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. 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

4. 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

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, 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%

9. 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%

10. Circulair Type Fixators Cattaneo et al Aldegheri and Dall Kashiwagi et alGamal Ahmed Hosny Number Of Segment43 20 18 Age 18 (10-36)19,512 (6-17)13 (8,5-17) BHİ days/cm 29,1 (22-35) 30 28 (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 segment10201127 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%