤10 cm,无明显成角畸形,胫骨上、下双节段截骨,向心性骨搬移。Ⅳ型:6 cm<上、下两段缺损≤10 cm,中段残留活骨≥6 cm,无明显成角畸形。将胫骨中间残留的一段活骨2处截骨,成为3块骨,中间骨块固定作为两块骨搬移再生的"母骨"支点,上下两段骨块反向分离牵拉,一期修复上下2区骨缺损。Ⅴ型:胫骨缺损>10 cm,合并骨干>7°成角畸形。采用腓骨上下两处截骨,先纵向牵拉使胫骨缺损间隙加大、成角畸形矫正,再横向牵拉将腓骨中间段搬移至胫骨缺损处,使其腓骨胫骨化。观察5个临床分型组骨缺损修复骨愈合、畸形矫正、有无肢体短缩等并发症、汇合端愈合情况等。拆除外固定后随访,采用改良Paley骨不连评价标准进行评价。结果:55例患者获得随访,随访时间24~104个月,平均(32.0±21.4)个月。所有患者均实现骨缺损修复并最终骨性愈合,骨愈合指数35~60d/cm,平均(49.0±6.4)d/cm。1例Ⅳ型,4例Ⅴ型患者术后肢体短缩>2.5 cm(2.7~3.5 cm)。末次随访无>7°局部畸形病例。未发生1例深部感染、血管神经损伤等并发症。17例因汇合端骨愈合迟缓,二次手术取自体髂骨植骨。带外固定架时间5~28个月。治疗效果:优41例、良11例、可3例,优良率94.5%(52/55)。结论:成人胫骨缺损新分型既有利于病情评估亦利于制定合理的治疗方案。针对不同类型制定的个体化骨搬移重建方法,可一期手术修复骨缺损、矫正畸形、延长肢体,临床疗效显著,值得推广。     

Orthofix单边外固定架骨搬运技术治疗胫骨大段骨缺损

目的总结采用Orthofix单边外固定架骨搬运技术治疗胫骨大段骨缺损的经验。方法回顾性分析自2014-01—2019-08采用Orthofix单边外固定架骨搬运技术治疗的41例胫骨大段骨缺损,骨搬运过程中患者需配合其他功能锻炼,同时注意观察耐受程度与软组织张力情况,定期摄X线片观察滑移骨段偏移情况与新生骨矿化情况。结果 41例均获得随访,随访时间平均25(16～48)个月。术后5例出现钉道感染,加强换药并应用抗生素治愈。16例牵拉区域疼痛明显,口服止痛药物后缓解。6例出现足下垂,骨愈合拆除外固定架后改善,嘱患者加强踝关节功能锻炼。12例出现轴向偏移,调整外固定架与骨延长速度后矫正。外固定架固定时间为14～18个月,平均16个月。胫骨缺损端愈合时间为6～8个月,平均7.6个月。末次随访时进行Kofoed踝关节评分,其中疼痛平均40.8分,功能平均22.3分,活动度平均14.8分。结论 Orthofix单边外固定架骨搬运技术治疗胫骨大段骨缺损可取得满意疗效,但是需要注意轴向偏移情况发生。     

