Limb Lengthening and Reconstruction Society orthopedic surgeons in the United States:An analysis of geographical distribution,academic,leadership,and demographic characteristics

BACKGROUND The Limb Lengthening and Reconstruction Society(LLRS)is a premier orthopedic specialty organization that promotes limb reconstruction for all ages.LLRS membership characteristics,however,are poorly reported.This study delineates orthopedic surgeon LLRS members’demographic traits,academic achievement,leadership attainment,and geographical distribution across the United States.AIM To inform aspiring orthopedic professionals,as well as to promote growth and diversity in both the LLRS organization and overarching field.METHODS This cross-sectional study examined United States LLRS members’academic,leadership,demographic,and geographical attributes.After reviewing the 2023 LLRS member directory,Google search results were matched to the listings and appended to the compiled data.Sex and ethnicity were evaluated visually utilizing retrieved images.The Hirsch index(H-index)of academic activity,residency and fellowship training,other graduate degrees,leadership positions,practice type(academic or non-academic),and spoken languages were categorized.LLRS members per state and capita determined geographic distribution.The Mann Whitney U test was applied to compare H-index between males and females,as well as to assess member differences pertaining to affiliation with academic vs non-academic practice facilities.RESULTS The study included 101 orthopedic surgeons,78(77.23%)Caucasian and 23(22.77%)non-Caucasian,79(78.22%)male and 22(21.78%)female.Surgeons with DO degrees comprised only 3.96%(4)of the cohort,while the vast majority held MDs[96.04%(97)].Mean H-index was 10.55,with male surgeons having a significantly higher score(P=0.002).Most orthopedic surgeons(88.12%,)practiced in academic centers.Of those professionals who occupied leadership positions,14%were women,while 86%were men.Additionally,19(37.25%)United States regions and the District of Columbia lacked an LLRS-member orthopedic surgeon.Total per capita rate across the United States was 0.30 LLRS orthopedic surgeons per 1 million people.CONCLUSION Over 21%of LLRS members are women,surpassing prior benchmarks noted in orthopedic faculty reporting.LLRS members’high research productivity scores imply field dedication that can refine expertise in the limb lengthening and reconstruction space.Gender disparities in leadership remain,however,necessitating greater equity efforts.A low rate of LLRS representation per capita must be addressed geographically as well,to affect improvements in regional care access.This study can serve to support aspiring orthopedic professionals,inform diversity,leadership,and field advancement strategies,and maintain the continued goal of enhanced patient care worldwide.

Femoral lengthening in young patients:An evidence-based comparison between motorized lengthening nails and external fixation

BACKGROUND Femoral lengthening is a procedure of great importance in the treatment of congenital and acquired limb deficiencies.Technological advances have led to the latest designs of fully implantable motorized intramedullary lengthening nails.The use of these nails has increased over the last few years.AIM To review and critically appraise the literature comparing the outcome of femoral lengthening in children using intramedullary motorized lengthening nails to external fixation.METHODS Electronic databases(MEDLINE,CINAHL,EMBASE,Cochrane)were systematically searched in November 2019 for studies comparing the outcome of femoral lengthening in children using magnetic lengthening nails and external fixation.The outcomes included amount of gained length,healing index,complications and patient reported outcomes.RESULTS Of the 452 identified studies,only two(retrospective and non-randomized)met the inclusion criteria.A total of 91 femora were included.In both studies,the age of patients treated with nails ranged from 15 to 21 years compared to 9 to 15 years for patients in the external fixation group.Both devices achieved the target length.Prevalence of adverse events was less in the nail(60%-73%)than in the external fixation(81%-100%)group.None of the studies presented patient reported outcomes.CONCLUSION The clinical effectiveness of motorized nails is equivalent or superior to external fixation for femoral lengthening in young patients.The available literature is limited and does not provide evidence on patient quality of life or cost effectiveness of the interventions.

