2017 ISAKOS Biennial Congress ePoster #1501
Distraction Osteogenesis Utilizing a Longitudinal Corticotomy
Maad F. Alsaati, MD, DES, DESCQ, Riyadh SAUDI ARABIA
Robert A Magnussen, MD, MPH, Worthington, OH UNITED STATES
Sebastien Lustig, MD, PhD, Lyon, Rhône Alpes FRANCE
Gazal Faisal Alsaati, MD, Washington Dc UNITED STATES
Philippe Noel Neyret, MD, PhD, Prof., Lyon La Tour De Salvagny FRANCE
Faisal Aa Alsaati, MD, Riyadh SAUDI ARABIA
Saati Medical Cneter, Riyadh, SAUDI ARABIA
FDA Status Not Applicable
Summary
The S-Z osteotomy safely reduces consolidation time of regenerative bone during distraction osteogenesis in the tibia relative to a transverse corticotomy.
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Abstract
Background
Distraction osteogenesis can be utilized to lengthen long bones that are
abnormally short secondary to trauma, infection or congenital deformities.
Traditionally described techniques involve the creation of a transverse corticotomy
followed by gradual distraction until the desired lengthening is achieved. A
consolidation phase follows, during which the newly formed bone ossifies and gains
strength. This phase can often be prolonged, introducing a risk of fracture. We
hypothesize that the use of a longitudinal corticotomy (S-Z osteotomy) results in more
rapid consolidation following distraction osteogenesis of shortened tibiae.
Methods
Sixty-seven lengthening procedures were performed in 51 patients ranging in
age from 9 to 38 years (mean 25 years). Diagnoses included short stature (32 tibiae),
post-polio limb deformity (22 tibiae), osteomyelitis (3 tibiae), trauma (2 tibiae), and
other diagnoses (8 tibiae). Forty-five lengthenings were performed via a longitudinal
corticotomy in the shape of an S (left tibia) or a Z (right tibia) (S-Z osteotomy) and
twenty-two were performed via a transverse corticotomy. Patients were followed until
consolidation of the regenerated bone was noted radiographically (consolidation time).
The healing index (consolidation time per centimeter of lengthening) was calculated for
each patient and any complications were noted. The mean healing index was compared
between the two groups.
Results
The healing index was significantly lower in the S-Z group (30.8 ± 9.6
days/cm) than in the transverse corticotomy group (46.8 ± 20.2 days/cm) (p < 0.0001).
The mean lengthening was 6.6 cm (range: 2.5 to 12.5 cm) in the S-Z group and 5.8 cm
(range: 2.0 to 12.0 cm) in the transverse group (p = 0.28). The mean consolidation time
was 6.3 ± 2.8 months (range: 3 to 16 months) in the S-Z group and 8.1 ± 3.8 months
(range: 3 to 13.5 months) in the transverse group (p = 0.03). One fracture of the
regenerative bone occurred in the transverse group and none occurred in the S-Z group.
Conclusion
The S-Z osteotomy safely reduces consolidation time of regenerative bone
during distraction osteogenesis in the tibia relative to a transverse corticotomy.