Callus distraction

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The callus , also callotasis or distraction osteogenesis is an in orthopedic and maxillofacial surgery used method for artificial extension of skeleton bone , most of the long bones . On the one hand, the method is suitable for correcting pathological malpositions (e.g. a functionally significant difference in leg length ); on the other hand, it is also used as a pure cosmetic operation without a medical indication . The surgeon cuts the bone to be lengthened and pulls the two halves apart slowly and continuously along the desired growth axis over several weeks to months using conventional external fixation or special intramedullary lengthening nails. Fresh bone substance (callus) is constantly forming between the two halves of the bone.

historical development

Hopkins and Penrose extended a bone intraoperatively in 1889 by inserting a bone block. In 1905, Alessandro Codivilla introduced surgical techniques to lengthen the lower extremities. These early surgical techniques had a high rate of complications , especially during the bone healing phase . Often the goal, namely bone lengthening, was not achieved.

The breakthrough came thanks to a technique introduced by the Russian orthopedic surgeon Gawriil Abramowitsch Ilisarow : Ilisarov developed a method based on the biology of the bone and the ability of the surrounding soft tissue to regenerate under tensile stress. This was done with the help of a special external fixator , the Ilizarov ring fixator . Although the actual nature of the complications did not change ( infection as the most common complication, especially at the entry points of the external fixator, pain , irritation of nerves and soft tissues), the incidence and severity of the complications could be reduced with the Ilizarov technique . The procedure became safer and the goal of bone lengthening was better achieved.

Fully implantable systems such as the Fitbone intramedullary distraction nail almost completely eliminate the risk of infection, as there is no connection between the system and the outside through the skin during the distraction phase. The risk of infection is thus limited to operations in which the intramedullary nail is inserted or removed. A motor in the system distracts the severed bone by up to 1 millimeter per day. Both the energy supply and the control of the system are carried out externally by means of induction and can be carried out by the patient himself. In addition to the reduced risk of infection, this type of callus distraction means significantly less stress for the user, since significantly fewer scars are created and no special care is required. In addition, physiotherapy can already be started during the treatment, which accelerates the progress of the treatment and thus reduces possible downtimes.

Lengthening of the extremities in the case of disproportionate short stature

For short people with disproportionate stature ( achondroplasia , hypochondroplasia ), single or multiple callus distractions of both arms and legs can be carried out in order to make everyday life easier for them due to the increased size. In the German-speaking countries, such limb extensions are rarely carried out, whereas in some southern European countries they are used for the majority of those affected.

With an extension, people of short stature can move around better in public space and, for example, use ATMs, public toilets or vehicles that are optimized for people of average height without aids.
While people with achondroplasia are noticeably small even after limb lengthening, those affected by hypochondroplasia can reach a size in the lower normal range with the treatment. So social stigma can be reduced in this way.
However, the doctor Robert Rödl points out: “In particular, limb lengthening has no influence on people's happiness and satisfaction. The limb lengthening only has an influence on the length of the limbs. "

Some doctors prefer limb lengthening between the ages of three and six, arguing that the child still needs more care and attention from their parents, while this dependency is more difficult for older children and adolescents to accept. In addition, little or no school time is missed due to the operations and restricted mobility. Other doctors, on the other hand, consider an age of around 14 years to be ideal for starting treatment, as those affected can then weigh up all the advantages and disadvantages of the procedure and make their own decision, while at the same time the new bone is still formed relatively quickly at this age.
The Little People of America association rejects an extension for younger children and demands that the person concerned should be old enough to be fully involved in the decision-making process for or against an extension.

Individual evidence

  1. ↑ Quoted after PB Magnuson: Lengthening shortened bones of the leg by operation. Ivory screws with removable heads as a means of holding the two bone fragments . In: Surgery, Gynecology & Obstetrics . No. 17, 1913, pp. 63-71.
  2. ↑ Alessandro Codivilla: On the means of lengthening in the lower limbs, the muscles, and tissues which are shortened through deformity . In: American Journal of Orthopedics Surgery . 2, 1905, p. 353.
  3. ^ V. Mosca, Moseley, CF: Complications of Wagner leg lengthening and their avoidance . In: orthop. trans. . 10, 1986, p. 462.
  4. ↑ a b c Rainer Baumgart, Augustin Betz, Leonhard Schweiberer : A Fully Implantable Motorized Intramedullary Nail for Limb Lengthening and Bone Transport . In: Clinical Orthopedics and Related Research . 343, October 1997, pp. 135-143. Accessed on December 27, 2006.  ( Page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice.@1@ 2Template: Dead Link / www.corronline.com  
  5. ^ Dror Paley: Problems, Obstacles, and Complications of Limb Lengthening by the Ilizarov Technique. . In: Clinical Orthopedics and Related Research . 250, January 1990, pp. 81-104. Accessed on December 21, 2006.  ( Page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice.@1@ 2Template: Dead Link / www.corronline.com  
  6. ^ Dror Paley: Current techniques of limb lengthening . In: Journal of Pediatric Orthopedics . 8, 1988, pp. 73-92.
  7. ↑ a b Augustin Betz, P.-M. Hax, R. Hierner, H.-R. Kortmann: Correction of the length of the lower extremity with fully implantable intramedullary distraction nails. Archived from the original on October 30, 2012. Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF) In: Trauma and Occupational Disease 2008 . 12, 2008, pp. 1-12. Retrieved March 9, 2013. @1@ 2Template: Webachiv / IABot / www.prof-betz.de
  8. ^ A b Johannes Correll, Johanna K. Correll: Achondroplasia and Hypochondroplasia - their pediatric orthopedic and orthopedic treatment . In: Mohnike, Klingebiel, Vaupel, Zabel (eds.): Achondroplasia and Hypochondroplasia . 2nd Edition. ABW Wissenschaftsverlag, 2013, ISBN 978-3-940615-41-1 , p. 76-78 .
  9. ↑ a b Robert Rödl: Extension concept in early childhood . In: Mohnike, Klingebiel, Vaupel, Zabel (eds.): Achondroplasia and Hypochondroplasia . 2nd Edition. ABW Wissenschaftsverlag, 2013, ISBN 978-3-940615-41-1 , p. 83-91 .
  10. ^ Extended Limb Lengthening, Position Summary. Little People of America Medical Advisory Board, 2006, accessed May 21, 2019 .

further reading