1. Reaching Greater Heights: Limb Lengthening
By Julie An

2. Purpose
Internship
Research Question
Primary Research
Future Plans

3. Internship Julie An, Howard High School
Potomac Valley Orthopaedic Association in Columbia
Dr. Daniel Tang

4. Internship Observed clinical sessions with patients Observed surgeries
Learned it is not just about medicine

5. Research Question
How are different limb lengthening techniques effective in correcting bone discrepancies and abnormalities?

6. Hypothesis
The PRECICE technique is most effective out of LATN and Ilizarov techniques in correcting bone discrepancies and deformities.

7. Limb Lengthening
Implemented to fix various bone abnormalities

8. Growth of New Bone New bone develops in between the gap

9. Angular deformity
Before
After

10. Tibial Non-union
Before
After

11. Primary Research Meta-analysis of PubMed articles
Created a chart to record data
Observed that PRECICE method had less complications compared to other methods
Final conclusion:
PRECICE = lengthening
Ilizarov = angular deformity

12. Primary Research Article # Etiology # Cases Average Age
Avg. Preoperative Discrepancy
Avg. Length Achieved (cm)
BHI (months/cm)
Retro/Pros
Method
Complications
Function
ROM
Time to Full Weight Bearing
Avg. Length of Follow Up (months)
congenital skeletal dysplasia longitudinal reduction defects idiopathic shortening posttraumatic condition previous infection previous resection post-tumor resection 19 20
3.7316
3.6947
Retro
PRECICE
6 need ECR adjustment 3 patients with complications -nail breakage of welding seam during consolidation period; required exchange nailing (1) 3
trauma polio 6
21.67
4.5 ( )
PHENIX
2 early arrest of distraction 1 acute pain, paralysis, paraesthesia
26.18 days/cm
7.3 (3-11)
Growth arrest after arthritis Growth arrest after fracture Congenital 15
12.27
4.9 ( )
Ilizarov
Pin tract infection delayed union hypaesthesia fracture
2 persistant knee stiffness
41.27 (15-99)
14 congenital short femur 9 proximal femoral focal deficiency 1 Russell-Silver syndrome 1 spondyloepiphyseal dysplasia 8 physeal arrest 3 enchondromatosis 1 fracture with shortening 37
11.6 (8.1-17)
7 (3-11.4) 20.4% of preoperative length
LON
13 patients -4 limbs failed to lengthen initally -3 fractures -2 nail failures -4 deep infections -2 joint sublaxations requiring operative care
full function in 94% of patients
68 (15-148)
congenital abnormality 59
4.8 ±0.16 ( 2-8)
26.3 ± 1.22 days/cm
4.5 +/- .2 years 24
32 (16-37)
2.8 (0-7)
4.4 (1.5-8)
ISKD
posttraumatic shortening 11
33 ± 7
3.6 ± 1.7
4 runaway nail 2 difficult-to-distract nail 3 poor bone regenerate
41.3
3.1
2.1
Taylor Spatial Frame LAP
1 knee stiffness 45
41.1
3.2
2.2
Classic
1 regenerate collaspe 2 pin site infection 3 knee stiffness
Knee Preop: Extension: -1.7 ° Flexion: ° Postop: E: -.1 ° F: 127 °
80.4

13. Future Plans
UMBC
Biology major
Medical school

14. Reference http://www.limblengthening.com/beforeafter.html
/limb-lengthening-booklet.pdf
ray2.jpg