Ваш регион

Москва

Wheeless' Textbook of Orthopaedics

Wheeless' Textbook of Orthopaedics

C.R. Wheeless MD


Limb Lengthening Fixators:

- Discussion of Limb Lengthening: - Distraction Histiogenesis: (osteoclasis): - Uniplanar Fixators: - see: EBI fixator - angular deformities are completely corrected in the OR; - osteotomy can be percutaneous using a Gigli saw which is passed percutaneously around the tibia (or femur), or can consist of a dome shaped osteotomy for deformities greater than 20 deg; - for tibia lengthening, a segment of the distal fibula must be removed; - referneces: Limb Lengthening and Correction of Angulation Deformity: Immediate Correction by Using a Unilateral Fixator. M. Kamegaya MD et al. Journal of Pediatric Orthopaedics. Vol 16. 1996. p 477-479. - Ring Fixator Technique: (see: Ilizarov technique) - bone transport: - use of oblique pulling wires decrease scarring of soft tissues; - transverse wires may be more useful for closing soft tissue defects; - bone may be transported over an IM nail which ensures proper direction of the transport and optimizes stability; - healing at the docking site may be facilitated by application of bone graft; - bone is lengthened at a rate of 1.0 to 1.5 mm per day. - gradual distraction allows the neurovascular bundle and muscles to lengthen safely; - note tethering effect of muscles: - lateral leg muscles tend to pull the distal fragment laterally, where as the posterior will tend to drag the distal fragment posteriorly; - to compensate, tilt the proximal ring in 5 deg of varus and in 5 deg of recurvatum; - osteotomy is performed at lower metaphyseal level for enhanced bone healing; - an insightful limb lengthening apparatus has been described by Brutscher et al. - only two rings (or points of fixation are required), one at each end of the bone; - at one side of the bone a metaphyseal corticotomy (or osteotomy) is made; - 3.5 mm cortical screws are inserted on opposite sides of the bone segment which is nearer the diaphysis; - two modified screws which contain a 1 mm hole thru the head are inserted thru opposite sides of the bone segment closer to the metaphyseal side; - two 0.5 mm wire are attached to the paired 3.5 mm cortical screws and are then passed thru the holes in the modified 3.5 mm screws, is passed out of the skin and is attached to a ratchet which is mounted on the external fixator; - the rachets allow controlled lengthening of 1 mm per day; - advantages: - this configuration allows an inexpensive fixator to be placed, with minimal need for transfixation wires; - references: Lengthening of the forearm by the Ilizarov technique. Limb lengthening in children using the Ilizarov method. Modern Techniques in Limb Lengthening--Symposium: Lengthening of the Forearm by the Ilizarov Technique. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Force and stiffness changes during Ilizarov leg lengthening. Lengthening of the humerus using the Ilizarov technique. Description of the method and report of 43 cases. Local Bone Transportation for Treatment of Intercalary Defects by the Ilizarov Technique: Biomechanical and Clinical Considerations. J. Aronson, E. Johnson, and JH Harp. CORR 243: 71, 1989. The Tension-Stress Effect on the Genesis and Growth of Tissues: II. The Influence of the Rate and Frequency of Distraction. Ilizarov-GA. Original Article: Clin Orthop. 1989 Feb. 239. pp 263-285. The use of the Ilizarov technique in the correction of limb deformities associated with skeletal dysplasia. DF Bell and MI Boyer. J. Pediatric Orthopaedics. Vol 12. 1992. p 283-290. Results of Tibial Lengthening with Ilizarov technique. DF Stanitski et al. J. Pediatric Orthopaedics. Vol 16. No 2. 1996. p 168. Cavitary osteomyelitis treated by fragmentary cortical bone transportation. J. Aronson. CORR. Vol 280. 1992. 153-159. Temporal and spatial increases in blood flow during distraction osteogenesis. J. Aronson. CORR. Vol 301. 1994. p 473-481. Treatment of infected non unions and segmental defects of the tibia by the method of Ilizarov. R. Cattaneo et al. CORR. Vol 280. 1992. 143-152. Large experimental segmental bone defects treated by bone transportation with monolateral external fixators. J. de Pablos et al. CORR. Vol 298. p 259-265, 1994. Biomechanical factors in the metaphyseal and diaphyseal lengthening osteotomy. An experimental and theoretic analysis in the ovine tibia. H. Steen et al. CORR. Vol 259. 1990. 282-294. The Role of Corticotomy and Osteotomy in the Treatment of Bone Defects Using the Ilizarov Technique. R. Brutscher, B.A. Rahn, A. Ruter, and S.M. Perren. J. Orthop. Trauma. 1993. Vol 7. No 3. p 261-269. Complications of limb lengthening. A learning curve. Factors affecting callus distraction in limb lengthening. Mechanical evaluation of external fixators used in limb lengthening. Current Techniques of Limb Lengthening. Paley, D. J. Pediatric Orthopaedics. 8: 73, 1988. Limb Lengthening and Correction of Angulation Deformity: Immediate Correction by Using a Unilateral Fixator. M. Kamegaya MD et al. Journal of Pediatric Orthopaedics. Vol 16. 1996. p 477-479. Technique: metaphyseal distraction for lower limb lengthening and correction of axial deformities. D Schlenzka. J. Pediatric Orthopaedics. Vol 10. 1990. p 202-205.
 
 
 
Задать вопрос
Самое популярное

Когда и как потерять девственность

Девственность и куриное яйцо. Какая между ними связь? А такая, что жители племени куаньяма, что живет на границе с Намибией, в древности лишали девочек девственности при помощи куриного яйца. Ненамно

Всё о температуре тела

Температура тела - комплексный показатель теплового состояния организма человека, отражающий сложные отношения между теплопродукцией (выработкой тепла) различных органов и тканей и теплообменом между

10 способов сбросить 5 кг

Небольшие изменения в питании и образе жизни помогут изменить ваш вес. Хотите сбросить лишние килограммы? Не переживайте, вам не придется морить себя голодом или делать изнурительные упражнения. Иссл

О насНаши клиентыРеклама медицинских центровМаркетинг для салонов красоты и SPA
Рейтинг Nedug.Ru - клиники Москвы, клиники Петербурга
© 2000-2016 Nedug.Ru. Информация на этом сайте не призвана заменить профессиональное медицинское обслуживание, консультации и диагностику. Если вы обнаружили у себя симптомы болезни или плохо себя чувствуете, то необходимо обратиться к врачу для получения дополнительных рекомендаций и лечения. Все замечания, пожелания и предложения присылайте на [email protected]