Benefits of Ilizarov automated bone distraction for nerves and articular cartilage in experimental leg lengthening

AIM To determine peculiarities of tissue responses to manual and automated Ilizarov bone distraction in nerves and articular cartilage.METHODS Twenty-nine dogs were divided in two experimental groups: Group M-leg lengthening with manual distraction(1 mm/d in 4 steps), Group A-automated distraction(1 mm/d in 60 steps) and intact group. Animals were euthanized at the end of distraction, at 30 th day of fixation in apparatus and 30 d after the fixator removal. M-responses in gastrocnemius and tibialis anterior muscles were recorded, numerical histology of peronealand tibialis nerves and knee cartilage semi-thin sections, scanning electron microscopy and X-ray electron probe microanalysis were performed.RESULTS Better restoration of M-response amplitudes in leg muscles was noted in A-group. Fibrosis of epineurium with adipocytes loss in peroneal nerve, subperineurial edema and fibrosis of endoneurium in some fascicles of both nerves were noted only in M-group, shares of nerve fibers with atrophic and degenerative changes were bigger in M-group than in A-group. At the end of experiment morphometric parameters of nerve fibers in peroneal nerve were comparable with intact nerve only in A-group. Quantitative parameters of articular cartilage(thickness, volumetric densities of chondrocytes, percentages of isogenic clusters and empty cellular lacunas, contents of sulfur and calcium) were badly changed in M-group and less changed in A-group.CONCLUSION Automated Ilizarov distraction is more safe method of orthopedic leg lengthening than manual distraction in points of nervous fibers survival and articular cartilage arthrotic changes.

Effect of lengthening along the anatomical axis of the femur and its clinical impact

AIM To review and study the effect of lengthening along the anatomical axis of long bones and its relation to the mechanical axis deviation.METHODS We try in this review to calculate and discuss the exact clinical impact of lengthening along the anatomical axis of the femur on affecting the limb alignment. Also we used a trigonometric formula to predict the change of the femoral distal anatomical mechanical angle(AMA) after lengthening along the anatomical axis. RESULTS Lengthening along the anatomical axis of the femur by 10% of its original length results in reduction in the distal femoral AMA by 0.57 degrees. There is no objective experimental scientific data to prove that the Mechanical axis is passing via the center of the hip to the center of the knee. There is wide variation in normal anatomical axis for different populations. In deformity correction, surgeons try to reproduce the normal usual bone shape to regain normal function, which is mainly anatomical axis. CONCLUSION Lengthening of the femur along its anatomical axis results in mild reduction of the distal femoral AMA. This may partially compensate for the expected mechanical axis lateralisation and hence justify its minimal clinical impact.

Histological changes after tibial lengthening with metaphyseal osteotomy in goats

The histological changes after tibial lengthening with metaphyseal osteotomywere observed in 30 goats.It was found that(1)a slow lengthening rate of 1 mm/d couldenable the tissues to adapt the mechanical traction and consequently increase thelengthening limitation;(2)the newly-formed bone in the lengthened area might be due to acombined osteogenesis of endochondral,intramembranous,and fibrous tissue ossification;and(3)the osteogenetic process could be distinguished into 3 stages as hemorrhage andorganization of the hematocele,callus formation,and remodelling of the newly-formedbones.

LOOSENING AND LENGTHENING OF INTESTINAL TRACT AFTER RECTAL ISOLATION IN ANUS－SAVING RESECTION FOR RECTAL CARCINOMA

In low rectal cancer surgery,the section of rectum destal to the lower tumor maigin is relaxed and lengthened after fully isolation of the organ. This would facilitate the adoption of anus saving operation.Before and after fully isolation of the rectum in low ratal cancer surgery, the distance between the lower tumor margin and the anorectal line was measured by the same rectuscope introduced through the anus.The two results were compared .The average lengthening was less than 1 cm if the lower tumor marginanorectal line distance was 5 cm.It was 1─2 cm if the lower tumor margin-anorectal distance was 6 cm.It was more than 2 cm if the distance was 7─9 cm.The loosening and lengthening of the rectal canal was related to the presence of lymphnode metastasis and the skill of the operator.The lengthening was also influenced by the body build of the patient,involvement of the rectal circumference and the Dukes stage. Modified Park's operation,trans abdominosacral resection with anastormosis of rectum,and anterior resection on transpubic approach are indicated for those in whom the lower tumor margin-anorectal line distance was 5 cm The rectectomy-anastomosis in the abdominal cavity(Dixon's operation)is indicated for those in whom the lower tumor margin-anorectal line was 6 cm.If manual anastomosis is difficult,stapling device may be used. The anus saving resection is easy if the distance was 7─9 cm.

