Role of hybrid monolateral fixators in managing humeral length and deformity correction

Figures & data

Table 1. Clinical details of the patients treated with humeral monolateral fixator

Case	Sex	Age, years	Side ^a	Etiology	Intial length ^a, cm	Lengthening achieved ^a, cm	Months with external fixator	Follow-up, years	Complications ^a
1	M	18	B	Achondroplasia	B: 17	B: 8	10	7	R: Varus angulation
2	M	13	B	Achondroplasia	B: 15	B: 11	7	2.5	R: Transient radial nerve palsy
3	F	14	B	Achondroplasia	B: 17	B: 9.5	7	4.5	B: Elbow contracture
4	F	12	B	Achondroplasia	B: 15	B: 10.5	7	2	–
5	F	11	B	Achondroplasia	B: 16.5	B: 10	6	3	R: Refracture
6	M	14	B	Achondroplasia	B: 15	B: 8	12	5.5	B: Elbow contracture
7	F	18	B	Achondroplasia	B: 22	B: 9	14	3.5	L: Refracture
8	F	14	B	Achondroplasia	B: 18	B: 10	8	1	–
9	F	12	B	Achondroplasia	B: 20	B: 9.5	8	1	–
10	F	11	B	Achondroplasia	B: 15	B: 10	12	2	R: Pin tract infection
11	M	10	B	Achondroplasia	B: 12	B: 8.5	9	1.5	R: Pin tract infection
12	F	12	B	Achondroplasia	B: 17	B: 10	7	3	L: Pin tract infection
13	F	14	B	Achondroplasia	B: 14.5	B: 6.5	19	4	–
14	M	19	B	Achondroplasia	B: 19.5	B: 10	8	2.5	B: Pin tract infection
15	F	13	B	Achondroplasia	B: 16	B: 10	8	2	–
16	F	11	B	Achondroplasia	B: 15	B: 10.5	9	1.2	R: Varus angulation
17	M	22	B	Achondroplasia	B: 20	B: 10	7	2	–
18	F	14	L	Osteomyelitis	R: 31, L: 27	L: 5	6	8	–
19	F	12	L	Osteomyelitis	R: 29, L: 23	L: 8	9	2	R: Refracture
20	F	10	L	Osteomyelitis	R: 27, L: 20	L: 9	7	5	–
21	M	15	R	Physeal injury	R: 22, L: 29	L: 7	6	6	–
22	F	13	R	Physeal injury	R: 20, L: 24	R: 4	6	4	R: Elbow contracture
23	M	18	R	Physeal injury	R: 23, L: 29	R: 6	9	4	R: Pin tract infection

^a Side: B – bilateral; L – left; B – bilateral

Figure 1. A. Case no 4. A 12-year-old girl with achondroplasia showing shortened right humerus.

B. Osteotomy and monolateral fixator application for gradual lengthening of shortened humerus.

C. Desired length achieved with use of monolateral fixator.

D. 7 months after osteotomy, full consolidation of the newly formed callus. The pixel value ratio (PVR) measured at this point was > 1 in all 4 cortices.

E. At the final follow up, 2 years after osteotomy.

Figure 2. A. Case no 20. A 10-year-old female with shortened and deformed (varus angulation) proximal humerus due to osteomyelitis.

B. Bifocal humeral osteotomy with use of hybrid monolateral fixator for correction of deformity and lengthening simultaneously.

C. Desired lengthening of the humerus at the distal osteotomy site.

D. Full consolidation of the lengthening site, 7 months after osteotomy. Proximal pins and assembly were removed after healing of proximal osteotomy, thereby converting it to a simple monolateral fixator.

E. Final follow-up 5 years after osteotomy, showing excellent remodeling.

Table 2. Comparison of various series using different modalities for humeral lengthening for various etiologies

	Cattaneo et al.	Kashiwagi et al.	Shadi et al.	Hosny et al.	Current series
No. of patients
1) Lengthening only	29	20	5	16	17
2) Lengthening and deformity correction	–	–	–	–	6
Mean age	18	12.8	15.7	13	14
Number of humeral segments	43	20	10	16	40
Fixator used	Ilizarov	Ilizarov	Monolateral	Monolateral	Monolateral
Mean length gained, cm	9	7.8	8.5	–	8.8
Pin tract infection	6	5	2	16	6
Elbow stiffness	3	2	2	–	3 patients (5 elbows)
Radial nerve palsy	1	2	1	1	1
Refracture	7	2	None	2	3
Varus angulation	None	None	None	–	2
External fixation index (days/cm)	NR	NR	26	–	30.3
Mean healing index (days/cm)	NR	30	NR	28	28.2

NR – not reported

Figure 3. A. Case no 5. Refracture after removal of the fixator at the mid-diaphyseal level.

B. Close reduction and U-arm slab application with abduction splint for 6 weeks.

C. Union of the fracture site X months after the fracture.