New findings in the field are presented in the recent JBJS Guest Editorial What’s New in Limb Lengthening and Deformity Correction. Here, we highlight the 5 most impactful studies, as selected by co-author Anirejuoritse Bafor, MBBS, FMCS(Ortho), FACS.
Lower-Extremity Assessment
In a study published in JBJS, researchers developed an automated system to assess lower-limb alignment from computed tomographic (CT) scans in order to facilitate 3-dimensional preoperative planning of orthopaedic surgery. Comparing this system with a manual system, they reported that the automated system showed good to excellent reliability and required 12 minutes of computation time, whereas the manual system required 60 minutes to complete the measurements1.
Lower Extremity
A study investigated the impact of burosumab, a monoclonal antibody that neutralizes fibroblast growth factor 23 (FGF23), on lower-limb deformity in children with FGF23-related hypophosphatemic rickets (HPR). A total of 5 patients (10 limbs) with HPR and a mean age of 7.2 years were included. Burosumab therapy favorably affected lower-limb malalignment, with an outcome of “improvement” in 6 limbs and an outcome of “no change” in 4 limbs at 12 months after treatment2.
The benefits of using an additional lag screw in medial opening-wedge high tibial osteotomy were assessed in a retrospective study comparing a cohort that underwent the osteotomy with the additional screw (114 knees) with a historical cohort that underwent the osteotomy alone (123 knees). The group with the additional screw demonstrated faster bone union and better functional outcome scores. The study authors concluded that use of a supplemental screw “improved the implant and fixation stability under immediate weight-bearing without causing complications”3.
Limb Lengthening
Bone-healing indices, radiographic changes, and patient-reported symptoms were evaluated in a cohort of 63 patients in whom STRYDE magnetic lengthening nails (NuVasive) were implanted between 2019 and 2021 for femoral or tibial lengthening. The study authors reported that, even though high rates of radiographic abnormalities were observed, bone healing in the femur was unaffected. The study was underpowered to determine whether radiographic changes affected bone healing in the tibia4.
Basic Science
The effect of reverse dynamization in distraction osteogenesis was investigated using a goat model in a study published in JBJS. Midshaft tibial osteotomies followed by limb distraction were performed in 18 goats, which were allocated to static fixation, dynamic fixation, or reverse dynamization. Accelerated formation and remodeling of regenerate bone was observed in the reverse dynamization group5.
What’s New in Limb Lengthening and Deformity Correction is freely available at JBJS.org.
What’s New by Subspecialty
Each month, JBJS publishes a review of the most pertinent studies from the orthopaedic literature in a select subspecialty. To read the reports, visit the What’s New by Subspecialty collection at JBJS.org.
Recent OrthoBuzz posts include: What’s New in Musculoskeletal Infection, What’s New in Orthopaedic Trauma, and What’s New in Spine Surgery.
References
- Kuiper RJA, Seevinck PR, Viergever MA, Weinans H, Sakkers RJB. Automatic assessment of lower-limb alignment from computed tomography. J Bone Joint Surg Am. 2023 May 3;105(9):700-12.
- Sawamura K, Hamajima T, Izawa M, Kaneko H, Kitamura A, Kitoh H. Changes of the lower limb deformity in children with FGF23-related hypophosphatemic rickets treated with Burosumab: a single-center prospective study. J Pediatr Orthop B. 2024 Jan 1;33(1):90-6.
- Ma HH, Lobenhoffer P, Yang JCS. The benefits of a percutaneous supplemental screw to reinforce the hinge of a medial open wedge tibial osteotomy. Arch Orthop Trauma Surg. 2023 Jul;143(7):3707-13.
- Reif TJ, Geffner A, Hoellwarth JS, Fragomen AT, Rozbruch SR. Precice Stryde® Magnetic Internal Lengthening Nail does not impair bone healing despite radiographic and clinical symptoms. Strategies Trauma Limb Reconstr. 2023 May-Aug;18(2):94-9.
- Bafor A, Iobst C, Samchukov M, Cherkashin A, Singh S, Aguilar L, Glatt V. Reverse dynamization accelerates regenerate bone formation and remodeling in a goat distraction osteogenesis model. J Bone Joint Surg Am. 2023 Dec 20;105(24):1937-46.