Limb length discrepancy(LLD)is a common orthopedic condition that can result in significant functional impairment,pain,and cosmetic deformities.Current reconstructive techniques for severe LLD are primarily based on c...Limb length discrepancy(LLD)is a common orthopedic condition that can result in significant functional impairment,pain,and cosmetic deformities.Current reconstructive techniques for severe LLD are primarily based on callus distraction,which is a time-consuming process that can lead to complications,such as significant infection,joint stiffness,and stress fractures.To reduce the therapeutic time and minimize the risk of complications,we investigated the use of vascularized bone flaps as a technical supplement to callus distraction in the reconstruction of short limbs.We present two cases of severe LLD in the upper and lower legs,in which a twostage reconstruction approach was used.In the first stage,external fixation was applied to the affected limb to correct the soft tissue length and convert the short deformity into a bone defect.In the second stage,the bone defect was reconstructed using bilateral(patient A)or unilateral(patient B)free vascularized fibula bone grafts.Both patients had complete survival of the fibular grafts without stress fractures,and bone consolidation took 8 months(patient A)and 4 months(patient B).Compared to the traditional callus distraction,the two-stage approach was found to be more time-saving and reliable.The entire reconstructive scheme required 18 and 4 months for patients A and B,respectively,whereas the traditional callus distraction required 41 and 17 months,respectively.These findings suggest that the use of vascularized bone flaps as a technical supplement for callus distraction may provide an effective and efficient alternative for the treatment of severe LLD.Further studies are needed to validate these results and assess the long-term outcomes of this approach.展开更多
BACKGROUND Simple bone cysts(SBC)are benign tumor-like bone lesions typically identified in children.While SBC may lead to growth disturbances or growth arrest,such cases are uncommon.The mechanisms behind these obser...BACKGROUND Simple bone cysts(SBC)are benign tumor-like bone lesions typically identified in children.While SBC may lead to growth disturbances or growth arrest,such cases are uncommon.The mechanisms behind these observations remain unclear.Additionally,research on the etiology of SBC remains inconclusive,and there has been no consensus on the appropriate timing and methodology for treatment.CASE SUMMARY Here,we present our experience in the successful surgical management of a 10-year-old girl with SBC,who presented with a pathological fracture complicated by malunion of the displaced fracture,varus deformity,and limb length discrepancy.We hypothesized two possible etiologies for the patient’s growth arrest and subsequent humerus varus deformity:(1)Direct disruption of the physis by fluid from the cyst itself;and(2)damage to the epiphysis due to repetitive pathological fractures associated with SBC.In addressing this case,surgical intervention was undertaken to correct the proximal humerus varus deformity.This approach offered the advantages of simultaneously correcting angular abnormalities,achieving mild limb lengthening,providing definitive SBC treatment,and reducing the overall treatment duration.CONCLUSION As per current literature,acute correction of acute angular deformity in proximal humeral SBC is not well comprehended.However,in this specific case,acute correction was considered an optimal solution.展开更多
Introduction: The progressive osseous lengthening on a single site corticotomy such as described by Ilizarov is a reliable but difficult method in the treatment of limb length discrepancies. The objective of this stud...Introduction: The progressive osseous lengthening on a single site corticotomy such as described by Ilizarov is a reliable but difficult method in the treatment of limb length discrepancies. The objective of this study was to appreciate the results of the recent application of this method in a low-income country such as Senegal. Material and Method: It was a retrospective study on 32 patients among whom 19 were men (people) and 13 were women over one continuous period of 7 years. The mean age was of 19 years with extremes of 10 and 36 years. Etiologies were dominated by osteoarthritis of the hip in 77.8%, traumatic sequela in 16.7% and the aseptic osteonecrosis of femoral head in 5.6%. The average duration of treatment was of 232 days with extremes of 110 and 363 days. Results: On the anatomical plan, the average lengthening was 55.89 mm that is 12.03% of the initial length with extremes of 35 and 110 mm. The equalization, in terms of length of the members, was obtained in 33.3% of the cases. The average index of cure was of 56.29 days, six patients, which are 18.75% of the cases, complained about pain at the end of treatment and walking without crutches was possible in 83.33%. The complications, in the phase of lengthening, were either mechanics, with 5 subluxations (3 at the level of the hip and 2 at the level of the knee), or biological with 7 infections (superficial 5 and 2 deep), 2 premature consolidations and 1 bleeding. The complications in the consolidation phase were also mechanical with 32 articular stiffness, 8 plastic deformations, 7 subluxations, a fracture and a collapse of the regenerate, or biological with 8 infections among which an osteitis and bleeding. Conclusion: Despite a strong rate of complications and sometimes not reached objectives, the results of this first series of lengthening are encouraging and rich in education and do not seem to be a limiting factor for the implementation of the method in developing countries.展开更多
