What’s New in Limb Lengthening and Deformity Correction 2020

Every month, JBJS delivers a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 13 subspecialties. Click here for a collection of all OrthoBuzz specialty-update summaries.

This month, Andrew G. Georgiadis, MD, co-author of the August 19, 2020 “What’s New in Limb Lengthening and Deformity Correction,” selected the five most clinically compelling findings from among the more than 50 noteworthy studies summarized in the article.

Congenital Limb Deficiencies
–A study of 42 children with severe fibular hemimelia found that levels of psychosocial adjustment and health-related quality of life were comparable among those who underwent staged reconstruction and those who underwent amputation, at a minimum of 2 years after treatment.

Congenital Dysplasia
–A study evaluating long-term outcomes of 34 patients who were treated with the Charnley-Williams procedure for congenital pseudarthrosis of the tibia found high rates of refracture after initial union, and that failure to operate on the fibula at the time of index surgery resulted in poor outcomes. On a more positive note, 10 of the 13 refractures healed upon retreatment.

Trauma
–A series of 14 patients with aseptic nonunion of the femur or tibia underwent long-bone compression with magnetic lengthening nails programmed “in reverse.”¹ The nails shortened by 6.7 mm and the bones shortened by an average of 3.1 mm. Union was achieved in 13 of 14 cases.

Limb Lengthening
–In a study comparing motorized internal lengthening with external fixation for humeral lengthening,² ultimate lengthening parameters were comparable, but motorized lengthening mitigated pin-site complications and allowed for reuse of the implant.

Pin-Site Management
–A randomized trial of 114 patients with external fixators concluded that there is no role for antiseptic preparations in routine pin care.³ Neither the antiseptic preparation used nor daily dressing changes affected the pin-site infection rate.

References

1. Fragomen AT, Wellman D, Rozbruch SR. The PRECICE magnetic IM compression nail for long bone nonunions: a preliminary report. Arch Orthop Trauma Surg. 2019 Nov;139(11):1551-60. Epub 2019 Jun 19.
2. Morrison SG, Georgiadis AG, Dahl MT. Lengthening of the humerus using a motorized lengthening nail: a retrospective comparative series. J Pediatr Orthop. 2019 Sep 23. Epub 2019 Sep 23.
3. Subramanyam KN, Mundargi AV, Potarlanka R, Khanchandani P. No role for antiseptics in routine pin site care in Ilizarov fixators: a randomised prospective single blinded control study. Injury. 2019 Mar;50(3):770-6. Epub 2019 Jan 23.