Table 2 Description of the procedures chosen and the outcomes. LON: lengthening over nail; LATN: lengthening and then nailing; BIQLI: body image quality of life inventory; RSE: Rosenberg self esteem; SIBID: situational inventory of body-image dysphoria; MBSRQ: the multidimensional Body-Self relations questionnaire; ISKD: intramedullary skeletal kinetic distractor; 1: based on the axial deviation, restricted joint movement, pronation of the foot, leg-length discrepancy and scars; 2: Catagni et al. classification [poor (0–4 points) = 0; patients; fair (5–9 points) = 0 patients; good (10 14 points) = 1 patient; and excellent (15–18 points) = 49 patients]; 3: improvement in self-esteem, distress or shyness and quality of life; 4: satisfied with the outcome of treatment, felt improvement of self-esteem, would undergo the procedure again, and would recommend it to another person having short stature; 5: measured with the standard visual analog scale (VAS) at least 1 year after removal of external fixator. No satisfaction: 0 highest level of satisfaction: 10; SARS: sports activity rating scale; IKDC: international knee Documentation committee subjective knee form
Author (Year) | Segment | Technique | Mean lengthening (mm) | Psychological outcomes | Functional outcomes | Complications (case) |
|---|---|---|---|---|---|---|
Catagni et al. (2005)[9] | Tibia | Ilizarov method | 70 | Satisfaction2: Excellent: 49 Good: 5 Aesthetic satisfaction: 70 | NA | Atrophy of the new bone: 2 Early consolidation: 1 Collapse of regenerate with proximal varus: 1 Proximal anterior bowing and distal valgus: 2 Proximal anterior tibial bowing: 3 Distal varus: 2 Distal valgus: 5 Limitation of dorsiflexion of the ankle: 2 length discrepancy: 1 Superficial infection at the pin site: 26 |
Park Hui Wan et al. (2008)[10] | Tibia | Ilizarov method: 16 LON: 28 | 62 Ilizarov method: 59 LON: 64 | Overall satisfaction: - Extremely satisfied: Ilizarov method: 2; LON: 6 - Moderately satisfied: Ilizarov method: 10; LON: 16 - No opinion: Ilizarov method: 2; LON: 4 - Moderately unsatisfied: Ilizarov method: 0; LON: 1 - Extremely unsatisfied: Ilizarov method: 2; B LON: 1 | Mobility during lengthening procedure: - Outdoor activities without help possible: Ilizarov method: 7; LON: 24; - Only indoor activities possible: Ilizarov method: 9; LON: 4 Physical activity at final follow-up: - No limitations in any activity: Ilizarov method: 12; LON: 21 - Limitations in vigorous activities: Ilizarov method: 4; LON: 7 Time interval until return to previous activity: - <6 months: Ilizarov method: 10; LON: 25 - >6 months: Ilizarov method: 6; LON: 3 | Complication per segment: Pin-track infection: 22 Wire breakage: 60 Screw breakage: 7 Axial deviation: 5 Delayed consolidation: 5 Premature consolidation: 9 Fibula migration: 4 Ankle valgus: 5 Knee and ankle contracture: 27 Neurapraxia: 7 |
Emara et al. (2011)[11] | Tibia | LATN | 76 | Satisfaction (yes or no): 91% yes (week 6); 81% yes (after external fixator removal); 94% yes (year 1) | NA | Decreased range of ankle dorsiflexion: 32 Disconfort: 32 Knee flexion deformity: 9 Transient nerve neuropraxia: 3 Reversible angular deformities: 4 Rotational deformities: 1 Anterior knee pain: 8 Mild behavioural disturbances: 12 Revision Surgeries: 4 |
