What’s New in Limb Lengthening and Deformity Correction 2021 

Every month, JBJS publishes a review of the most pertinent and impactful studies reported in the orthopaedic literature during the previous year in 14 subspecialty areas. Click here for a collection of all such OrthoBuzz Guest Editorial summaries.

This month, co-author Andrew G. Georgiadis, MD selected the 5 most clinically compelling findings from among the >60 studies highlighted in the most recent “What’s New in Limb Lengthening and Deformity Correction.”

Limb Lengthening 

–Investigators in one recent study used an internal extramedullary technique to achieve femoral lengthening in 11 skeletally immature patients¹. Complication rates were similar to those seen with other femoral-lengthening techniques, which suggests that newer technology could be developed for all-internal lengthening in this younger age group.

Congenital Limb Deficiencies 

–In an essay, a young woman who was born with congenital short limb and her mother offer their perspectives on a childhood “interrupted” by multiple limb-lengthening procedures².

Bone Dysplasias and Tumors 

–In a retrospective study of 10 patients with congenital tibial dysplasia, researchers evaluated isolated distal tibial growth modulation as the primary surgical treatment³. Mean follow-up was 5.1 years. No patient sustained a tibial fracture or developed a tibial pseudarthrosis after guided growth was initiated.

Blount Disease 

–A retrospective multicenter study assessed the use of guided growth in the correction of Blount disease in 45 patients (55 limbs)⁴. The authors found that 64% to 88% of cases could be corrected at a mean of 24 months. The mean correction rate was 1° per month.

Trauma 

–In a study involving a caprine model of tibial osteotomy, researchers evaluated animal groups treated with static fixation, dynamic fixation, and reverse dynamization. They found that reverse dynamization was superior for speed and strength of bone-healing⁵.

References

1. Dahl MT, Morrison SG, Laine JC, Novotny SA, Georgiadis AG. Extramedullary motorized lengthening of the femur in young children. J Pediatr Orthop. 2020 Nov/Dec;40(10):e978-83.
2. Hootnick D, Ellingsworth L, Mauchin R, Brown AC. “It occupied her entire childhood”: looking back on limb-lengthening. Pediatrics. 2021 Feb;147(2):e20201055. Epub 2021 Jan 5.
3. Laine JC, Novotny SA, Weber EW, Georgiadis AG, Dahl MT. Distal tibial guided growth for anterolateral bowing of the tibia: fracture may be prevented. J Bone Joint Surg Am. 2020 Dec 2;102(23):2077-86.
4. Danino B, Rödl R, Herzenberg JE, Shabtai L, Grill F, Narayanan U, Gigi R, Segev E, Wientroub S. The efficacy of guided growth as an initial strategy for Blount disease treatment. J Child Orthop. 2020 Aug 1;14(4):312-7.
5. Glatt V, Samchukov M, Cherkashin A, Iobst C. Reverse dynamization accelerates bone-healing in a large-animal osteotomy model. J Bone Joint Surg Am. 2021 Feb 3;103(3):257-63.