Fracture Following Lower Limb Lengthening in Children: A Series of 58 Patients

Orthop Traumatol Surg Res. 2013 Feb;99(1):72-9. doi: 10.1016/j.otsr.2012.08.005. Epub 2012 Dec 13.

Abstract

Introduction: Fracture is one of the main complications following external fixator removal used in cases of progressive lower limb lengthening; rates as high as 50% are found in the literature. The aim of this study was to determine the factors influencing this complication.

Materials and methods: One hundred and eleven cases of lower limb lengthening were performed in 58 patients (40 femurs and 71 tibias). The mean age at surgery was 10.1years old. Lengthening was performed in all cases with an external fixator alone, associated in 39.6% of cases with intramedullary nailing. The patients were divided into three groups according to disease etiology (congenital, achondroplasia and other). The fractures were classified according to the Simpson classification.

Results: Twenty fractures were recorded (18%). Sixteen fractures were found in patients with congenital disease, four with achondroplasia and none in the group of other etiologies. The fracture was more often in the femur (27.5%) than in the tibia (12.7%).

Discussion: The rate of fracture is influenced by different factors depending on the etiology of disease. In congenital diseases, the fracture rate is higher when there is lengthening of more than 15% of the initial length and a delay between surgery and the beginning of lengthening of less than 7days. In patients with achondroplasia, the influence of a relative percentage of lengthening is less important than in those with congenital disease. However, to avoid fractures, lengthening should not be started in children under the age of nine. Moreover, lengthening should begin at least 7days after the fixator has been placed.

Type of study: Retrospective.

Level of evidence: Level IV.

MeSH terms

  • Achondroplasia
  • Adolescent
  • Bone Lengthening / adverse effects*
  • Bone Regeneration
  • Child
  • Child, Preschool
  • External Fixators
  • Female
  • Femur / surgery*
  • Fracture Fixation, Intramedullary
  • Fractures, Bone / etiology*
  • Humans
  • Leg Length Inequality / etiology
  • Leg Length Inequality / surgery
  • Male
  • Retrospective Studies
  • Tibia / surgery*
  • Young Adult