Results of Humeral Lengthening W ith U nilateral E xternal F ixator

Results of Humeral Lengthening With Unilateral

External Fixator

Short Humerus

• Spinal flexibility decreases by aging that cause limitation of

upper limb function self service personal and perineal

hygiene

• Cosmetic

Psychologic

Functional problems.

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

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

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%

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%

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%

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%

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%

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

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

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%

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%

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% .

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%

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%