The etiology of short stature affects the clinical outcome of lower limb lengthening using external fixation

Figures & data

Flow diagram of search methods and criteria.

Table 1. The number of patients from each study and the number of total segments included in outcome analysis

Author/Year	Journal	Total no. of
		patients	segments
Aldegheri 1999	J Bone Joint Surg (Am)	67	134
Aldegheri et al. 2001	J Pediatr Orthop B	130	480
Aldegheri et al. 1988	J Bone Joint Surg (Br)	72	234
Bidwell et al. 2000	J Bone Joint Surg (Br)	10	28
Catagni et al. 2005	J Bone Joint Surg(Br)	54	108
Cattaneo et al. 1988	Int Orthop	22	44
Hahn et al. 2003	Yonsei Medical Journal	6	12
Kim et al. 2012	J Bone Joint Surg (Br)	12	24
Kim et al. 2012	Clin Orthop	22	88
Kitoh et al. 2007	J Pediatr Orthop	9	32
Lie et al. 2009	Hong Kong Med J	8	26
Ng BKW et al. 2003	Hong Kong J Paediatr	14	38
Noonan et al. 1997	Iowa Orthop J	8	16
Noonan et al. 1998	J Bone Joint Surg (Am)	37	134
Park et al. 2008	J Bone Joint Surg (Am)	16	32
Trivella et al. 1996	J Bone Joint Surg (Br)	16	64
Vaidya et al. 2006	J Pediatr Orthop	24	47
Venkatesh et al. 2009	J Bone Joint Surg (Br)	20	40
Total		547	1,581

Table 2. Demographics of patients undergoing limb lengthening for short stature

	A/H ^a	TS ^b	CSS ^c	Total	No. of available patients	Studies not included
No. of patients	367	77	103	547	547	None
No. of patients in each study (range)	5–100	6–20	3–54	3–100	547	None
Sex
Male	157	0	40	197	444
Female	143	77	27	247	444	Park et al. 2008, Aldegheri 1999, Noonan et al. 1998
Age in years	14.5	18.2	21.7	16.3	547	None
(range)	4–35	12–24	14–47	4–47
No. of segments lengthened	1,111	234	236	1,581	547	None
No. of tibias	620	152	194	966	547	None
No. of femurs	491	82	42	615
Average follow-up	4.1	4.9	5.1	4.3	276	Aldegheri and Dall’Oca 2001, Aldegheri et al. 1988, Noonan et al. 1998, Ng et al. 2003, Kitoh et al. 2007

^a Achondroplasia/hypochondroplasia

^b Turner’s syndrome

^c Constitutional short stature

Table 3. Amount of lengthening and healing index

	A/H ^a	TS ^b	CSS ^c	Total average	No. of patients included	Studies not included
Mean length gained per limb in cm (range)	9 (6–12)	8 (6–9)	6 (4–9)	9 (4–12)	547	None
Mean percentage increase per limb (range)	36 (20–53)	26 (10–41)	18 (7–30)	32 (7–53)	319	Cattaneo et al. 1988, Catagni et al. 2005, Aldegheri and Dall’Oca 2001, Noonan et al. 1998, Ng et al. 2003, Bidwell et al. 2000)
Healing index in days/cm (range)	31 (24–41)	45 (31–57)	32 (30–67)	33 (24–67)	407	Aldegheri and Dall’Oca 2001, Bidwell et al. 2000

^a Achondroplasia/hypochondroplasia

^b Turner’s syndrome

^c Constitutional short stature

Table 4. Reported complications for limb lengthening

	A/H ^a	TS ^b	CSS ^c	p-value	Total	Studies not included
Complications/ total segment (%)	487/707 (68)	109/154 (71)	209/196 (106)	< 0.001	805/1,057 (76)	Cattaneo et al. 1988, Aldegheri and Dall’Oca 2001
Sequelae/total segment (%)	19/1,111 (1.7)	5/234 (2.1)	4/236 (1.7)	0.9	28/1,581 (1.8)	None

^a Achondroplasia/hypochondroplasia

^b Turner’s syndrome

^c Constitutional short stature

Table 5. Reported sequelae of limb lengthening

	A/H ^a	TS ^b	CSS ^c	Total
Stiff ankle	11	3	2	16
Residual peroneal nerve paralysis	2	0	0	2
Necrosis of the femoral head	0	2	0	2
Knee valgus	3	0	0	3
Ankle valgus	3	0	1	4
Septic arthritis	0	0	1	1
Total no. of sequelae	19	5	4	28

^a Achondroplasia/hypochondroplasia

^b Turner’s syndrome

^c Constitutional short stature

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