11/01/14 1Professor Freih Abuhassan - University

of Jordan

Limb Lengthening in Limb Lengthening in Skeletal Dysplasia.Skeletal Dysplasia.

Limb Lengthening in Limb Lengthening in Skeletal Dysplasia.Skeletal Dysplasia.

Freih Odeh Au HassanFreih Odeh Au HassanF.R.C.S. (Eng.), F.R.C.S. (Tr. & Orth.)F.R.C.S. (Eng.), F.R.C.S. (Tr. & Orth.)

Professor of OrthopedicsProfessor of Orthopedics

Mr. Frank McManus, M.Ch, F.R.C.S.I.Mr. Frank McManus, M.Ch, F.R.C.S.I.Consultant Orthopedic SurgeonConsultant Orthopedic Surgeon

Cappagh Orthopedic HospitalCappagh Orthopedic Hospital

11/01/14 2Professor Freih Abuhassan - University

of Jordan

Short Stature ProblemsShort Stature Problems

-- Social.Social.

- Family.- Family.

- Psychological.- Psychological.

- Lumbar hyperlordosis.- Lumbar hyperlordosis.

- Physical obstacles.- Physical obstacles.

11/01/14 3Professor Freih Abuhassan - University

of Jordan

* Public transport.Public transport.* Public telephone.Public telephone.* Public bath rooms.Public bath rooms.* Driving license.Driving license. ““140 cm140 cm””..

11/01/14 4Professor Freih Abuhassan - University

of Jordan

Why Leg lengthening in Why Leg lengthening in SkeletalSkeletal Dysplasia?Dysplasia?

* Correct shortening.* Correct shortening.* * ““ Angulation. Angulation.* * ““ Contractures. Contractures.* * ““ Rotation. Rotation.* * ““ Hyperlordosis. Hyperlordosis.* Joint stabilization.* Joint stabilization.

11/01/14 5Professor Freih Abuhassan - University

of Jordan

Why short stature people Why short stature people ask for lengthening ?ask for lengthening ?

1. To be friends with normal people.1. To be friends with normal people.2. To be able to do ordinary things.2. To be able to do ordinary things.3. To be comfortable.3. To be comfortable.4. To find a good job.4. To find a good job.5. To drive a car.5. To drive a car.

DeBastiani, Clin. Orth. 1990DeBastiani, Clin. Orth. 199011/01/14 6

Professor Freih Abuhassan - University of Jordan

Pre Operative assessmentPre Operative assessment

* Two visits.* Two visits.* Physiotherapist.* Physiotherapist.* To meet another patient.* To meet another patient.* Video tape of pin tract care.* Video tape of pin tract care.* X-rays, measurements.* X-rays, measurements.* Photography.* Photography.

11/01/14 7Professor Freih Abuhassan - University

of Jordan

Osteogenesis after osteotomyOsteogenesis after osteotomy

1.1. Maximum preservation of intraosseous Maximum preservation of intraosseous

&extraosseous blood supply.&extraosseous blood supply.

2. Maximum preservation of periosteum.2. Maximum preservation of periosteum.

3. Stable ext. fixator during & after 3. Stable ext. fixator during & after lengthening.lengthening.

Ilizarov, Clin. Orth. 1990.Ilizarov, Clin. Orth. 1990.

11/01/14 8Professor Freih Abuhassan - University

of Jordan

Osteogenesis after osteotomyOsteogenesis after osteotomy

CONTCONT……....

4. Delay prior to distraction.4. Delay prior to distraction.5. Distraction rate 1mm/d (Divided).5. Distraction rate 1mm/d (Divided).6. Physiological use of the limb.6. Physiological use of the limb.

Ilizarov, Clin. Orth., 1990.Ilizarov, Clin. Orth., 1990.11/01/14 9

Professor Freih Abuhassan - University of Jordan

Functional BenefitsFunctional Benefits

1.1. Improve hyper lordosisImprove hyper lordosis

due to tension on Hamstrings.due to tension on Hamstrings.

2. 2. Improve walking due to:Improve walking due to: * Decrease in the anserine movement.* Decrease in the anserine movement.

* Decrease rotation & angular * Decrease rotation & angular deformitiesdeformities..

De Bastiani, Clin. Orth., 1990.De Bastiani, Clin. Orth., 1990.11/01/14 10

Professor Freih Abuhassan - University of Jordan

Percutaneous releases in Percutaneous releases in Hyperlordosis.Hyperlordosis.

* Adductors.* Adductors.* Sartorius.* Sartorius.* Rectus femoris.* Rectus femoris.* Fascia lata.* Fascia lata.____________________________ ____________________________ Vilarrubias, Clin. Orth., 1990.Vilarrubias, Clin. Orth., 1990.