Ilizarov外固定架骨搬移技术联合皮瓣、VSD技术治疗胫骨长段骨缺损及骨外露的疗效分析

[目的]探讨和总结Ilizarov外固定架骨搬移技术联合皮瓣、VSD技术治疗胫骨长段骨缺损及骨外露的手术方法及其疗效。[方法]本科2011年10月~2013年12月应用Ilizarov环形外固定架联合皮瓣、VSD技术治疗胫骨长段骨缺损及骨外露患者16例;小腿软组织缺损范围(4.0~6.0)cm×(3.0~4.5)cm,胫骨骨缺损长度4.5~8.0 cm,平均6 cm。先清创取出死骨块、VSD技术覆盖创面控制感染,再用Ilizarov骨搬移技术使骨缺损修复,骨折愈合。参照Paley评价标准进行功能评价,并分析其骨折愈合时间、带外固定架时间、术后患肢功能恢复情况。[结果]所有病例均获得随访,随访时间9~24个月,平均10.5个月。其中11例应用皮瓣转移覆盖创面修复,3例通过游离皮片移植创面愈合,2例经换药愈合,软组织修复良好。使用VSD 3~6期,平均4.8期;带外固定架时间6~18个月,平均10.3个月;骨段搬移延长4.5~8.0 cm,平均6 cm;骨折愈合时间6~15个月,平均9.8个月。根据Paley骨折愈合与功能分级评价骨搬移结果及功能,优9例,良5例,可2例。[结论]Ilizarov外固定架骨搬移技术联合皮瓣、VSD技术治疗胫骨长段骨缺损及骨外露具有操作简便、疗效肯定、并发症发生率低、可随时调整纠正畸形等优点,值得推广。     

骨搬移治疗胫骨感染性骨不连

目的分析骨搬移治疗胫骨感染性骨不连的临床疗效。方法2002年10月至2007年10月采用胫骨感染骨端清创、重建外固定支架加压固定及胫骨干骺端截骨骨搬移治疗胫骨感染性骨不连、纠正肢体短缩畸形45例。结果45例胫骨感染均得到一期控制,软组织缺损创面消灭,4例出现钉道感染;44例骨折愈合,1例骨折端再次形成骨不连;39例双下肢长度基本恢复一致,6例仍有1．5～3cm肢体短缩畸形存在,1例因截骨端提前愈合使肢体未能达到预期长度;术后截骨端骨延长2～9cm,平均延长6cm,无血管及神经损伤的症状出现;术后外固定支架固定6～12个月,平均8个月,所有病例延长区新骨组织形成良好。结论采用骨搬移治疗胫骨感染性骨不连,能达到一次手术兼顾控制骨端感染、消灭皮肤创面、骨折端不需植骨达到骨性愈合及均衡肢体长度的临床治疗作用,是治疗胫骨感染性骨不连的理想方法。     

Correction of angular deformities by physeal distraction.

Physeal distraction is an alternative to more conventional treatments for the correction of angular deformities of the long bones. Twenty deformities of the femur and tibia, nine of which also involved associated shortening, were partially or completely corrected. In eight cases, there was physeal bony bridge. Complete correction of the angular deformity was achieved in 17 patients, and in seven patients, more than 80% correction was achieved. There were complications in four patients that hindered complete correction of the deformity, or shortening, or both. The external control of the correction until consolidation occurs is progressive and fairly noninvasive. The method allows external control of the correction until consolidation; it acts at the site of the deformity itself and permits lengthening and angular correction during therapy. In deformities with a physeal bony bridge, correction can be achieved with physeal distraction alone, prior resection of the bridge is not unnecessary. The technique is indicated in cases of angular deformities in patients nearing skeletal maturity and particularly in subjects in whom there is associated shortening.     

Tibial lengthening and concomitant foot deformity correction in 14 patients with permanent deformity after poliomyelitis

Background In neuromuscular diseases, limb lengthening and foot deformity correction are associated with a high risk of complications associated with distraction callus and joint contracture. We have found no published articles of tibial lengthening and concomitant foot deformity correction using the Ilizarov method or traditional methods. To compare result of gradual distraction with triple arthrodesis for foot deformity combined with tibial lengthening, we investigated healing index and complications of two methods.

Patients and methods We reviewed 14 patients with permanent deformity after poliomyelitis who underwent tibial lengthening and concomitant foot deformity correction using the Ilizarov external fixator. Tibial lengthening over an intramedullary nail was performed in 3 patients and lengthening without a nail was performed in 11 patients.