Autogenous iliotibial band enhancement combined with tendon lengthening plasty to treat patella baja:A case report

BACKGROUND Patella baja is a severe complication after knee injury or surgery,resulting in pain and impaired movement.This disorder is also a substantial challenge for orthopaedic surgeons.Currently,no consensus exists regarding the gold standard management of patella baja.If not appropriately treated,significant dysfunction of the knee joint will occur.CASE SUMMARY A 46-year-old man with a left patellar fracture was treated with tension band fixation at a local hospital.He had undergone a second operation at the same hospital because of limited knee flexion 6 mo after surgery.Unfortunately,the patellar tendon was ruptured.The patellar tendon was subsequently repaired using an ipsilateral semitendinosus tendon.Two years later,the patient presented to our department with knee pain and loss of range of motion.Autogenous iliotibial band(ITB)enhancement combined with sagittal tendon lengthening plasty was used to improve the symptoms of the knee joint.The patient was followed up for 2 years.The knee joint function of the patient returned to the normal level.CONCLUSION We successfully treated patella baja using autogenous ITB enhancement combined with sagittal tendon lengthening plasty.

Complication of lengthening and the role of post-operative care, physical and psychological rehabilitation among fibula hemimelia

There is a clear clinical need for efficient physiotherapy and rehabilitation programs during and after bone lengthening and reconstruction for gaining the optimal effect and also prevention or treatment of lengthening side effects.Pin tract infection is the most prevalent side effect during lengthening which could be prevented and treated initially via proper wound care.Muscle contractures are typically a consequence of the generated tension on the distracted muscle.It can be managed by physiotherapy initially and surgically in later severe stages.Furthermore,it is essential to avoid muscle contracture development,which is the demonstration of the imbalanced muscle appeals on the joint to inhibit the following subluxation.The knee is the furthermost affected joint by the aforementioned problem due to the inherent lack of ligamentous and bony stability.Joint stiffness is the other possible unfavorable effect of lengthening.It happens because of extensive muscle contractures or may possibly be attributed to rigidity of the joint following the amplified pressure on the joint surface during the process of lengthening.Physiotherapy and occupational therapy including endurance and strength exercise as well as stretching play an important role during the rehabilitation periods for the prevention and also the treatment of muscle contracture and the following deformity and also joint stiffness.Likewise,the effect of mental and physical rehabilitation programs should not be overlooked.

Limb lengthening with PRECICE magnetic nail in pediatric patients: A systematic review

BACKGROUND Limb lengthening techniques play an increasingly important role in the pediatric orthopedic field.The principles of the osteogenesis distraction bonded traditionally with external fixators;however,the recent deployment of fully implantable systems has been able to overcome severities related to external fixators.The PRECICE®is an implantable limb lengthening intramedullary nail system that is remotely controlled and magnetically driven.AIM To review the current literature available on this matter in order to assess the PRECICE clinical and radiological outcomes and its possible complications in a population of pediatric patients undergoing limb lengthening.METHODS Only five studies met the inclusion criteria and were consequently included in the review for a total of 131 patients and 135 femurs.The clinical and radiological outcomes of interest were:the main lengthening obtained,the distraction rate,the period of time to full weight bearing,the consolidation index,and the Association for the Study and Application of Methods of Ilizarov score.RESULTS In conclusion,data collected from the articles under investigation were comparable with the exception of the consolidation index.Unfortunately,the study population was too small and the patients’follow-up was too short to make definitive conclusions.CONCLUSION This review shows that the PRECICE Nail System is still a therapeutic challenge in limb lengthening for pediatric orthopedic surgeons;however,careful preoperative planning and an accurate surgical technique could allow the correction of more complex deformities with a low rate of complications.

Electrophysiological observation on tibial nerve during and after limblengthening in rabbits

Objective: To observe the subclinical damage and natural repairing process of the tibial nerve during and after limb lengthening with slow stretching in 10 rabbits. Methods: The tibia of Japanese rabbits was lengthened by 4O%. Before, during and in the following 8 weeks after the limb elongation, the compound sensory evoked potential (CSEP) of posterior tibial nerves in both hind limbs was recorded with electrophysiological instrument. The histological changes were observed under light and electron microscope . Results: During limb lengthening, significant changes in the latent period, peak value and area of the CSEP were fond. The latent period recovered by 50% ac 65% respectively in 2th and 4th week after the tibia being lengthened by 40%. An the 3 parameters of the CSEP, were restored up to 95% as the control in 8th week after elongation and the histological damages also recovered at the same time. Conclusion: The subclinical damage of the peripheral nerve during limb lengthening is temporary and convertible with Ilizarov’s [1] gradual limb lengthening method .

