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Growth disturbance after lengthening of the lower limb and quantitative assessment of physeal closure in skeletally immature patients with achondroplasia

Authors
Song, S. H.Kim, S. E.Agashe, M. V.Lee, H.Refai, M. A.Park, Y. E.Choi, H. J.Park, J. H.Song, H. R.
Issue Date
4월-2012
Publisher
BRITISH EDITORIAL SOC BONE JOINT SURGERY
Keywords
RECURRENT G380R MUTATIONS; DISTRACTION OSTEOGENESIS; CORRELATION-COEFFICIENT; LONGITUDINAL GROWTH; RABBIT TIBIA; BONE-GROWTH; PATTERNS; CHILDREN; MODEL
Citation
JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, v.94B, no.4, pp.556 - 563
Indexed
SCIE
SCOPUS
Journal Title
JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME
Volume
94B
Number
4
Start Page
556
End Page
563
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/108875
DOI
10.1302/0301-620X.94B4.28375
ISSN
0301-620X
Abstract
This study evaluated the effect of limb lengthening on longitudinal growth in patients with achondroplasia. Growth of the lower extremity was assessed retrospectively by serial radiographs in 35 skeletally immature patients with achondroplasia who underwent bilateral limb lengthening (Group 1), and in 12 skeletally immature patients with achondroplasia who did not (Group 2). In Group 1, 23 patients underwent only tibial lengthening (Group 1a) and 12 patients underwent tibial and femoral lengthening sequentially (Group 1b). The mean lengthening in the tibia was 9.2 cm (59.5%) in Group 1a, and 9.0 cm (58.2%) in the tibia and 10.2 cm (54.3%) in the femur in Group 1b. The mean follow-up was 9.3 years (8.6 to 10.3). The final mean total length of lower extremity in Group 1a was 526.6 mm (501.3 to 552.9) at the time of skeletal maturity and 610.1 mm (577.6 to 638.6) in Group 1b, compared with 457.0 mm (411.7 to 502.3) in Group 2. However, the mean actual length, representing the length solely grown from the physis without the length of distraction, showed that there was a significant disturbance of growth after limb lengthening. In Group 1a, a mean decrease of 22.4 mm (21.3 to 23.1) (4.9%) was observed in the actual limb length when compared with Group 2, and a greater mean decrease of 38.9 mm (37.2 to 40.8) (8.5%) was observed in Group 1b when compared with Group 2 at skeletal maturity. In Group 1, the mean actual limb length was 16.5 mm (15.8 to 17.2) (3.6%) shorter in Group 1b when compared with Group 1a at the time of skeletal maturity. Premature physeal closure was seen mostly in the proximal tibia and the distal femur with relative preservation of proximal femur and distal tibia. We suggest that significant disturbance of growth can occur after extensive limb lengthening in patients with achondroplasia, and therefore, this should be included in pre-operative counselling of these patients and their parents.
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