case presentation: distraction osteogensis · distraction osteogenesis intercalary transport • a...
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Case Presentation:Distraction
OsteogensisDan Hampton, M.D.
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20 year old male presents with right hand amputation after meat grinder accident in a commercial meat processing plant.
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Initial image at presentation
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Hand surgically reattached POD 6
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POD 11
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Distraction Osteogenesis
Gavriil Abramovich Ilizarov
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Ilizarov Technique
• Osteotomy created that preserves periosteum as much as possible
• Proximal and distal fixation blocks typically secured with some combination ring fixators, wires, and/or pins
• Distraction is slow, with approximately 0.5mm of separation per day
• Two basic types
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Distraction Osteogenesis
Intercalary Transport • A bone fragment is moved from
the proximal fixation site to the distal docking site (or vice versa)
• Does not lengthen the soft tissues
• Proximal fixation block and distal fixation block are stationary
• Useful for complex fractures with devitalized bone
Non-intercalary Transport
• The distal fixation block is moved relative to the proximal fixation block
• Stretches soft tissue and results in lengthening of the extremity
• Can apply tension in reverse direction to treat non-union
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Intercalary Transport
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POD 11 POD 39POD 25 POD 53
Non-Intercalary Transport
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POD 53
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Complications
Tresley J, Schoenleber SJ, Singer AD, Clifford P. Skeletal Radiol Skeletal Radiology 44.2 (2014): 179-95
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Complications
Tresley J, Schoenleber SJ, Singer AD, Clifford P. Skeletal Radiol Skeletal Radiology 44.2 (2014): 179-95
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Additional Complications
• Infection• Nonunion at docking site• Over lengthening• Soft tissue injury, particularly with lengthening
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References
Tresley J, Schoenleber SJ, Singer AD, Clifford P. “Ilizarov” External Fixation: What the Radiologist Needs to Know. Skeletal Radiol Skeletal Radiology 44.2. 2015. 179-95.
Murray JH, Fitch RD. Distraction histiogenesis: principles and indications. J Am Acad Orthop Surg. 1996;4(6):317–27.