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MUSCULOSKELETAL SURGERY

, Volume 103, Issue 3, pp 257–262 | Cite as

Surgical technique and outcomes for bilateral humeral lengthening for achondroplasia: 26-year experience

  • I. Ginebreda
  • D. Campillo-RecioEmail author
  • C. Cárdenas
  • J. Tapiolas
  • P. Rovira
  • A. Isart
Original Article
  • 60 Downloads

Abstract

Background

Elongation in patients with achondroplasia provides better overall skeletal proportionality and significantly improves such individuals’ access to their perineal region to self-manage personal hygiene. This paper describes our surgical technique and outcomes for bilateral humeral lengthening in achondroplasia patients over 26 years.

Methods

Ours was a retrospective study of 55 patients with achondroplasia-related short stature, in whom bilateral humeral lengthening was performed from 1990 to 2016. We describe the surgical technique and analyze mean gain in humeral length, days using an external fixator, mean percentage of lengthening, external fixation index, type of callus, and complications. Pre- and postoperative radiographic measurements were obtained. Patients also were contacted by telephone and asked about their ability to perform peri-anal self-hygiene and about their overall satisfaction.

Results

In total, 110 humeri were lengthened (28 males and 27 females) with medium elongation of 9.5 cm on the right and 9.6 cm on the left, while averaging 220 days in an external fixator. We observed 14 minor complications. There was no significant association between pin position and type of callus, and elongation most often external and in the presence of a straight callus. Before elongation, 77.1% of patients reported difficulties with perineal hygiene and 85.4% could not put their hands in their pockets. Upon completion of lengthening, 100% could perform both tasks and 94.5% were very satisfied.

Conclusions

Bilateral humeral elongation yields significant improvements in patient autonomy, with a relatively low complication rate and very high patient satisfaction.

Keywords

Humeral lengthening Achondroplasia Surgical technique 

Notes

Funding

This research received no specific grants from any funding agency in the public, commercial, or not-for-profit sectors. Neither of the authors, their immediate family, nor any research foundation with which they are affiliated have received any financial payments or other benefits from any commercial entity related to the subject of this article.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Hospital ethics committee approval was obtained by the ‘Comité de Etica Asistencial Hospital Quiron Salud.’

Informed consent

Informed consent was obtained from parents/LAR of all participants included in the study.

References

  1. 1.
    Horton WA, Hall JG, Hecht JT (2007) Achondroplasia. Lancet Lond Engl 370(9582):162–172CrossRefGoogle Scholar
  2. 2.
    Kitoh H, Kitakoji T, Kurita K, Katoh M, Takamine Y (2002) Deformities of the elbow in achondroplasia. J Bone Joint Surg Br 84(5):680–683CrossRefGoogle Scholar
  3. 3.
    Damsin JP, Ghanem I (2000) Upper limb lengthening. Hand Clin 16(4):685–701PubMedGoogle Scholar
  4. 4.
    Kashiwagi N, Suzuki S, Seto Y, Futami T (2001) Bilateral humeral lengthening in achondroplasia. Clin Orthop 391:251–257CrossRefGoogle Scholar
  5. 5.
    Vilarrubias JM, Ginebreda I, Fernandez-Fairen M (1988) 500 cases of lower limb lengthening using a personal technic in achondroplasia. Acta Orthop Belg 54(4):384–390PubMedGoogle Scholar
  6. 6.
    Cai G, Yang L, Saleh M, Coulton L (2007) The effect of tibial diaphyseal lengthening on the longitudinal growth of the tibia. J Pediatr Orthop Part B 16(6):403–407CrossRefGoogle Scholar
  7. 7.
    Paley D (1988) Current techniques of limb lengthening. J Pediatr Orthop 8(1):73–92CrossRefGoogle Scholar
  8. 8.
    Cattaneo R, Villa A, Catagni M, Tentori L (1988) Strategies for limb lengthening in achondroplasia using the Ilizarov method–the experience of the hospital of Lecco, Italy. Basic Life Sci 48:381–388PubMedGoogle Scholar
  9. 9.
    Shadi M, Musielak B, Koczewski P, Janusz P (2018) Humeral lengthening in patients with achondroplasia and in patients with post-septic shortening: comparison of procedure efficiency and safety. Int Orthop 42(2):419–426CrossRefGoogle Scholar
  10. 10.
    Hamanishi C, Yasuwaki Y, Kikuchi H, Tanaka S, Tamura K (1992) Classification of the callus in limb lengthening. Radiographic study of 35 limbs. Acta Orthop Scand 63(4):430–433CrossRefGoogle Scholar
  11. 11.
    Paley D (1990) Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop 250:81–104Google Scholar
  12. 12.
    Yasui N, Kawabata H, Kojimoto H, Ohno H, Matsuda S, Araki N et al (1997) Lengthening of the lower limbs in patients with achondroplasia and hypochondroplasia. Clin Orthop 344:298–306CrossRefGoogle Scholar
  13. 13.
    Malot R, Park K-W, Song S-H, Kwon H-N, Song H-R (2013) Role of hybrid monolateral fixators in managing humeral length and deformity correction. Acta Orthop 84(3):280–285CrossRefGoogle Scholar
  14. 14.
    McLawhorn AS, Sherman SL, Blyakher A, Widmann RF (2011) Humeral lengthening and deformity correction with the multiaxial correction system. J Pediatr Orthop Part B 20(2):111–116CrossRefGoogle Scholar
  15. 15.
    Hosny GA (2016) Humeral lengthening and deformity correction. J Child Orthop 10(6):585–592CrossRefGoogle Scholar
  16. 16.
    Kim S-J, Agashe MV, Song S-H, Choi H-J, Lee H, Song H-R (2012) Comparison between upper and lower limb lengthening in patients with achondroplasia: a retrospective study. J Bone Joint Surg Br 94(1):128–133CrossRefGoogle Scholar
  17. 17.
    Nakano-Matsuoka N, Fukiage K, Harada Y, Kashiwagi N, Futami T (2017) The prevalence of the complications and their associated factors in humeral lengthening for achondroplasia: retrospective study of 54 cases. J Pediatr Orthop B 26(6):519–525CrossRefGoogle Scholar
  18. 18.
    Kiss S, Pap K, Vízkelety T, Terebessy T, Balla M, Szőke G (2008) The humerus is the best place for bone lengthening. Int Orthop 32(3):385–388CrossRefGoogle Scholar
  19. 19.
    Kitoh H, Mishima K, Matsushita M, Nishida Y, Ishiguro N (2014) Early and late fracture following extensive limb lengthening in patients with achondroplasia and hypochondroplasia. Bone Jt J 96–B(9):1269–1273CrossRefGoogle Scholar
  20. 20.
    Lee FY-I, Schoeb JS, Yu J, Christiansen BD, Dick HM (2005) Operative lengthening of the humerus: indications, benefits, and complications. J Pediatr Orthop 25(5):613–616CrossRefGoogle Scholar

Copyright information

© Istituto Ortopedico Rizzoli 2018

Authors and Affiliations

  1. 1.ICATMEHospital Universitari Quiron-DexeusBarcelonaSpain

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