Results The mean external fixation time was 6 (3.6- 10) months without nail and 1.6 (1.5-1.7) months with nail, whereas the mean healing index was 1.8 (0.8-3.1) months/cm without nail and 2 (1.8-2.3) months/cm with nail. Concomitant foot treatments included triple arthrodesis in 7 patients, pantalar arthrodesis in 2 patients with fiail ankle, and gradual foot frame distraction without bony foot procedures in 5 patients. Delayed consolidation and recurrent equinus contracture of the ankle requiring additional lengthening of the Achilles tendon were the most common bone and joint complications during tibial lengthening.

Interpretation The gradual foot frame distraction method was associated with major complications, such as recurrent foot deformity, joint luxation, and arthritis. We therefore recommend triple arthrodesis as a concomitant procedure during tibial lengthening     

Limb lengthening and correction of deformity in the lower limbs of children with osteogenesis imperfecta

We performed limb lengthening and correction of deformity of nine long bones of the lower limb in six children (mean age, 14.7 years) with osteogenesis imperfecta (OI). All had femoral lengthening and three also had ipsilateral tibial lengthening. Angular deformities were corrected simultaneously. Five limb segments were treated using a monolateral external fixator and four with the Ilizarov frame. In three children, lengthening was done over previously inserted femoral intramedullary rods. The mean lengthening achieved was 6.26 cm (mean healing index, 33.25 days/cm). Significant complications included one deep infection, one fracture of the femur and one anterior angulation deformity of the tibia. The abnormal bone of OI tolerated the external fixators throughout the period of lengthening without any episodes of migration of wires or pins through the soft bone. The regenerate bone formed within the time which is normally expected in limb-lengthening procedures performed for other conditions. We conclude that despite the abnormal bone characteristics, distraction osteogenesis to correct limb-length discrepancy and angular deformity can be performed safely in children with OI.     

Tibial lengthening and concomitant foot deformity correction in 14 patients with permanent deformity after poliomyelitis

BACKGROUND: In neuromuscular diseases, limb lengthening and foot deformity correction are associated with a high risk of complications associated with distraction callus and joint contracture. We have found no published articles of tibial lengthening and concomitant foot deformity correction using the Ilizarov method or traditional methods. To compare result of gradual distraction with triple arthrodesis for foot deformity combined with tibial lengthening, we investigated healing index and complications of two methods. PATIENTS AND METHODS: We reviewed 14 patients with permanent deformity after poliomyelitis who underwent tibial lengthening and concomitant foot deformity correction using the Ilizarov external fixator. Tibial lengthening over an intramedullary nail was performed in 3 patients and lengthening without a nail was performed in 11 patients. RESULTS: The mean external fixation time was 6 (3.6-10) months without nail and 1.6 (1.5-1.7) months with nail, whereas the mean healing index was 1.8 (0.8-3.1) months/cm without nail and 2 (1.8-2.3) months/cm with nail. Concomitant foot treatments included triple arthrodesis in 7 patients, pantalar arthrodesis in 2 patients with flail ankle, and gradual foot frame distraction without bony foot procedures in 5 patients. Delayed consolidation and recurrent equinus contracture of the ankle requiring additional lengthening of the Achilles tendon were the most common bone and joint complications during tibial lengthening. INTERPRETATION: The gradual foot frame distraction method was associated with major complications, such as recurrent foot deformity, joint luxation, and arthritis. We therefore recommend triple arthrodesis as a concomitant procedure during tibial lengthening     

Verlängerung der unteren Extremität mit dem Intramedullary Skeletal Kinetic Distractor (ISKD)

