{"id":6880,"date":"2021-08-23T18:14:42","date_gmt":"2021-08-23T11:14:42","guid":{"rendered":"https:\/\/cms.drdoan.vn\/?p=6880"},"modified":"2021-08-23T18:14:42","modified_gmt":"2021-08-23T11:14:42","slug":"brief-history-and-principle-of-bone-healing-in-leg-lengthening","status":"publish","type":"post","link":"https:\/\/cms.drdoan.vn\/en\/brief-history-and-principle-of-bone-healing-in-leg-lengthening\/","title":{"rendered":"Brief history and principle of bone healing in leg lengthening"},"content":{"rendered":"

Brief history<\/strong><\/p>\n

In 1903, Codivilla A. successfully performed the first limb lengthening procedure by performing osteotomy, followed by continuous stretching and casting. After that, several physicians such as Magnuson and Fasset also performed similar surgeries. However, this type of surgery caused various severe complications and sequelae like skin and nerve damage, tendon tears, pseudarthrosis, incorrect healing due to uncontrolled stretching rate as well as immobilized bone cavity.<\/p>\n

In 1913, Louis Ombre’danne attempted to perform femoral osteotomy followed by stretching that created a 4cm cavity. He used an external fixator with 2 nails and reached the stretching rate of 5mm per day. However, the fast stretching rate caused skin necrosis and infection. In addition, the fixator was not firm as it only had 2 nails. After that, many practitioners attempted to improve the fixator to make it more stabilized and improve osteotomy techniques by paying more attention to the periosteum, setting up a waiting time after the osteotomy, etc. Despite the attempts, the risk of severe complications such as pin site infection, skin and nerve damage, nonunion, incorrect healing and joint deformity was still high.<\/p>\n

In 1963, Wagner H. performed a limb lengthening procedure using a monolateral external fixator on the diaphysis after removing the hindering periosteum and soft tissues, with the stretching rate of 1.5-3mm per day. After the desired length had been reached, the patient’s bone was compressed with splints and it also received grafting. However, many complications such as infection, poor healing, reoperation, etc. still occured, thus this technique was no longer applied.<\/p>\n

In 1951, a Russian professor named Gavriil Abramovich Ilizarov created a ring external fixator to treat bone fracture and assist in leg lengthening procedures. Based on researches from tests on animals, he discovered the principle of distraction osteogenesis and applied it to limb lengthening: Use the osteotomy technique that preserves most of the bone tissue such as periosteum and bone marrow. The cavity should be slowly stretched at the rate of 1mm per day with an elastic external fixator. Compress the stretched limb early and start to do exercise for the joints as soon as possible. The cavity will slowly be filled with new bone. The limb lengthening procedure is successfully performed without bone grafting and with minor soft tissue damage.<\/p>\n

By applying external fixation and osteotomy techniques, with the same stretching rate, in 1971, Ilizarov.G.A announced the results of 215 cases of limb lengthening that he performed with the raised length ranging between 3 and 24 cm. There were 20 patients with limb length discrepancy ranging from 9 to 24 cm. There were 19 cases with complications: meralgia paresthetica (4 cases), pin-site inflammation (11 cases) and osteomyelitis (4 cases).<\/p>\n

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However, it was not until 1981 did Western countries notice Ilizarov’s limb lengthening technique when he was invited to come to Italy to introduce it. Soon after that, the technique was widely spread, applied and developed around the world as a revolutionary breakthrough in limb lengthening.<\/p>\n

During the 1990s, with the development of external fixators and the application of Ilizarov’s limb lengthening principle, limb lengthening had produced better results with fewer complications. At the moment, we can divide leg lengthening into 3 types:<\/p>\n