Maffulli, Nicola; (1994) Lengthening in congenital limb length discrepancy using callotasis: Clinical, radiological and physiological studies. Doctoral thesis (Ph.D.), University College London (United Kingdom).

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Abstract

Limb lengthening is widely practised for short stature and limb length discrepancy. Gradual callus distraction following corticotomy, while breaching the cortex, leaves intact the medullary canal, and produces elongation of bone and soft tissues. Published work has generally reported the results of dwarfism and post-traumatic conditions. Data regarding the correction of congenital limb length discrepancy are not at present available. This thesis reports the work, carried out in a longitudinal fashion, performed on a selected group of 24 children undergoing lengthening to correct lower and upper limb congenital length discrepancy. The procedure, while being described by other authors as practically risk free, proved to have a significant number of problems, with all children suffering from pin site infection. The children had to be protected in a cast when the external fixation apparatus was removed to prevent fracture of the regenerate bone, which occurred in some of the early patients. Also, joint contractures had to be prevented and treated by intense physiotherapy. One child suffered from toxic shock following septicaemia stemming from pin site infection. Ultrasound scanning gives valuable information on the morphology of the regenerate bone. However, it is probably not sensitive enough to replace serial conventional radiographs in assessing the maturity of the newly formed bone. Children with a congenital short femur take two years to return to the pre-lengthening isometric strength of their knee extensor muscles.

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