Top

Published in:

01-02-2010 |

Noninvasive Quantitative Assessment of Bone Healing After Distraction Osteogenesis

Authors: Oladapo M. Babatunde, M.D., Austin T. Fragomen, M.D., S. Robert Rozbruch, M.D.

Published in: HSS Journal ® | Issue 1/2010

Abstract

One of the greatest challenges of limb lengthening and deformity correction is deciding when the bone has healed enough to remove the external fixator. Standard radiography is the most common imaging method used to assess bone healing after distraction osteogenesis because it is widely available, cheap, and relatively safe. However, other imaging technologies and methods are being investigated that will help quantify bone healing after distraction osteogenesis, providing an objective method for deciding when it is appropriate to remove an external fixator. This review will examine the latest techniques used to assess bone healing after distraction osteogenesis including dual-energy X-ray absorptiometry scans, ultrasound, quantitative computed tomography, and digital radiography (X-ray). Recommendations for clinical practice will be outlined.

Codivilla A (1994) On the means of lengthening, in the lower limbs, the muscles and tissues which are shortened through deformity. 1904. Clin. Orthop. Relat. Res 301:4–9PubMed

Bertram C, Nielander KH, Konig DP (1999) Pioneers in the lengthening of the extremities. Chirurg 70 no. 11, 1374–1378CrossRefPubMed

Birch JG, Samchukov ML (2004) Use of the Ilizarov method to correct lower limb deformities in children and adolescents. J. Am. Acad. Orthop. Surg. 12 no. 3, 144–154PubMed

Fragomen AT, Rozbruch SR (2007) The mechanics of external fixation. HSS J. 3 no. 1, 13–29CrossRefPubMed

Marsh DR, Shah S, Elliott J, Kurdy N (1997) The Ilizarov method in nonunion, malunion and infection of fractures. J. Bone Jt. Surg. Br. 79 no. 2, 273–279CrossRef

Paley D, Herzenberg JE, Paremain G, Bhave A (1997) Femoral lengthening over an intramedullary nail. A matched-case comparison with Ilizarov femoral lengthening. J. Bone Jt. Surg. Am. 79 no. 10, 1464–1480

Velazquez RJ, Bell DF, Armstrong PF, Babyn P, Tibshirani R (1993) Complications of use of the Ilizarov technique in the correction of limb deformities in children. J. Bone Jt. Surg. Am 75 no. 8, 1148–1156

Cattermole HC, Cook JE, Fordham JN, Muckle DS, Cunningham JL (1997) Bone mineral changes during tibial fracture healing. Clin. Orthop. Relat. Res 339:190–196CrossRefPubMed

Garcia-Cimbrelo E, Olsen B, Ruiz-Yague M, Fernandez-Baillo N, Munuera-Martinez L (1992) Ilizarov technique. Results and difficulties. Clin. Orthop. Relat. Res. 283:116–123PubMed

10.

Eldridge JC, Bell DF (1991) Problems with substantial limb lengthening. Orthop. Clin. North Am. 22 no. 4, 625–631PubMed

11.

Ghoneem HF, Wright JG, Cole WG, Rang M (1996) The Ilizarov method for correction of complex deformities. Psychological and functional outcomes. J. Bone Jt. Surg. Am. 78 no. 10, 1480–1485

12.

Ilizarov GA (1990) Clinical application of the tension-stress effect for limb lengthening. Clin. Orthop. Relat. Res. 250:8–26PubMed

13.

Rozbruch SR, Kleinman D, Fragomen AT, Ilizarov S (2008) Limb lengthening and then insertion of an intramedullary nail: a case-matched comparison. Clin. Orthop. Relat. Res. 466:2923–2932CrossRefPubMed

14.

Dinah AF (2004) Predicting duration of Ilizarov frame treatment for tibial lengthening. Bone 34 no. 5, 845–848CrossRefPubMed

15.

Fischgrund J, Paley D, Suter C (1994) Variables affecting time to bone healing during limb lengthening. Clin. Orthop. Relat. Res. 301:31–37PubMed

16.

