Clinical evaluation of patients submitted to osteogenic distraction in the lower limb at a university hospital

Sampaio, Francisco Macruz Baltazar; Marçal, Leilane Passoni; Reis, Diogo Gontijo dos; Kasuo, Adolfo Watanabe; Fraga, Carlos Eduardo Cabral; Moraes, Frederico Barra de

doi:10.1016/j.rboe.2016.08.010

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ORIGINAL ARTICLES • Rev. bras. ortop. 51 (05) • Sep-Oct 2016 • https://doi.org/10.1016/j.rboe.2016.08.010 copy

Clinical evaluation of patients submitted to osteogenic distraction in the lower limb at a university hospital^☆ ☆ Study conducted at the Department of Orthopedics and Traumatology, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, GO, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

To evaluate the clinical characteristics from patients submitted to osteogenic distraction to correct bone gap at a university hospital.

METHODS:

Retrospective transversal study, with a convenience sample, from 2000 to 2012, evaluating clinical aspects of patients treated, submitted to osteogenic distraction (bone transport) with Ilizarov's external fixation device. The chi-squared, Fisher's, and Mann-Whitney's U tests were used with a 5% level of significance (p < 0.05).

RESULTS:

33 patients were studied, of whom 28 men (84.8%). The more frequent age was from 21 to 40 years. Most patients were from the metropolitan region of the capital (57.6%). The leg was the most affected limb (75.8%), and the left side was the most affected (66.7%). The most common cause was infected pseudoarthrosis (75.8%). The most common bone transportation type was bifocal (75.8%). Mean previous surgery at others institutions were 2.62 (1.93 standard deviation), and mean surgeries after treatment were 1.89 (1.29 standard deviation). Ilizarov's external fixation device was used for 1.94 years (1.34 mean deviation), from one to six years. The most common complications were pin infection (57.6%), equinus (30.3%), deep infection (24.2%), and shortening (21.2%).

CONCLUSION:

Osteogenic distraction for bone gaps were more frequent in young adults, men, in the leg, with bifocal transportation, after several previous surgeries, treated for a mean of two years, with many complications (infections were the most common).

Keywords:
Pseudoarthrosis; Osteogenesis, distraction; Ilizarov technique

Factor	n	%
Age
10–20^a	5	15.2
21–40^a	17	51.5
41–60^a	9	27.3
>60^a	2	6.1
Total	33	100.0

Origin
Greater Goiânia	19	57.6
Countryside Goiás	12	36.4
Other states	2	6.1
Total	33	100.0

Sex
Male	28	84.8
Female	5	15.2
Total	33	100.0

Topography
Femur	6	18.2
Tibia	25	75.8
Tibia and femur	2	6.1
Total	33	100.0

Side
Right	11	33.3
Left	22	66.7
Total	33	100.0

Causes
Congenital diseases	1	3.0
Tumor	2	6.1
Infected pseudoarthrosis	25	75.8
Non-infected pseudarthrosis	4	12.1
Chronic osteomyelitis	1	3.0
Total	33	100.0

Type of transport
Bifocal	25	75.8
Trifocal convergent	6	18.2
Trifocal tandem bone transport	2	6.1
Total	33	100.0

Factor	n	Mean	SD	Min	Max
Number of prior surgeries	29	2.62	1.93	1	10
Number of revisions	28	1.89	1.29	1	6

Factor	n	%
Complications
1. Screw infection	19	57.6
2. Deep infection	8	24.2
3. Equinus	10	30.3
4. Knee flexion	2	6.1
5. ROM limitation	1	3.0
6. Axial deviation	6	18.2
7. Repeated fracture	1	3.0
8. Amputation or disarticulation	3	9.1
9. Shortening	7	21.2
10. Soft tissue impingement	2	6.1
11. Others	5	15.2

Factor	n	%
Complication 1
No	12	36.4
Yes	21	63.6
Total	33	100.0

Complication 2
No	13	39.4
Yes	20	60.6
Total	33	100.0

Complication 3
No	29	87.9
Yes	4	12.1
Total	33	100.0

Complications	Complication 1		p	Complication 2		p	Complication 3		p
	n	%		n	%		n	%
Age
10–20ª	4	19.0		4	20.0		0	0.0
21–40ª	10	47.6		11	55.0		3	75.0
41–60ª	6	28.6		4	20.0		1	25.0
>60ª	1	4.8		1	5.0		0	0.0
Total	21	100.0	0.815	20	100.0	0.575	4	100.0	0.691

Origin
Greater Goiânia	16	76.2		12	60.0		1	25.0
Countryside Goiás	5	23.8		7	35.0		3	75.0
Other states^b	0	0.0		1	5.0		0	0.0
Total	21	100.0	0.009	20	100.0	0.918	4	100.0	0.225

Sex
Male	19	90.5		16	80.0		3	75.0
Female	2	9.5		4	20.0		1	25.0
Total	21	100.0	0.328	20	100.0	0.625	4	100.0	0.500^a

Topography
Femur	4	19.0		3	15.0		2	50.0
Tibia	15	71.4		16	80.0		2	50.0
35 + 41.16	2	9.5		1	5.0		0	0.0
Total	21	100.0	0.520	20	100.0	0.780	4	100.0	0.201

Side
Right	8	38.1		7	35.0		1	25.0
Left	13	61.9		13	65.0		3	75.0
Total	21	100.0	0.703	20	100.0	1.000	4	100.0	1.000^a

Causes
Congenital diseases	1	4.8		1	5.0		0	0.0
Tumor	1	4.8		2	10.0		0	0.0
Infected pseudoarthrosis	15	71.4		13	65.0		3	75.0
Non-infected pseudarthrosis	3	14.3		3	15.0		1	25.0
Chronic osteomyelitis	1	4.8		1	5.0		0	0.0
Total	21	100.0	0.796	20	100.0	0.445	4	100.0	0.882

Type of transport
Bifocal	15	71.4		14	70.0		4	100.0
Trifocal convergent	5	23.8		5	25.0		0	0.0
Trifocal tandem bone transport	1	4.8		1	5.0		0	0.0
Total	21	100.0	0.520	20	100.0	0.446	4	100.0	0.483

class

	Mean	Median	p	Mean	Median	p	Mean	Median	p
Number of prior surgeries	2.84	2.0	0.599	2.88	2.0	0.368	3.50	4.0	0.041^b
Number of revision surgeries	2.11	1.00	0.362	2.11	1.00	0.362	2.0	2.0	0.544^b
Time of use	2.33	2.0	0.12	2.15	2.0	0.263	2.25	1.00	0.549^b

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] * Corresponding author. E-mail: frederico barra@yahoo.com.br(F.B. Moraes).

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Clinical evaluation of patients submitted to osteogenic distraction in the lower limb at a university hospital☆ ☆ Study conducted at the Department of Orthopedics and Traumatology, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, GO, Brazil.

ABSTRACT

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Clinical evaluation of patients submitted to osteogenic distraction in the lower limb at a university hospital^☆ ☆ Study conducted at the Department of Orthopedics and Traumatology, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, GO, Brazil.