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Results of Humeral Lengthening With Unilateral External Fixator.

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Presentation on theme: "Results of Humeral Lengthening With Unilateral External Fixator."— Presentation transcript:

1 Results of Humeral Lengthening With Unilateral External Fixator

2 Short Humerus Spinal flexibility decreases by aging that cause limitation of upper limb function  self service  personal and perineal hygiene Cosmetic Psychologic Functional problems.

3 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 Nov;9(4): 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 Jan;(250): Yasui N, Kawabata H, Nakase T, Shibata T, Ohno H, Ochi T. Humeral lengthening and deformity correction. Orthopade Jan;29(1): German. Kashiwagi N, Suzuki S, Seto Y, Futami T. Bilateral humeral lengthening in achondroplasia. Clin Orthop Relat Res Oct;(391):251-7 Gamal Ahmed Hosny. Unilateral humeral lengthening in children and adolescents. Journal of Pediatric Orthopaedics B 2005, 14:439–443

4 Humerus Lengthening With Unilateral Ex. Fix. Poul J, Syebis M. Results of lengthening 20 humeri. Acta Chir Orthop Traumatol Cech. 2001;68(5): 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 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): 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

5 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%

6 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%

7 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%

8 Result Mean follow-up 49 months (range, ). Mean EFT 216 days (range, ) Mean EFI 33,1 (range, 19– 50 ) days/cm. B.K.. 17 Years. M. Epiphysitis. 7,5 cm. 47%

9 The Mean Lengthening Rate The mean lengthening 7,26 cm (range, 3,7-12 cm). 56 % ( %) 66 % ( %) in achondroplasia. M.G. 7 Years.M. Achondroplasia. 9.5 cm. 95%

10 Circulair Type Fixators Cattaneo et al Aldegheri and Dall Kashiwagi et alGamal Ahmed Hosny Number Of Segment Age 18 (10-36)19,512 (6-17)13 (8,5-17) BHİ days/cm 29,1 (22-35) (25-35) Bilateral 14 achondroplasia10 achondroplasia Unilateral 18 all Gain of length cm9 (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 non2(10%)1 Fracture 7(16%)non2(10%)2 (13%) Functional excellent /good 10 excellent/ 6 good

11 U.E.F. M shadiPoul jSandor Kiss et allOur Study Number of segment Age15,712 (7-16)17,8 (12-31)11,9 (4-30) BHI days/cm2728,63233,1 Shortening cm 8,38 Circular Ex.Fix. 7 Unilateral Ex.Fix.all13Wagner,allall Bilateral5 achondroplasia21 7 achondroplasia 2 epiphyseal displasia Unilateralall1699 Gain of length cm8,57,16,2 (4,5-10,5)7,26 Gain of length per%>50% 27% (16-44) 56 % (25-95) 66% achondroplasia Radial nerve1 at follow313 Fracture 3 Follow-up2 years 4 years

12 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%

13 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%

14 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%.

15 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%

16 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%


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