OBJECTIVE: Callus distraction of the femur or tibia with an intramedullary distractor, which lengthens mechanically through alternating rotations of at least 3 degrees. INDICATIONS: Femoral or tibial shortening between 20 and 80 mm. Angular and rotational deformities can be corrected at the osteotomy site. CONTRAINDICATIONS: Open epiphyses. Small medullary canal (after intramedullary reaming femoral diameter < 14.5 mm, tibial diameter < 12.5 mm). Severe deformities. Insufficient compliance. Osteitis. Soft-tissue infections. SURGICAL TECHNIQUE: Supine position. Femoral shaft osteotomy at the proximal or middle third by multiple drill holes completed with a chisel. For lengthening of the tibia, osteotomy with a Gigli saw is preferred. Control of the rotation by two parallel 3.0-mm Kirschner wires. Correction of angular or rotational deformities. Via stab incision reaming of the medullary canal with a flexible reamer. The femur is overreamed 2.0 mm and the tibia 1.5 mm above the desired implant diameter. Insertion of the Intramedullary Skeletal Kinetic Distractor (ISKD) into the medullary canal and distal locking in freehand technique. Control of the rotation and of the osteotomy gap. Proximal locking with an aiming device. For femoral lengthening 3 days and for tibial lengthening 5 days postoperatively the distraction is begun by increasing mobilization with partial weight bearing, to achieve daily distraction of 1 mm. In case of insufficient distraction, additional rotations are performed by the patient while checking the external monitor that displays the daily and total distraction length. RESULTS: Intramedullary lengthening with the ISKD was performed in four patients having an average age of 29 years (18-36 years). Two femoral shortenings were combined with complex rotational and angular deformities. The average lengthening of three femora and one tibia was 31 mm (26-40 mm). The average intraoperative blood loss was 230 ml (110-320 ml), the mean surgical time 108 min (90-145 min). The average daily distraction amounted to 1.2 mm (0.9-1.8 mm). Full weight bearing was permitted after 10 weeks (7-14 weeks), return to regular work after 11 weeks (7-16 weeks). At follow-up examination of an average of 2.3 years postoperatively the knee range of motion was full. Consolidation was noted 80 days (51-111 days) postoperatively with an average consolidation index of 2.9 days/mm (1.8-4.1 days/mm). No complications were observed. According to the Paley Score all patients had an excellent outcome.     

Limb lengthening with a fully implantable mechanical distraction intramedullary nail

AIM: The morbidity of fixator-assisted distraction osteogenesis should be reduced by intramedullary lengthening devices. The ISKD (intramedullary skeletal kinetic distractor) is a new, fully implantable mechanical lengthening nail. In a prospective cohort trial the possibilities and limitations of the device used on femur and tibia are examined. METHODS: 22 patients with a mean age of 25 (range: 16-46) years were treated with an ISKD for femoral (n = 16) and tibial (n = 6) lengthening. The average leg length discrepancy was 48 (range: 25-80) mm. The follow-up was 21 (range: 7-37) months. Clinical and radiological results and complications were evaluated. RESULTS: The results of femoral and tibial applications of the ISKD are different. At the tibia, in three patients a pseudarthrosis occurred and slow callus formation was observed twice. An equinus contracture became evident in 2 patients. At the femur, in one case the lengthening was not accomplished with the device. Five patients were manipulated under anaesthesia at least once to achieve the aim of distraction. Three of these patients received retrograde implantation of the ISKD. An infection or interlocking screw failure was not observed either at the femur or the tibia. CONCLUSION: The ISKD reduces fixator-associated problems but incorporates its own difficulties which are mainly based on the guidance of the device. Careful patient advice in monitoring the lengthening process is mandatory. At the femur 8 cm of lengthening can be achieved but the nail tends to "block". Proper reaming and osteotomy techniques are important. A lengthening of more than 1 mm/day is recommended to prevent early consolidation. At the tibia weak callus formation and soft tissue contractures occur, therefore not more than 4 cm lengthening should be planned, the distraction speed has to be reduced noticeable below 1 mm/day and the initial immobilisation should be for more than a week.     