Anand A, Feldman DS, Patel RJ, Lehman WB, Bosse HJvan, Badra MI, Sala DA (2006) Interobserver and intraobserver reliability of radiographic evidence of bone healing at osteotomy sites. J. Pediatr. Orthop. B. 15 no. 4, 271–272PubMed

17.

Starr KA, Fillman R, Raney EM (2004) Reliability of radiographic assessment of distraction osteogenesis site. J. Pediatr. Orthop. 24 no. 1, 26–29PubMed

18.

Dahl MT, Gulli B, Berg T (1994) Complications of limb lengthening. A learning curve. Clin. Orthop. Relat. Res. 301:10–18PubMed

19.

Danziger MB, Kumar A, DeWeese J (1995) Fractures after femoral lengthening using the Ilizarov method. J. Pediatr. Orthop. 15 no. 2, 220–223PubMed

20.

Simpson AH, Kenwright J (2000) Fracture after distraction osteogenesis. J. Bone Jt. Surg. Br. 82 no. 5, 659–665CrossRef

21.

Aquerreta JD, Forriol F, Canadell J (1994) Complications of bone lengthening. Int. Orthop. 18 no. 5, 299–303CrossRefPubMed

22.

Forriol F, Iglesias A, Arias M, Aquerreta D, Canadell J (1999) Relationship between radiologic morphology of the bone lengthening formation and its complications. J. Pediatr. Orthop. B. 8 no. 4, 292–298CrossRefPubMed

23.

Dwyer JS, Owen PJ, Evans GA, Kuiper JH, Richardson JB (1996) Stiffness measurements to assess healing during leg lengthening. A preliminary report. J. Bone Jt. Surg. Br. 78 no. 2, 286–289

24.

Richardson JB, Cunningham JL, Goodship AE, O’Connor BT, Kenwright J (1994) Measuring stiffness can define healing of tibial fractures. J. Bone Jt. Surg. Br. 76 no. 3, 389–394

25.

Reichel H, Lebek S, Alter C, Hein W (1998) Biomechanical and densitometric bone properties after callus distraction in sheep. Clin. Orthop. Relat. Res. 357:237–246CrossRefPubMed

26.

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 no. 4, 430–433PubMed

27.

Tselentakis G, Owen PJ, Richardson JB, Kuiper JH, Haddaway MJ, Dwyer JS, Evans GA (2001) Fracture stiffness in callotasis determined by dual-energy X-ray absorptiometry scanning. J. Pediatr. Orthop. B. 10 no. 3, 248–254CrossRefPubMed

28.

Chotel F, Braillon P, Sailhan F, Gadeyne S, Gellon JO, Panczer G, Pedrini C, Berard J (2008) Bone stiffness in children: Part II. Objectives criteria for children to assess healing during leg lengthening. J. Pediatr. Orthop 28 no. 5, 538–543PubMed

29.

Eyres KS, Bell MJ, Kanis JA (1993) Methods of assessing new bone formation during limb lengthening. Ultrasonography, dual energy X-ray absorptiometry and radiography compared. J. Bone Jt. Surg. Br. 75 no. 3, 358–364

30.

Eyres KS, Bell MJ, Kanis JA (1993) New bone formation during leg lengthening: evaluated by dual energy X-ray absorptiometry. J. Bone Jt. Surg. Br. 75 no. 1, 96–106

31.

Maffulli N, Cheng JC, Sher A, Lam TP (1997) Dual-energy X-ray absorptiometry predicts bone formation in lower limb callotasis lengthening. Ann. R. Coll. Surg. Engl. 79 no. 4, 250–256PubMed

32.

Reiter A, Sabo D, Pfeil J, Cotta H (1997) Quantitative assessment of callus distraction using dual energy X-ray absorptiometry. Int. Orthop. 21 no. 1, 35–40CrossRefPubMed

33.

Saran N, Hamdy RC (2008) DEXA as a predictor of fixator removal in distraction osteogenesis. Clin. Orthop. Relat. Res. 466:2955–2961CrossRefPubMed

34.

