Humeral lengthening in patients with achondroplasia and in patients with post-septic shortening: comparison of procedure efficiency and safety

• Published in: International orthopaedics Vol. 42; no. 2; pp. 419 - 426
• Main Authors: Shadi, Milud, Musielak, Bartosz, Koczewski, Paweł, Janusz, Piotr
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2018
• Subjects: Achondroplasia - complications; Achondroplasia - surgery; Adolescent; Adult; Arthritis, Infectious - complications; Arthritis, Infectious - surgery; Bone Lengthening - adverse effects; Bone Lengthening - methods; External Fixators - adverse effects; Female; Humans; Humerus - surgery; Ilizarov Technique; Male; Medicine; Medicine & Public Health; Original Paper; Orthopedics; Osteogenesis, Distraction - adverse effects; Osteogenesis, Distraction - methods; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Retrospective Studies; Treatment Outcome; Wound Healing; Young Adult; Achondroplasia; Post-septic shortening; Upper extremity lengthening; Monolateral fixators; Humeral lengthening
• ISSN: 0341-2695; 1432-5195; 1432-5195
• DOI: 10.1007/s00264-017-3632-x

Purpose Although humeral lengthening in patients with achondroplasia is an accepted procedure for improving functional status, there is still a paucity of information about the effectiveness of the method. Therefore, the aim of this study was to evaluate the efficacy and safety of humeral lengthening using monolateral fixators in patients with achondroplasia and unilateral shortening. Methods Twenty-one patients (31 humeri) were included in this study. The study group consisted of eight patients with achondroplasia (16 segments). The control group consisted of 13 patients with post-septic shortening of the humerus (15 segments). All subjects underwent distraction osteogenesis with the use of a monolateral fixator. Results The mean lengthening in the patients with achondroplasia was 8.29 cm, whereas in the control group it was 7.34 cm ( p  = 0.1677). The mean lengthening percentage in the patients with achondroplasia (50% of the initial length of the humerus) was significantly greater than in the control group (33% of the initial length of the humerus) ( p  = 0.0007). The mean healing index was 24.8 days/cm in the patients with achondroplasia and 28.56 days/cm in the control group ( p  = 0.1832). The overall complication rates for the achondroplastic and post-septic patients were, respectively, 175% and 160% ( p  = 0.1420). Conclusions Humeral lengthening with use of monolateral fixators in patients with achondroplasia is an efficient method. Although the segment lengthening percentage is significantly greater in patients with achondroplasia than in patients with post-septic shortening of the humerus, the safety of this procedure is comparable.