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Early and late fracture following extensive limb lengthening in patients with achondroplasia and hypochondroplasia.
[achondroplasia]
Two
types
of
fracture
,
early
and
late
,
have
been
reported
following
limb
lengthening
in
patients
with
achondroplasia
(
ACH
)
and
hypochondroplasia
(
HCH
)
.
We
reviewed
25
patients
with
these
conditions
who
underwent
72
segmental
limb
lengthening
procedures
involving
the
femur
and
/
or
tibia
,
between
2003
and
2011
.
Gender
,
age
at
surgery
,
lengthened
segment
,
body
mass
index
,
the
shape
of
the
callus
,
the
amount
and
percentage
of
lengthening
and
the
healing
index
were
evaluated
to
determine
predictive
factors
for
the
occurrence
of
early
(
within
three
weeks
after
removal
of
the
fixation
pins
)
and
late
fracture
(
>
three
weeks
after
removal
of
the
pins
)
.
The
Mann‑
Whitney
U
test
and
Pearson
's
chi
-squared
test
for
univariate
analysis
and
stepwise
regression
model
for
multivariate
analysis
were
used
to
identify
the
predictive
factor
for
each
fracture
.
Only
one
patient
(
two
tibiae
)
was
excluded
from
the
analysis
due
to
excessively
slow
formation
of
the
regenerate
,
which
required
supplementary
measures
.
A
total
of
24
patients
with
70
limbs
were
included
in
the
study
.
There
were
11
early
fractures
in
eight
patients
.
The
shape
of
the
callus
(
lateral
or
central
callus
)
was
the
only
statistical
variable
related
to
the
occurrence
of
early
fracture
in
univariate
and
multivariate
analyses
.
Late
fracture
was
observed
in
six
limbs
and
the
mean
time
between
removal
of
the
fixation
pins
and
fracture
was
18
.
3
weeks
(
3
.
3
to
38
.
4
)
.
Lengthening
of
the
tibia
,
larger
healing
index
,
and
lateral
or
central
callus
were
related
to
the
occurrence
of
a
late
fracture
in
univariate
analysis
.
A
multivariate
analysis
demonstrated
that
the
shape
of
the
callus
was
the
strongest
predictor
for
late
fracture
(
odds
ratio
:
19
.
3
,
95
%
confidence
interval
:
2
.
91
to
128
)
.
Lateral
or
central
callus
had
a
significantly
larger
risk
of
fracture
than
fusiform
,
cylindrical
,
or
concave
callus
.
Radiological
monitoring
of
the
shape
of
the
callus
during
distraction
is
important
to
prevent
early
and
late
fracture
of
lengthened
limbs
in
patients
with
ACH
or
HCH
.
In
patients
with
thin
callus
formation
,
some
measures
to
stimulate
bone
formation
should
be
considered
as
early
as
possible
.
Diseases
Validation
Diseases presenting
"late fracture in univariate"
symptom
achondroplasia
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