Staged upper and lower limb lengthening performing bilateral simultaneous surgery of the femur and tibia in achondroplas
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ORTHOPAEDIC SURGERY
Staged upper and lower limb lengthening performing bilateral simultaneous surgery of the femur and tibia in achondroplastic patients Antonio Leiva‑Gea1 · Francisco Borja Delgado‑Rufino1 · Alfonso Queipo‑de‑Llano1 · Jorge Mariscal‑Lara1 · Maximiano Lombardo‑Torre1 · Felipe Luna‑González1 Received: 6 August 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction Surgical lengthening and angular correction of the limbs are an option for treating the orthopedic clinical manifestations in patients with achondroplasia. This study assesses a staged limb lengthening protocol, performing simultaneous bilateral lengthening of the femur and tibia (stage I [S1]), and humeral lengthening (stage II [S2]). Materials and methods Twenty-one achondroplastic patients were included in this study, and 106 segments (34 femurs, 34 tibias and 38 humeri) were lengthened. Achondroplasia patients with a growth curve below the mean of the standard growth curves for achondroplasia were included in S1. The remaining patients were included directly in S2. Variables analyzed included anthropometric measurements, lengthening outcomes, difficulties, and functionality. Results Of the all patients included in the protocol, 15 patients completed S1 and S2, 4 only completed S2, and 2 only completed S1. Height and limb–trunk ratio before S1 were 107.65 ± 7.14 cm and 1.89 ± 0.10 and after S1 were 126.50 ± 9.19 cm and 1.64 ± 0.09, respectively. Limbs were lengthened 14.43 ± 1.41 cm (femurs and tibias) for S1 and 9.95 ± 0.60 cm for S2 (humeri), with a stage healing index of 18.23 ± 3.54 in S1 and 28.92 ± 4.42 in S2. Correction of lower angular deviations, functional improvement, and a controlled complications rate were achieved in all patients. Conclusions The limb lengthening protocol proposed in this study is a suitable treatment for achondroplasia patients to achieve the agreed-upon objectives (limb–trunk ratio, improved functionality, and lower limb alignment). The reproducibility of the procedure and patient safety were upheld. Keywords Achondroplasia · Lower limb lengthening · Humeral lengthening · External fixator
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00402-020-03360-3) contains supplementary material, which is available to authorized users.
Orthopedic clinical manifestations can arise in achondroplasia patients during their lifetime. Notable manifestations include angular deformity of the lower limbs, and proximal (rhizomelic) shortening of the upper and lower limbs [1]. Shortened limbs result in disproportion between the trunk and the limbs [2], with final mean height in achondroplasia
* Antonio Leiva‑Gea [email protected]
Maximiano Lombardo‑Torre [email protected]
Francisco Borja Delgado‑Rufino [email protected]
Felipe Luna‑González [email protected]
Alfonso Queipo‑de‑Llano [email protected]
1
Jorge Mariscal‑Lara [email protected]
Servicio de Cirugía Ortopédica y T
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