Long-term psychosocial functioning after Ilizarov limb lengthening during childhood

Figures & data

Table 1.  Patients' medical data.

Population	n = 37 (22 females)
Cause
Congenital (n = 22)
hypoplasia		14
hemiatrophy		4
skeletal dysplasia		1
femur-fibula-ulna syndrome		1
Ollier's disease		2
Acquired (n = 12)
trauma		7
infection		4
Perthes' disease		1
unknown		3
Age at time of lengthening (years)	13.2 (8.0–20)
Number of lengthening procedures
Patients with 1 lengthening procedure (n = 30)
femur		10
tibia		14
both segments		6
Patients with 2 lengthening procedures (n = 7)
2 × tibia		3
2 × femur		2
* 1 × femur, 1 × both segments		1
1 × tibia, 1 × both segments		1
Lengthening
femoral		15
tibial		21
femoral and tibial lengthening		8
Months in frame ^a	7.4 (3.0–12)
Leg-length discrepancy (cm) ^a,^c	5.2 (1.5–16)
Amount of lengthening (cm) ^a	4.1 (1.5–9)
Months follow-up ^a	83 (24–169)
Age at time of follow-up (years) ^b	22 [3.3] (17–30)
Mean remaining LLI at follow-up ^b,^c	1.9 [4.1] (0–20)
LLI equalized		14
LLI ≤ 2 cm		17
LLI > 2 cm		6

^a Mean (range).

^b Mean [SD] (range).

^c Due to a greater growth velocity in the healthy limb, in one patient

the LLI was 16 cm before and after surgery, and 20 cm at the end

of the procedure.

Table 2.  Mean scores and standard deviations of perceived competence (range 0–100) before the procedure and at follow-up. High scores indicate higher perceived competence.

Scale	Before procedure	SD	At follow-up	SD	Mean difference	95% CI	SD	p-value
Scholastic competence (SC) ^a	55	30	65	31	11	-5–26	41	0.2
Social acceptance (SA) ^a	56	31	49	34	-7	-21–7	37	0.3
Athletic competence (AC) ^a	42	28	36	30	-6	-18–5	31	0.3
Physical appearance (PA) ^a	49	34	63	31	15	3–26	31	0.02 ^c
Behavioral conduct (BC) ^a	55	27	67	30	12	-2–26	36	0.08
Close friendship (CF) ^b	51	26	48	33	-3	-20–15	34	0.7
Global self-worth (GS) ^a	59	33	60	33	1	-10–12	30	0.9
Overall (OV) ^a	52	22	56	21	4	-4–11	20	0.3

^a n = 30

^b n = 17

^c p < 0.05. Paired t-test.

Table 3.  Mean HRQoL scores (TAAQOL; range 0–100) for young adults after an Ilizarov limb lengthening procedure and for the general population. High scores indicate better quality of life.

Scale	Mean for Ilizarov patients (n = 37)	SD	Mean for general population (n = 422–428)	SD	Mean difference	95% CI	p-value
Gross motor	77	26	97	10	20	11–29	< 0.01 ^a
Fine motor	99	7	99	4	1	-1–2	0.34
Cognitive function	86	20	89	18	3	-3–10	0.30
Sleeping	73	29	82	21	9	-1–19	0.08
Pain	65	26	84	17	20	10–29	< 0.01 ^a
Social function	92	14	91	15	-1	-6–4	0.78
Daily activities	85	22	89	18	4	-3–10	0.25
Sexuality	93	16	90	20	-4	-10–3	0.32
Vitality	64	24	72	20	4	0–16	0.05 ^a
Happiness	72	21	75	18	3	-4–9	0.39
Depressive feelings	82	18	84	16	3	-3–8	0.43
Aggressiveness	91	13	89	15	3	-3–7	0.43

Student's t-test. ^a p < 0.05.

Table 4.  Mean HRQoL domain scores (max. range 0–100).

Scale	Normal group (n = 422–428)	All (n = 37)	LLI of ≤ 2 cm (n = 31)	LLI of > 2 cm (n = 6)
Gross motor	97	77 ^a	83 ^a	49 ^a
Fine motor	99	99	99	94
Cognitive function	89	86	90	66
Sleep	82	74	77	49 ^a
Pain	84	65 ^a	68 ^a	47 ^a
Social function	91	92	93	83
Daily activities	89	85	90	60
Sexuality	90	93	94	88
Vitality	72	64 ^a	66	51 ^a
Happiness	75	72	74	65
Depressive feelings	84	82	86	58 ^a
Aggressiveness	89	91	92	87

^a p < 0.05. Student's t-test.

Table 5.  Mean HRQoL domain scores (max. range 0–100) according to severity of LLI.

Scale	LLI of ≤ 2 cm (n = 31)	LLI of > 2 cm (n = 6)	Mean diffe rence	95% CI	p-value
Gross motor	83	49	-34	-55 to 12	< 0.01 ^a
Fine motor	99	94	-6	-22 to 10	0.4
Cognitive function	90	66	-25	-60 to 11	0.2
Sleep	77	49	-29	-53 to -4	0.03 ^a
Pain	68	47	-21	-44 to 2	0.07
Social function	93	83	-11	-43 to 21	0.4
Daily activities	90	60	-30	-68 to 9	0.1
Sexuality	94	88	-7	-41 to 28	0.6
Vitality	66	51	-15	-36 to 7	0.2
Happiness	74	65	-8	-28 to 11	0.4
Depressive feelings	86	58	-28	-41 to -14	< 0.01 ^a
Aggressiveness	92	87	-8	-27 to 11	0.4

^a p < 0.05. Student's t-test.