Minimally Invasive Plate Osteosynthesis to Prevent or Treat the Deformity after Distraction Osteogenesis

Chang-Wug Oh; Byung-Chul Park; Il-Hyung Park; Hee-Soo Kyung; Woo-Kie Min; Seung-Hoon Baek; Seung-Kil Baek

doi:10.4055/jkoa.2007.42.6.764

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Oh, Park, Park, Kyung, Min, Baek, and Baek: Minimally Invasive Plate Osteosynthesis to Prevent or Treat the Deformity after Distraction Osteogenesis

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2007; 42(6): 764-771.

Published online: 31 December 2007

DOI: https://doi.org/10.4055/jkoa.2007.42.6.764

Minimally Invasive Plate Osteosynthesis to Prevent or Treat the Deformity after Distraction Osteogenesis

Chang-Wug Oh, M.D., Byung-Chul Park, M.D., Il-Hyung Park, M.D., Hee-Soo Kyung, M.D., Woo-Kie Min, M.D.

, Seung-Hoon Baek, M.D., Seung-Kil Baek, M.D.

Department of Orthopedic Surgery, College of Medicine, Kyungpook National University, Daegu, Korea.

Address reprint requests to Chang-Wug Oh, M.D. Department of Orthopedic Surgery, College of Medicine, Kyungpook National University, 50, Samdeok 2-ga, Jung-gu, Daegu 700-721, Korea. Tel: +82.53-420-5630, Fax: +82.53-422-6605, cwoh@knu.ac.kr

Abstract

Purpose

To determine the efficacy of minimally invasive plate osteosynthesis (MIPO) for distraction callus after a lengthening procedure with an external fixator.

Materials and Methods

Distraction osteogenesis were performed using an external fixator for growth arrest (7 cases), congenital pseudoarthrosis of tibia (2 cases), and congenital leg length discrepancy (2 cases). MIPO was performed using a locking compression plate over the distraction callus. The mean age of the index procedure was 11 years, and mean amount of distraction was 5.4 cm. Eight were treated earlier to remove the external fixator after achieving of the target length, and 3 were treated as a salvage operation of fractures after removal.

Results

In all patients, the distraction callus healed with its length or correction into the original alignment maintained. The mean external fixation index was 34.3 days/cm and the mean healing index was 52.6 days/cm. In 8 patients with the early removal of the external fixator, the mean external fixation index was 26.9 days/cm. No patient developed a deep infection or implant failure. All patients recovered their preoperative joint motion and were satisfied with their function.

Conclusion

MIPO can prevent or correct a deformity after distraction osteogenesis, and allow patients to return to their daily life earlier.

Keywords: Distraction osteogenesis, External fixator, Minimally invasive plate osteosynthesis

Figures and Tables

Fig. 1

(Case No. 4) A 9 year-old girl with post-septic growth arrest underwent tibial lengthening with ilizarov ring fixator (A & B). After achieving desired length (C), percutaneous plating was performed using two plates in view of small size of tibia (D). Fixator was removed and alignment is well maintained (E). External fixation index was 15.1 days/cm, and healing index was 45.6days/cm with the good consolidation of callus (F). The patient suffered a superficial infection. But, she could have a good function after removal of plates (G & H).

Fig. 2

(Case No. 5) A 10 year-old girl had a leg length discrepancy with deformity due to traumatic growth arrest of the distal femur and proximal tibia. With corrective osteotomy of the distal femur, femoral lengthening was conducted with a monolateral external fixator (A & B). After achieving target length, percutaneous plating was done under the fluoroscopic guide (C & D). The distraction segment was well maintained (E), after the external fixator was removed (F). At 14 months postoperatively, the distraction callus healed (G), and the patient gained the equalization of legs (H).

Fig. 3

(Case No. 9). A 5 year-old girl with femoral shortening (A) underwent limb lengthening with monolateral fixtor (B&C). With maturing of the distraction callus, the external fixtor was removed (D). But, a varus collapse occurred at 1 week after removal (E). Percutaneous plating was done with correction of deformed callus (F). Good alignment was achieved after operation (G). Although a small plate was fixed for stress fracture at the previous pin track, the distraction callus matured with marrow canalization (H) and she showed an excellent function (I).

Table 1

Clinical Details and Results of the Eleven Patients

EFI, external fixation index; HI, healing index; Supf. infection, superficial infection; Ex-fix, external fixator; CPT, congenital pseudoarthorsis of tibia.

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ORCID iDs: Woo-Kie Min
https://orcid.org/http://orcid.org/0000-0003-2079-5085
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