Subsidence of callotasis zone in distraction osteogenesis after external fixator removal, measured by RSA

Abstract

Background and purpose In clinical practice, achieved lengthening of a callotasis zone should be maintained after the external fixator has been removed. The common understanding has been that the regenerated bone may subside. To investigate this, we used high-resolution radiostereometric analysis (RSA) with accurate measurement of the lengthening zone.

Patients and methods We assessed the longitudinal subsidence of a callotasis zone after removal of the external fixator in distraction osteogenesis in 16 patients who underwent 17 segmental lengthening operations on the tibia (n = 9) or femur (n = 8). Median lengthening was 32 (6–80) mm. RSA was performed at the end of the consolidation period before the external fixation device was removed, and this was later repeated at a median time of 11 (4–32) weeks after frame removal.

Results A minimal median longitudinal change of 0.01 (–0.28 to 0.60) mm across the lengthening zone occurred in uncomplicated cases.

Interpretation Our results indicate that no subsidence of clinical interest occurs after external frame removal.

RBG participated in planning the study, performed the radiological work, and did all the RSA examinations and analyses. She also wrote the manuscript. HS supervised the study and the writing process and assisted in planning, in frame building, and at surgical procedures. LPK and JH both participated in planning the study; they built the fixators and did the surgery. They also revised and approved the manuscript.

We want to thank statistician Jonas Ranstam for helpful advice and assistance.