Forearm lengthening using Ilizarov external fixator
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ORIGINAL ARTICLE
Forearm lengthening using Ilizarov external fixator Kamal El-Gafary & Wael El-adly
Received: 27 March 2012 / Accepted: 9 January 2013 # EFORT 2013
Abstract Background We present our experience with forearm lengthening using Ilizarov external fixator in cases of length discrepancies between radius and ulna and forearm–wrist deformity that occurred duo to different causes. Methods Twelve patients were treated by Ilizarov external fixator between 2008 and 2010 with a mean age of 10 years. There were seven males and five females. The etiology was Madelung’s deformity in seven patients, multiple cartilaginous exostosis in three patients, post-traumatic growth arrest of distal radius epiphysis in one patient, and chronic osteomyelitis of radius in one patient. The length discrepancy ranged from 1 to 4 cm (mean 2.2 cm). Lengthening of radius was done in nine patients and lengthening of ulna in three patients. The mean of follow-up period was 2 years. Results At follow-up, all patients were satisfied with the functional and cosmetic results. There was an improvement in pain and range of motion .The mean length gained was 2.2 cm and the mean healing index was 43.7 days/cm. Conclusions Lengthening of short forearm is functionally, cosmetically, and psychologically beneficial. The Ilizarov method is a reliable, successful, and safe method, and it is the gold standard to treat forearm length discrepancy and deformity problems preserving a satisfactory function of upper limb during treatment. Keywords Forearm lengthening . Ilizarov external fixator . Madelung’s deformity . Multiple cartilaginous exostosis
Introduction
forearm has rarely been performed for shortening of the forearm and is usually performed for discrepancies in lengths between the radius and ulna and forearm–wrist deformity [1]. Forearm deformities with upper limb discrepancy include several congenital and acquired pathologies that require lengthening, practically divided into six categories [1] (Table 1). Clinical examples are radial club hand, Madelung’s deformity, multiple cartilaginous exostosis, and post-traumatic epiphyseal growth arrest. Conservative methods of treatment are ineffective and do not prevent progression of the deformity [2]. A number of surgical techniques have been developed [3–9], Dobyns et al. [3] divided these into three broad groups: those applied to the radius such as epiphysiodesis, corrective osteotomy, and physiolysis; those applied to the ulna such as epiphysiodesis, excision of the head, shortening osteotomy, and creation of pseudarthrosis with or without fusion of the radius; and combined techniques in which both bones are dealt with usually by one or other of the above methods. Some of the more ablative procedures, however, have given rise to long-term problems [10]. The use of Ilizarov external fixator has enabled correction of limb length discrepancy as well as deformity in all of the limb segments; this technique of lengthening relies on bone regeneration rather than bone grafting [11, 12]. The specific c
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