改良双侧胫肌延长术的疗效分析

目的 探讨改良双侧胫骨延长术的治疗效果。方法 1997年5月－2000年5月对32例患者行双侧胫骨延长达到增高目的,其中8例膝内翻。手术为颈骨结节下1．0cm处骨膜下横形截断胫骨,腓骨于外踝上10cm水平处横形截断,胫肌骨置入带锁髓内钉,近端上锁,小腿外置延长器,每日缓慢牵伸延长胫骨,达到预期延长目的后2周拆除延长器,同时带锁髓内钉远端上锁,延长段骨质完全愈合约1年后取出带锁髓内钉。结果 32例术后双侧胫骨延长3．5－12．0cm,平均8．5cm,延长时间为53－180天,平均128天,延长段骨痂生长时间为120－270天,平均180天,随访1－3年,患者在增高高度、步态及关节活动度等方面满意率达98％。结论 改良后的双侧胫肌延长术,胫骨骨折愈合时间缩短,并发症少,可同时矫正膝内、外翻畸形。     

Changes in canine peripheral nerves during experimental callus distraction

In 24 beagles, lengthening of the right tibia was performed by callus distraction after osteotomy and application of a ring fixator. Distraction was started the fifth day after surgery with a distraction rate of 0.5 mm twice per day and ended after 25 days. A control group of six additional dogs underwent tibial osteotomy and external fixation without distraction. Twelve animals with leg lengthening and three animals without leg lengthening were sacrificed immediately after the distraction period of 25 days (Group A), the remaining 15 dogs were sacrificed after an additional consolidation phase of another 25 days (Group B). From the distracted right leg and from the left control side of each animal, the tibial and peroneal nerves were removed and studied by means of morphometric analysis of semithin sections and electron microscopic study. The authors reported only minor alterations of the myelinated nerve fibers consisting in relatively thin myelinated remyelinating nerve fibers, single axon degeneration, or macrophages. There was no axonal sprouting. In contrast, electron microscopic study disclosed signs of late Wallerian degeneration and axonal regeneration of the nonmyelinated axons. Morphometric analysis of the peroneal nerves revealed a significant increase of fiber density and a reduced mean axon and fiber diameter in the consolidation period (Group B). Similar changes were found in the tibial nerves in Group A and disappeared in the consolidation phase (Group B). These features indicate that callus distraction leads to moderate degenerative changes, followed by repair mechanisms, almost complete recovery, and some nerve fiber growth.     

Lower extremity lengthening by Wagner's method and by callus distraction

Fifty-three patients underwent 64 lengthenings of the femur or tibia by the Wagner technique or by the callus distraction method. Thirty-six femoral and 28 tibial segments were lengthened. Simultaneous lengthening of the femur and tibia was performed in seven limbs. Three segments underwent repeat lengthenings. The average length gained by the Wagner method was 5.1 cm in the femur and 5.4 cm in the tibia. Length gains by callus distraction were 4.9 cm in the femur and 4.5 cm in the tibia. Complication rates were fewer and less severe with callus distraction. The number of operations, days of hospitalization, and length of total treatment were less in patients operated on with the callus distraction method than in those who underwent the Wagner technique.     

First experience with correction of limb-length inequality and angular and rotational deformities of the tibia using the Taylor spatial frame

The authors analyse the first results of correction surgery for limb-length inequality and rotational and angular deformities of the tibia using the Taylor spatial frame in combination with the Ilizarov external fixator in three patients. The shortening of the tibia, 65 mm on the average (55, 60 and 80 mm, respectively), was due to tibial hemimilia in two patients and traumatic epiphyseolysis of the distal tibia in one patient. Distraction at a rate of 1 mm/day was controlled three-times a day on two contralateral struts. It started on the seventh day after osteotomy in all three patients. On the second post-operative day, rehabilitation started with standing up and walking with crutches. The additional fixation of the heel and foot was removed at 3 months after distraction was terminated so that ankle exercise would be possible. No serious complications were recorded. The average distraction index was 0.91 and the average tibial lengthening was 65 mm. Callus consolidation was achieved at 131 days after the end of distraction phase. Approximately at 10 months post-operatively, the patients reported full weight-bearing of the extremity.