Braillon P, Chotel F, Berard J (2008) Limb lengthening: contribution of dual energy X-ray absorptiometry. J. Musculoskelet. Neuronal. Interact. 8 no. 1, 32PubMed

35.

Young JW, Kostrubiak IS, Resnik CS, Paley D (1990) Sonographic evaluation of bone production at the distraction site in Ilizarov limb-lengthening procedures. AJR. Am. J. Roentgenol. 154 no. 1, 125–128PubMed

36.

Bail HJ, Kolbeck S, Krummrey G, Weiler A, Windhagen HJ, Hennies K, Raun K, Raschke MJ (2002) Ultrasound can predict regenerate stiffness in distraction osteogenesis. Clin. Orthop. Relat. Res. 404:362–367CrossRefPubMed

37.

Markel MD, Chao EY (1993) Noninvasive monitoring techniques for quantitative description of callus mineral content and mechanical properties. Clin. Orthop. Relat. Res. 293:37–45PubMed

38.

Markel MD, Wikenheiser MA, Morin RL, Lewallen DG, Chao EY (1990) Quantification of bone healing. Comparison of QCT, SPA, MRI, and DEXA in dog osteotomies. Acta Orthop. Scand. 61 no. 6, 487–498PubMedCrossRef

39.

Markel MD, Morin RL, Wikenheiser MA, Robb RA, Chao EY (1991) Multiplanar quantitative computed tomography for bone mineral analysis in dogs. Am. J. Vet. Res. 52 no. 9, 1479–1483PubMed

40.

Markel MD, Morin RL, Wikenheiser MA, Lewallen DG, Chao EY (1991) Quantitative CT for the evaluation of bone healing. Calcif. Tissue Int. 49 no. 6, 427–432CrossRefPubMed

41.

Harp JH, Aronson J, Hollis M (1994) Noninvasive determination of bone stiffness for distraction osteogenesis by quantitative computed tomography scans. Clin. Orthop. Relat. Res. 301:42–48PubMed

42.

Aronson J, Shin HD (2003) Imaging techniques for bone regenerate analysis during distraction osteogenesis. J. Pediatr. Orthop. 23 no. 4, 550–560CrossRefPubMed

43.

Skaggs DL, Leet AI, Money MD, Shaw BA, Hale JM, Tolo VT (1999) Secondary fractures associated with external fixation in pediatric femur fractures. J. Pediatr. Orthop. 19 no. 5, 582–586CrossRefPubMed

44.

Kolbeck S, Bail H, Weiler A, Windhagen H, Haas N, Raschke M (1999) Digital radiography. A predictor of regenerate bone stiffness in distraction osteogenesis. Clin. Orthop. Relat. Res. 366:221–228CrossRefPubMed

45.

Hazra S, Song HR, Biswal S, Lee SH, Lee SH, Jang KM, Modi HN (2008) Quantitative assessment of mineralization in distraction osteogenesis. Skelet. Radiol. 37 no. 9, 843–847CrossRef

Title: Noninvasive Quantitative Assessment of Bone Healing After Distraction Osteogenesis
Authors: Oladapo M. Babatunde, M.D.
Austin T. Fragomen, M.D.
S. Robert Rozbruch, M.D.
Publication date: 01-02-2010
Publisher: Springer-Verlag
Published in: HSS Journal ® / Issue 1/2010
Print ISSN: 1556-3316
Electronic ISSN: 1556-3324
DOI: https://doi.org/10.1007/s11420-009-9130-y

At a glance: The STEP trials

Springer Medicine

Noninvasive Quantitative Assessment of Bone Healing After Distraction Osteogenesis

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2010

Musculocutaneous Neuropathy: Case Report and Discussion

Posterior Ankle Impingement: Clarification and Confirmation of the Pathoanatomy

Nonoperative Management of Complete Lateral Elbow Ligamentous Disruption in an NFL Player: A Case Report

Detection of Pulmonary Embolism in the Postoperative Orthopedic Patient Using Spiral CT Scans

Creation of a Novel Recuperative Pain Medicine Service to Optimize Postoperative Analgesia and Enhance Patient Satisfaction

Musculoskeletal Complications of Hemophilia