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Fracture following lower limb lengthening in children: a series of 58 patients.
[achondroplasia]
Fracture
is
one
of
the
main
complications
following
external
fixator
removal
used
in
cases
of
progressive
lower
limb
lengthening
;
rates
as
high
as
50
%
are
found
in
the
literature
.
The
aim
of
this
study
was
to
determine
the
factors
influencing
this
complication
.
One
hundred
and
eleven
cases
of
lower
limb
lengthening
were
performed
in
58
patients
(
40
femurs
and
71
tibias
)
.
The
mean
age
at
surgery
was
10
.
1
years
old
.
Lengthening
was
performed
in
all
cases
with
an
external
fixator
alone
,
associated
in
39
.
6
%
of
cases
with
intramedullary
nailing
.
The
patients
were
divided
into
three
groups
according
to
disease
etiology
(
congenital
,
achondroplasia
and
other
)
.
The
fractures
were
classified
according
to
the
Simpson
classification
.
Twenty
fractures
were
recorded
(
18
%
)
.
Sixteen
fractures
were
found
in
patients
with
congenital
disease
,
four
with
achondroplasia
and
none
in
the
group
of
other
etiologies
.
The
fracture
was
more
often
in
the
femur
(
27
.
5
%
)
than
in
the
tibia
(
12
.
7
%
)
.
The
rate
of
fracture
is
influenced
by
different
factors
depending
on
the
etiology
of
disease
.
In
congenital
diseases
,
the
fracture
rate
is
higher
when
there
is
lengthening
of
more
than
15
%
of
the
initial
length
and
a
delay
between
surgery
and
the
beginning
of
lengthening
of
less
than
7
days
.
In
patients
with
achondroplasia
,
the
influence
of
a
relative
percentage
of
lengthening
is
less
important
than
in
those
with
congenital
disease
.
However
,
to
avoid
fractures
,
lengthening
should
not
be
started
in
children
under
the
age
of
nine
.
Moreover
,
lengthening
should
begin
at
least
7
days
after
the
fixator
has
been
placed
.
Retrospective
.
Level
IV
.
Diseases
Validation
Diseases presenting
"congenital disease"
symptom
achondroplasia
coats disease
congenital toxoplasmosis
dentin dysplasia
hirschsprung disease
holt-oram syndrome
homocystinuria without methylmalonic aciduria
lamellar ichthyosis
megacystis-microcolon-intestinal hypoperistalsis syndrome
oligodontia
omenn syndrome
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