11/01/14 11Professor Freih Abuhassan - University

of Jordan

Post operatively.Post operatively.

* Observation for NVD.* Observation for NVD.

* Pin tract care.* Pin tract care.

* Lengthening training.* Lengthening training.

* Chart for lengthening.* Chart for lengthening.

11/01/14 12Professor Freih Abuhassan - University

of Jordan

7 patients7 patients

Age : 11 - 19 Y (14)Age : 11 - 19 Y (14)

5 M, 2 F5 M, 2 F

11/01/14 13Professor Freih Abuhassan - University

of Jordan

16 Segments16 Segments

* 12 tibia.* 12 tibia.

* 04 femurs.* 04 femurs.

Orthofix Monolateral Lengthener.Orthofix Monolateral Lengthener.

11/01/14 14Professor Freih Abuhassan - University

of Jordan

Skeletal Dysplasia GroupSkeletal Dysplasia Group

4 Achondroplasia.4 Achondroplasia.

1 Hypo achondroplasia.1 Hypo achondroplasia.

1 Metaphyseal Chond.Dys.1 Metaphyseal Chond.Dys.

1 Acrodystosis.1 Acrodystosis.

11/01/14 15Professor Freih Abuhassan - University

of Jordan

Increase in segment length.Increase in segment length.

14.6 Cm (11 - 17 cm).

11/01/14 16Professor Freih Abuhassan - University

of Jordan

Days in lengthenerDays in lengthener

233 Day (210 - 540)233 Day (210 - 540)

11/01/14 17Professor Freih Abuhassan - University

of Jordan

Percentage increase in Percentage increase in segment length.segment length.

53.25% (36.5% - 71%).53.25% (36.5% - 71%).

11/01/14 18Professor Freih Abuhassan - University

of Jordan

Procedure per patient.Procedure per patient.

* * Total Procedures:Total Procedures: 99______99______

7 patients.7 patients.

* 14.1 (10 - 19)* 14.1 (10 - 19)

11/01/14 19Professor Freih Abuhassan - University

of Jordan

Procedures per segmentProcedures per segment

* * Total Procedures:Total Procedures: 9999 Segments : 16 Segments : 16

* 6.18 (4 - 11)* 6.18 (4 - 11)

11/01/14 20Professor Freih Abuhassan - University

of Jordan

COMPLICATIONSCOMPLICATIONS

*Pin tract infection. *Pin tract infection. 44* Fracture. Fracture. 33* Axial deviation. Axial deviation. 99* Re osteoclasis tibia. Re osteoclasis tibia. 22

11/01/14 21Professor Freih Abuhassan - University

of Jordan

COMPLICATIONS COMPLICATIONS CONT..CONT..

* Re osteoclasis fibula. 1Re osteoclasis fibula. 1* Knee contracture. 3Knee contracture. 3* TA contracture. 6TA contracture. 6* Thin osteogenic bone. 2Thin osteogenic bone. 2

11/01/14 22Professor Freih Abuhassan - University

of Jordan

CONCLUSIONCONCLUSION

** MMultiple procedures.ultiple procedures.

* * MManageable complications.anageable complications.

* * MMore gain in height : Up to 34 cm.ore gain in height : Up to 34 cm.

* * MMorale for the patient.orale for the patient.

* * MMany months of lengthening.any months of lengthening.

* * MMore headache for the surgeon.ore headache for the surgeon.11/01/14 23

Professor Freih Abuhassan - University of Jordan

Achondroplastic FemalesAchondroplastic Females

Patient Age Bone Length Increase Increase %

EB (F) 15 Y L TR T

17 cm17 cm

48%

LS (F) 12 Y L FR F

15 cm15 cm

46%

11/01/14 24Professor Freih Abuhassan - University

of Jordan

Achondroplastic MalesAchondroplastic Males

Patient Age Bone Length Increase Increase %

JC (M) 11 Y R FL FR TL T

15 cm15 cm15 cm15 cm

57%55%68%71%

MH (M) 15 Y R TL T

12.5 cm12.5 cm

57%60%

11/01/14 25

Professor Freih Abuhassan - University of Jordan

Other Dysplasia GroupOther Dysplasia Group

Patient Age Dx Bone LengthIncrease

Increase %

SM 15 Acrod L TR T

16 cm16 cm

57%57%

TK 12 H. Ach. L TR T

15 cm15 cm

54%54%

JC 19 M.Cho L TR T

11 cm11.5 cm

36.5%37.5%

11/01/14 26Professor Freih Abuhassan - University

of Jordan

11/01/14 27Professor Freih Abuhassan - University

of Jordan