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Objective Guidelines for Removing an External Fixator after Tibial Lengthening Using Pixel Value Ratio: A Pilot Study

Authors
Zhao, LiFan, QingVenkatesh, K. P.Park, Man S.Song, Hae Ryong
Issue Date
Dec-2009
Publisher
LIPPINCOTT WILLIAMS & WILKINS
Citation
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, v.467, no.12, pp.3321 - 3326
Indexed
SCIE
SCOPUS
Journal Title
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH
Volume
467
Number
12
Start Page
3321
End Page
3326
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/118887
DOI
10.1007/s11999-009-1011-7
ISSN
0009-921X
Abstract
During limb lengthening over an intramedullary nail, decisions regarding external fixator removal and weightbearing depend on the amount of callus seen at the lengthening area on radiographs. However, this method is subjective and objective evaluation of the amount of callus likely would minimize nail or interlocking screw breakage and refracture after fixator removal. We asked how many cortices with full corticalization of the newly formed bone at the lengthening area are needed to allow fixator removal and full weightbearing and how to radiographically determine the stage of corticalization. We retrospectively reviewed 17 patients (34 lengthenings) who underwent bilateral tibial lengthenings over an intramedullary nail. The average gain in length was 7.2 +/- A 3.4 cm. We determined the pixel value ratio (ratio of pixel value of regenerate versus the mean pixel value of adjacent bone) of the lengthened area on radiographs. There were no nail or screw breakage and refracture. Partial weightbearing with crutches was permitted when the pixel value ratio was 1 in two cortices and full weightbearing without crutches was permitted when the pixel value ratio was 1 in three cortices. The pixel value ratio on radiographs can be an objective parameter for callus measurement and may provide guidelines for the timing of external fixator removal. We cannot determine from our limited data the minimum pixel value in how many cortices would suggest safe removal, but we can say our criteria were not associated with subsequent refracture.
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