Epiphyseal Lengthening Operation-An Improved Technique

An improved method of epiphyseal lengthening operation and subsequent outer fixation are presented on the basis of experience in 30 cases. The operative technique is described in detail, including the different options of separative traction and osteotomy at subtrochanteric , distal part of the upper femur and lower tibial levels. The physiological and histological research concerning this method is discussed. The authors believe that this procedure is better than the other methods.

Effects of duration of type 2 diabetes mellitus on lengthening and enlargement of small abdominal aortic aneursym

Objective: The purpose of our study aimed at evaluating the relationship of type 2 diabetes with longitudinal extension of AAA. Methods: All of 460 AAA patients aged from 41 to 92 years were retrospected in our study, and they were at least twice admitted into our hospital from January 2000 to April 2010. All patients received ultrasound measurement of aorta during each admission. Results: Our results indicated that changes of length of AAA were significantly greater in patients with diabetes than those in patients without diabetes. Type 2 diabetes was associated with length extension of AAA. In subgroup analysis, type 2 diabetes was only related to length change of small AAA rather than large AAA. Diabetes was not an independent risk factor for length extension of small AAA. There was no significant difference of glycosy-lated hemoglobin between diabetes patients and nondiabetes patients. Conclusions: Type 2 diabetes mellitus is closely related to length growth of small AAA, whereas diabetes is not an independent risk factor for length extension of small AAA, and serum glucose under better control could not bring about better result in limiting length extension of small AAA.

A Therapeutic Concept by “Watted” for the Surgical Lengthening of the Lower Face by Short Face Syndrome

The continuously growing esthetic awareness for the facial appearance and the spreading of information about the possibilities of adult treatment by public media result in an increase of adult patients which seek orthodontic treatment to improve their facial esthetics. In general, these patients show such a severe skeletal deformity that it is detectable even by non-experts because of its extraoral manifestation, which is the main motivation for treatment. Because of the nature of these deformities and because of the lacking growth usable for therapy the only promising treatment for these patients is the combined orthodontic-surgical approach. Besides a stable and functional occlusion with physiologic position of the condyle, the goals of treatment are the improvement of the dental and, above all, facial esthetics since the patient judges the success of treatment mostly by the extraoral appearance. The dentofacial appearance must be defined prior to treatment to plan the individual right approach in knowledge of the different treatment possibilities for Angle Class II deformities and thus be able to reach for both sides—patient and orthodontist—satisfying result. With this article, a systematic therapy concept to treat patients with Class II deformities and skeletal deep bite with a short lower face (short face syndrome) under consideration of the soft tissue analysis is presented.

Effects of Crown Lengthening on Bi, PLI and PD Levels in Patients with Different Periodontal Biotypes

Objective:To investigate the effect of crown lengthening on patients with different periodontal biological types.Methods:60 patients with different periodontal biotypes treated in our hospital from May 2017 to February 2019 were retrospectively analyzed.According to the different periodontal biotypes,the above-mentioned patients were further divided into control group(thin fan type,30 cases)and observation group(thick flat type,30 cases).The periodontal probing depth(PD),plaque index(PLI),bleeding index(BI)and gingival margin position at 1 week,1 month,2 months and 3 months after operation were compared between the two groups.Results:The PD,Bi and PLI values of the two groups after treatment were lower than those before treatment(P<0.05);There was no significant difference in gingival margin position between the two groups after 1 week to 1 month and 1 month to 2 months(P>0.05);After 2 months to 3 months of treatment,the gingival margin distance of the observation group was larger than that of the control group,and the difference was statistically significant(P<0.05).Conclusion:Crown lengthening can effectively improve the periodontal indexes of different periodontal biotypes,and the gingival margin of thick and flat type patients moves more toward the crown.