基金supported by the National Nature Science Foundation(grant nos.81871577 and 81971864)。
文摘Limb length discrepancy(LLD)is a common orthopedic condition that can result in significant functional impairment,pain,and cosmetic deformities.Current reconstructive techniques for severe LLD are primarily based on callus distraction,which is a time-consuming process that can lead to complications,such as significant infection,joint stiffness,and stress fractures.To reduce the therapeutic time and minimize the risk of complications,we investigated the use of vascularized bone flaps as a technical supplement to callus distraction in the reconstruction of short limbs.We present two cases of severe LLD in the upper and lower legs,in which a twostage reconstruction approach was used.In the first stage,external fixation was applied to the affected limb to correct the soft tissue length and convert the short deformity into a bone defect.In the second stage,the bone defect was reconstructed using bilateral(patient A)or unilateral(patient B)free vascularized fibula bone grafts.Both patients had complete survival of the fibular grafts without stress fractures,and bone consolidation took 8 months(patient A)and 4 months(patient B).Compared to the traditional callus distraction,the two-stage approach was found to be more time-saving and reliable.The entire reconstructive scheme required 18 and 4 months for patients A and B,respectively,whereas the traditional callus distraction required 41 and 17 months,respectively.These findings suggest that the use of vascularized bone flaps as a technical supplement for callus distraction may provide an effective and efficient alternative for the treatment of severe LLD.Further studies are needed to validate these results and assess the long-term outcomes of this approach.
文摘BACKGROUND Simple bone cysts(SBC)are benign tumor-like bone lesions typically identified in children.While SBC may lead to growth disturbances or growth arrest,such cases are uncommon.The mechanisms behind these observations remain unclear.Additionally,research on the etiology of SBC remains inconclusive,and there has been no consensus on the appropriate timing and methodology for treatment.CASE SUMMARY Here,we present our experience in the successful surgical management of a 10-year-old girl with SBC,who presented with a pathological fracture complicated by malunion of the displaced fracture,varus deformity,and limb length discrepancy.We hypothesized two possible etiologies for the patient’s growth arrest and subsequent humerus varus deformity:(1)Direct disruption of the physis by fluid from the cyst itself;and(2)damage to the epiphysis due to repetitive pathological fractures associated with SBC.In addressing this case,surgical intervention was undertaken to correct the proximal humerus varus deformity.This approach offered the advantages of simultaneously correcting angular abnormalities,achieving mild limb lengthening,providing definitive SBC treatment,and reducing the overall treatment duration.CONCLUSION As per current literature,acute correction of acute angular deformity in proximal humeral SBC is not well comprehended.However,in this specific case,acute correction was considered an optimal solution.
文摘Introduction: The progressive osseous lengthening on a single site corticotomy such as described by Ilizarov is a reliable but difficult method in the treatment of limb length discrepancies. The objective of this study was to appreciate the results of the recent application of this method in a low-income country such as Senegal. Material and Method: It was a retrospective study on 32 patients among whom 19 were men (people) and 13 were women over one continuous period of 7 years. The mean age was of 19 years with extremes of 10 and 36 years. Etiologies were dominated by osteoarthritis of the hip in 77.8%, traumatic sequela in 16.7% and the aseptic osteonecrosis of femoral head in 5.6%. The average duration of treatment was of 232 days with extremes of 110 and 363 days. Results: On the anatomical plan, the average lengthening was 55.89 mm that is 12.03% of the initial length with extremes of 35 and 110 mm. The equalization, in terms of length of the members, was obtained in 33.3% of the cases. The average index of cure was of 56.29 days, six patients, which are 18.75% of the cases, complained about pain at the end of treatment and walking without crutches was possible in 83.33%. The complications, in the phase of lengthening, were either mechanics, with 5 subluxations (3 at the level of the hip and 2 at the level of the knee), or biological with 7 infections (superficial 5 and 2 deep), 2 premature consolidations and 1 bleeding. The complications in the consolidation phase were also mechanical with 32 articular stiffness, 8 plastic deformations, 7 subluxations, a fracture and a collapse of the regenerate, or biological with 8 infections among which an osteitis and bleeding. Conclusion: Despite a strong rate of complications and sometimes not reached objectives, the results of this first series of lengthening are encouraging and rich in education and do not seem to be a limiting factor for the implementation of the method in developing countries.
