PATHOLOGICAL FRACTURES FOLLOWING BONE LENGTHENING

Prévot J., FOCKENS W.

Abstract


197 limb lengthenings were performed in our Department since 1985.
Femur: 87 cases - average gain 8,5 cm (ranging from 4 to 15 cm)
Tibia: 92 cases - average gain 7,3 cm (ranging from 3 to 15 cm)
Humerus: 18 cases - average gain 9 cm (ranging from 8 to 10 cm) 14 fractures were observed after surgery, i.e. 7% of cas-es. Indications for lengthening were: lower Umb: congenital (17 fibular hemimelias, 5 phocomelias and congenital coxa-vara, 26 short statures among then 12 achondroplasias), post-infectious (10) or post-trauma epiphysiodesis and malunion (14).
upper limb: 18 humerus: congenital: humerus varus (2), achondroplasia (12), post-infectious (3) and bone cyst (1).
The femur was involved in 9/87 cases (10%) ; tibia in 3/92 (3,2%) and humerus in 2/18 (11%). Fractures occurred prefe-rentially for large gains (over 7 cm). They were observed early (within 3 months) after apparatus removal: 35 %, or later (between 3 to 6 months): 56 % . One very late fracture occured at 15 months: 5%. They occured at equivalent rates in congenital and other etiologies. However, they occur less in achondroplasia (2 cases).
Anatomically 3 categories were individualized:
1) Transverse fracture with angulation but without overlapping (8 cases, among then 7 femoral) observed early (3 post-op. months). This fracture type is instable and justifies an ESIN (Technique from Nancy).
2) Plastic inflexion: 2 cases of moderate inflexion, stabilized with a cast and 3 cases of large inflexion, needing a new ex-ternal fixator.
3) Overlapping (2 cases): these fractures are irreducible (soft tissues retraction) and must be treated with setting of a new external fixator.
After a review of the literature, and the etiology fractures occurring after lengthening, we conclude, based on our expe-rience, that an angulated fracture needs an ESIN to prevent displacement and overlapping.

Keywords


pathological fractures, bone lengthening, children

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