The Load-Displacement Curves of Deep Fascia in Response to Tension Stress Principle during Limb Lengthening: a Preliminary Study

Objective:To investigate the load displacement curves of deep fascia of leg in response to the Tension Stress principle during limb lengthening. Methods:Limb lengthening animal model was established in New Zealand white rabbits using a unilateral external fixator applied with four pins to the medial surface of tibia and monofocal proximal diaphysis with closed multiple drill holes and osteoclasis between the second and the third pins.Seven days after operation,distraction was initiated at distraction rates of 1mm/day and 2mm/day in two steps,and proceeded until increases of 10% and 20% in the initial length of tibia had been achieved.The fascia samples of 30mm×10mm were clamped with the Instron 1122 tensile test device at room temperature with the constant tensile rate of 5mm/min.After 5 load download tensile tests had been performed,the samples were elongated until rupture.And the load displacement curves were automatically generated. Results:The normal fascias showed typical load displacement rule of collagenous tissues.And each experimental group of fascias kept the characteristics.The curves of fascias at a rate of 1mm/day were closer to the curves of normal fascias.For the normal fascias,the ultimate tension strength was avarage 2.69N,and the strain at rupture was avarage 14.11%.And the ultimate tension strength of the fascias after limb lengthening increased. Conclusion:These results prove that the Tension Stress during limb lengthening has great effect upon the load displacement curves of fascia.The curves of fascia at a distraction rate of 1mm/day were closer to the curves of normal fascia.

Lengthening osteotomy of the fibula in treatment of treating lateral malleolar malunon

Objective To investigate the therapeutic effect of lengthening and rotational osteotomy of the fibula for lateral malleolar malunion.Methods Twenty-three patients who suffered from the traumatic arthritis of ankle were due to

Lengthening of a below knee amputation stump with Ilizarov technique in a patient with a mangled leg

A below knee amputation(BKA)requires sufficient stump length for the fitting of a modern prosthesis.In cases of trauma where the levels of injury are unpredictable,achieving sufficient stump length can be a challenge.We described a case report of using the Ilizarov technique for bone lengthening at the residual BKA stump for a patient who sustained a mangled limb following a road traffic accident.Using this technique,we have successfully lengthened the tibial stump adequately for a functioning prosthesis.As shown in this case,we believe that this technique could attain an excellent outcome for a selected group of patients with short residual BKA stump.

Anti-lysyl oxidase combined with a vacuum device induces penile lengthening by remodeling the tunica albuginea

This study aimed to explore whether and how anti-lysyl oxidase(anti-LOX)combined with a vacuum device(VD)could promote penile lengthening and to evaluate the effect on erectile function.This study was performed on four groups of adult rats:control,anti-LOX,VD(negative pressure value of-300 mmHg),and anti-LOX+VD.Penile length was measured by a modified VD method and verified on exposed length data.Intracavernous pressure(ICP)and maximum ICP/mean arterial pressure(MAP)ratio were recorded to assess erectile function.For corpus cavernosum,LOX activity and concentrations of pyridinoline,desmosine,hydroxyproline,and elastin were analyzed;transmission electron microscope and Hart’s elastin staining were performed to monitor microstructural changes.Anti-LOX and VD significantly lengthened the penis by 10.8%(3.75 mm)and 8.2%(2.48 mm)compared with the control group,respectively,while anti-LOX+VD achieved the longest penile size(40.58±0.40 mm)which was 17.4%longer than the control group(34.58±0.54 mm).After 1-week washout,no penile retraction was observed.Meanwhile,exposed penile length data confirmed that the penis in the anti-LOX+VD group was also significantly longer.Anti-LOX inhibited LOX activity to reduce pyridinoline level,which led the penile tunica albuginea remodeling.However,it had no effect on hydroxyproline,desmosine,and elastin levels.Moreover,anti-LOX had no impact on erectile function,which was determined by ICP and ICP/MAP ratio.These results suggest that anti-LOX elongates the penis by reducing pyridinoline,which induces tunica albuginea remodeling.This lengthening effect was more obvious when combined with a VD.All procedures had no impact on erectile function.

Component changes of calcium and phosphorus in osteogenesis by lengthening procedures in adult canines

Objective: To explore chemical component changes of dog bone at different lengthening time and in different bone regions of interest, and to evaluate the mineralization during Ilizarov lengthening process. Methods: The ash weight, the concentrations of calcium, phosphorus and the calcium/phosphorus ratio were measured at different intervals (2, 4, 6, 8, 12 weeks) since lengthening and the lengthened part was compared with a control area at each interval. Results: The ash weight, the concentrations of calcium and phosphorus in the lengthened area differed at all development time. The calcium/phosphorus (Ca/P) ratio in the lengthened region remained significantly lower than that in the control region up to 12 weeks after the lengthening. Conclusions: These results suggest that also other inorganic ions play an important role in the mineralization process and that they become relatively more important since 8 weeks after the lengthening.