Results of Humeral Lengthening W ith U nilateral E xternal F ixator
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Results of Humeral Lengthening With Unilateral
External Fixator
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Short Humerus
• Spinal flexibility decreases by aging that cause limitation of
upper limb function self service personal and perineal
hygiene
• Cosmetic
Psychologic
Functional problems.
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Humerus Lengthening with Circular Ex. Fix.
•Cattaneo R, Catagni MA, Guerreschi F. Applications of the Ilizarov method in the humerus. Lengthenings and nonunions. Hand Clin. 1993 Nov;9(4):729-39.
•Cattaneo R, Villa A, Catagni MA, Bell D. Lengthening of the humerus using the Ilizarov technique. Description of the method and report of 43 cases.Clin Orthop Relat Res. 1990 Jan;(250):117-24.
•Yasui N, Kawabata H, Nakase T, Shibata T, Ohno H, Ochi T. Humeral lengthening and deformity correction. Orthopade. 2000 Jan;29(1):58-62. German.
•Kashiwagi N, Suzuki S, Seto Y, Futami T. Bilateral humeral lengthening in achondroplasia. Clin Orthop Relat Res. 2001 Oct;(391):251-7
•Gamal Ahmed Hosny. Unilateral humeral lengthening in children and adolescents. Journal of Pediatric Orthopaedics B 2005, 14:439–443
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Humerus Lengthening With Unilateral Ex. Fix.
• Poul J, Syebis M. Results of lengthening 20 humeri. Acta Chir Orthop Traumatol Cech. 2001;68(5):289-93.
• Cordonnier D, Barbier J, Desrousseaux JF. Severe angular deformity of the humerus: unilateral external fixation for correction and bone lengthening. Rev Chir Orthop Reparatrice Appar Mot. 2004 Feb;90(1):83-7.
• Francis Young-In Lee, MD, J. Scott Schoeb, MD, John Yu, BS, Brett D. Christiansen, MD,
and Harold M. Dick, MD.Operative Lengthening of the Humerus Indications, Benefits, and Complications. J Pediatr Orthop 2005;25:613–616
• Shadi M, Koczewski P. Humeral lengthening with a monolateral external fixator in achondroplasia. Pediatr Endocrinol Diabetes Metab. 2007;13(3):121-4.
• Sándor Kiss & Károly Pap & Tibor Vízkelety & Tamás Terebessy & Mária Balla & György
Szőke. The humerus is the best place for bone lengthening. International Orthopaedics (SICOT) (2008) 32:385–388
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Humerus Lengthening
• We use Unilateral external fixator (U.E.F.) since 2001 in all cases more comfortable
• Prophylactic radial nerve release in all.
A.B. 6 Years. M. 6 cm.45%
A.K. 8 Years. M. SED. 10 CM .95%
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Humerus Lengthening With U.E.F
• Between 2001 and 2009
• Mean age 11.9 (range, 30-4) years
• 27 humeri in 18 patients
A.K. 8 Years. M. SED. 10 CM 95%
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Etiology
• 9 bilateral
7 achondroplasia
2 epiphyseal dysplasia
• 9 unilateral
4 septic artritis
2 tumor sequelae
3 hemimelia
A.M. 23 Years.F. Post infection. 8 cm .40%
N.P. 7 years. F.Achondroplasia. 6 cm. 50%
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Result
• Mean follow-up 49 months (range, 11-104).
• Mean EFT 216 days (range, 120-510 )
• Mean EFI 33,1 (range, 19– 50 ) days/cm.
B.K.. 17 Years. M. Epiphysitis. 7,5 cm. 47%
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The Mean Lengthening Rate
• The mean lengthening 7,26 cm (range, 3,7-12 cm).
56 % (25- 95 %)
66 % (45- 95 %) in achondroplasia.
M.G. 7 Years.M. Achondroplasia. 9.5 cm . 95%
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Circulair Type Fixators
Cattaneo et
alAldegheri and Dall
Kashiwagi et al Gamal Ahmed Hosny
Number Of Segment 43 20 20 18
Age 18 (10-36) 19,5 12 (6-17) 13 (8,5-17)
BHİ days/cm 29,1 (22-35) 30 28 (25-35)
Bilateral 14 achondroplasia 10 achondroplasia 10 achondroplasia
Unilateral 18 all
Gain of length cm 9 (5-16) 10,2 (8-12) 7,8 (3,5-10) 8,6 (5.5-15)
Gain of length per% 57 (38-72) % 50% up to %115
Radial nerve non 2(10%) 1
Fracture 7(16%) non 2(10%) 2 (13%)
Functional excellent /good 10 excellent/ 6 good
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U.E.F. M shadi Poul j Sandor Kiss et all Our Study
Number of segment 10 20 11 27
Age 15,7 12 (7-16) 17,8 (12-31) 11,9 (4-30)
BHI days/cm 27 28,6 32 33,1
Shortening cm 8,3 8
Circular Ex.Fix. 7
Unilateral Ex.Fix. all 13 Wagner ,all all
Bilateral 5 achondroplasia 2 1
7 achondroplasia 2 epiphyseal
displasia
Unilateral all 16 9 9
Gain of length cm 8,5 7,1 6,2 (4,5-10,5) 7,26
Gain of length per% >50% 27% (16-44)56 % (25-95) 66% achondroplasia
Radial nerve 1 at follow 3 1 3
Fracture 3
Follow-up 2 years 4 years
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Paley’s Functional Scores
• Excellent in 11,
• Good in 15,
• Fair in one humerus
U.B. 5 Years. Achondroplasia. 7.5 cm. 80%
M.A. 13 Years. M. Achondroplasia. 8 cm. 62%
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Paley’s Bone Scores
• Excellent in 22
• Good in 5 humeri
N.P.7 Years. F.Achondroplaizia. 6,5 cm. 50%
M.G.7 Years. M. 9.5 CM .95%
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Complications• 7 problems; 2 grade I, 2 grade II , 1 grade III pin tract infection
3 radial nerve palsy spontaneously resolved
E.G. 16 Years. 6 cm . Lymphoma.33% .
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Complications
M.G. 5 Years. M. L ulnar hemimelia. 3,7 CM .25%
• No sequelae
•3 obstacles; 3 regenerate fractures
M.A. 13 Years. M. Achondroplasia. 8 cm. 62%
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LAST WORD• Unilateral external fixator provide adequate stability,
low complication rate, high length amount and comfort for humeral lengthening
• The range-of-motion of the adjacent joints are preserved
T.K. 15 Years.M. Dwarfism.8 CM.50%