Risk factors for and complications of distraction osteogenesis

Eur J Orthop Surg Traumatol. 2014 Jul;24(5):693-8. doi: 10.1007/s00590-013-1261-7. Epub 2013 Jun 23.


Purpose: Distraction osteogenesis is commonly used for limb deformities and reconstruction of bone defects with satisfactory outcome for the patients. However, it is associated with a risk of complications. The present study aims to assess the incidence of complications and to identify the risk factors that may predict distraction osteogenesis-related complications.

Materials and methods: We retrospectively studied 63 patients (mean age 13.5 years; range 3-57 years) who had 74 distraction osteogenesis procedures from 2004 to 2009. A circular external fixator was used in 58 procedures, and a monolateral in 16 procedures. Fixator's time, days of treatment, lengthening percentage, bone healing index, distraction regenerate length and index, risk factors and complications were evaluated. The mean follow-up was 5 years (range 2-7 years).

Results: Complications occurred in 57 of the 74 procedures (77%); 70% were major complications and 30% were minor. Complications were more common in adults. Bone healing index, days of treatment and fixator's time were univariate predictors of complications. Bone healing index and adult age were the only multivariate predictors of complications.

Conclusion: Adult age and bone healing index are the most important multivariate predictors of distraction osteogenesis-related complications. Routine follow-up after implant removal, selection of younger patients with minor risk factors and shorter fixator's time are necessary to reduce the rate of distraction osteogenesis-related complications.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Female
  • Fracture Fixation / statistics & numerical data
  • Fracture Healing / physiology
  • Humans
  • Leg Length Inequality / physiopathology
  • Leg Length Inequality / surgery*
  • Length of Stay
  • Male
  • Middle Aged
  • Osteogenesis, Distraction / adverse effects*
  • Retrospective Studies
  • Risk Factors
  • Young Adult