Elbatrawy et al. (2014)[12] | Tibia | Ilizarov method | 69 | Satisfaction2: Good: 1 Excellent: 49 | NA | Loss of ankle dorsiflexion: 50 Pain: 35 Insomnia: 6 Behavioral changes: 3 Muscle contractures: 14 Superficial pin tract infection: 2 Tightness of Achilles tendon: 12 Mild misalignment: 16 Hypotrophic regenerate bone: 4 Cystic regenerate: 1 Large cyst: 1 Wire slippage: 1 Broken proximal ring: 1 Bilateral varus deformity: 1 |
Novikov et al. (2014)[13] | Tibia: 124 | Ilizarov Method | 69 | Satisfaction4: 130 out of 131 patients | NA | Pin tract infections: 5 Common peroneal neuropathy: 6 Equinus of the ankle: 12 Fixed flexion deformity of the knee: 14 Osteomyelitis: 3 Delayed consolisation: 6 Deformity of the regenerate: 9 Knee subluxation: 1 Delayed fracture: 1 |
Tibia + Femur: 6 | ||||||
Femur: 1 | ||||||
Motallebi Zadeh et al. (2014)[13] | Tibia | LON (Ilizarov + Nail) | 66.5 | Satisfaction5: Median: 8.7 (1–10 scale) | NA | Pin tract infection: 65 Fracture pin: 39 Equinus deformity: 22 Achilles tendon lenghtening: 39 Nonunion: 3 prenature consolidation: 7 Nail breakage: 16 ibial fracture: 5 Compartment syndrone: 1 |
Kocaoglu et al. (2015)[15] | Femur: 15 | LON (hybrid + Nail) | 75 | Emotional well being average: 68.72 (scale: 1-100) Role limitations due to emotional problems average: 87.87 (scale: 1-100) | Role limitations due to physical health: 77.45 Physical functioning: 87.25 | Pin track infection: 21 Scar tissue: 2 Distal locking screw irritation: 7 compartment syndrome: 1 Deformity of regenerate while on fixator: 2 External fixator system not working properly: 1 |
Tibia:17 | LON (Ilizarov + Nail) | |||||
Guerreschi et al. (2016)[16] | Tibia | Ilizarov method | 72 | Final aesthetic satisfaction: All patients stated that they would recommend the treatment to others of similar stature. 53 would have the surgery again; 10 were undecided (63 total) | Satisfaction1: Excellent: 88.8% Good: 7.9% Fair: 3.1% Maintaining of sportive Activity: satisfactory in all cases | Segments: Pin trac infection: 25 Proximal tibia procurvatus: 4 Proximal tibia recurvatus: 2 Distal tibia varus/valgus: 7 Limited ankle dorsal flexion: 4 Athrophic new bone: 2 Equinus foot: 42 Collapse of new bone: 5 Leg length discrepancy: 1 Early fibular consolidation: 4 Foot pronation: 6 |
Park Hoon et al. (2016)[17] | Tibia | LON | 67 | NA | NA | Valgus deviation proximal and distal (significant increase) |
Park Kun-Bo et al. (2018)[18] | Tibia | LATN: 63 LON: 50 (Ilizarov + interlocking nail) ISKD: 12 | 63 | NA | SARS: 71.5 vs. 65.2 (1 year) and 74.7 (2 years) IKDC: 84.1 vs. 66.8 and 83.9 Patient self-reported ability scores: 94.6 and 89.9 for daily living and light sports, respectively, and 68.1 for moderate-to-strenuous sports. | Segments: Pin-site infection: 28 Equinus contracture: 94 Temporary hypoesthesia: 26 Knee contracture: 10 Delayed consolidation: 6 Pin breakage: 6 Equinus contracture: 4 Axial deviation: 2 Impending compartment syndrome: 1 |
Havitcioglu et al. (2020)[19] | Femur | Precice®: 6 ISKD: 1 Fitbone®: 1 | 87 | Satisfaction3: 9 out of 9 patients | NA | Proximal locking screw runaway: 1 Insufficient bone regeneration: 2 Quadriceps contracture: 1 |
Tibia | Precice®: 1 | |||||
Assayag et al. (2020)[20] | Femur: 12 | Precice®: 14 LATN: 1 | 64 | BIQLI: significant improvement (0.62 to 1.67) SIBID: significant improvement (1.3 to 1.02) MBSRQ: no significant change | NA | Femoral varus and procurvatum: 1 Premature consolidation: 2 Ankle equinus contractures: 2 Delayed consolidation: 6 |
Tibia + Femur: 1 | ||||||
Tibia: 2 |