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ADVERSE EVENTS IN LIMB LENGTHENING

Author: Dimitrios Giotikas MD, PhD

Any medical intervention has some potential adverse events. It is the duty of the treating doctor to inform their patients about any risks related to their treatment in order to help them make informed decisions about their body and well being. In the context of limb lengthening we divide the adverse events into problems, obstacles and complications.

“Problems” are events that can be managed relatively easily and without the need of surgery.

“Obstacles” are temporary events that require further surgical intreventions to be managed, but are resolved before the completion of the treatment, without leaving long-term consequences.

“Complications” are events that remain after the completion of  treatment and cause long -term or even permanent consequences.

Non-union

Malunion

Deep Vein Thrombosis and Pulmonary Embolism (Blood clots)

The Anaesthetist will make sure that no problems which could disturb the anaesthesia will arise, or will preempt any potential issues. He will also determine which type of anaesthesia and post-operative pain management would be right for each patient.
​The surgery can be done with general anaesthesia (fully asleep) or regional (spinal, epidural anaesthesia with the patient awake.) This is anaesthetist’s decision, but if you have any preference you are encouraged to request it. If there is no contraindication, our anaesthetic team will be happy to follow your preference.

Fixed Joint Contractures

Other reported complications in distraction osteogenesis include joint stiffness and subluxation as well as axial deviation.1,4,5 During the lengthening process, there is a tendency for the bone segment being lengthened to gradually veer off its intended course due to muscle imbalance or instability secondary to an inadequate external fixator construct.

References

 1. Aronson J, Harrison BH, Stewart CL, Harp JH, Jr. The histology of distraction osteogenesis using different external fixators. Clin Orthop Relat Res. 1989; 241:106-16.

4. Goldstein RY, Jordan CJ, McLaurin TM, et al. The evolution of the Ilizarov technique; Part 2: The principles of distraction osteosynthesis. Bull Hosp Jt Dis. 2013; 71(1):96-103.

5. Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res. 1990; 250:81-104.

Neuroapraxia

Neurovascular compromise is less of a concern than musculotendinous injury during the process of gradual bone lengthening. Nerves and vessels are able to adapt in length during the distraction process and recover from temporary degenerative changes within two months after distraction has ceased.4,5

Neurovascular compromise is most often the result of surgical technique, such as pin placement, significant edema and/or compartment syndrome.

References

4. Goldstein RY, Jordan CJ, McLaurin TM, et al. The evolution of the Ilizarov technique; Part 2: The principles of distraction osteosynthesis. Bull Hosp Jt Dis. 2013; 71(1):96-103.

5. Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res. 1990; 250:81-104.

References

  1. Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res. 1990 Jan;(250):81-104.

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