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Philip K. McClure
International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 W. Belvedere Ave, Baltimore, MD 21215, USA

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Journal article
Published: 30 August 2021 in Children
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Previous studies on lengthening for achondroplasia have reported bilateral extensive femoral lengthening followed by bilateral extensive tibial lengthening. To decrease trauma on soft tissues and joints, we propose bilateral simultaneous moderate femoral lengthening and moderate tibial lengthening followed by a similar repeat lengthening a few years later. Fifty patients with achondroplasia underwent 65 simultaneous bilateral femoral and tibial lengthening procedures. Segment lengthening amount and adverse events were obtained from medical records. Mean follow-up after bone healing was 35.6 months. Mean tibial lengthening was 52 mm; mean femoral lengthening was 72 mm. Average healing index was 1.4 months/cm for the tibia and 1 month/cm for the femur. Mean duration of treatment with external fixation was 6.7 months (range, 4.4–10.5 months). Thirty-eight (76%) of 50 patients experienced one or more adverse events during lengthening. We observed 78 adverse events, 35 (45%) of which required additional surgical procedures. All resolved by the end of treatment. Mechanical axis deviation improved from a mean of 15 mm medially to 8 mm medially. Simultaneous lengthening of four segments in patients with achondroplasia is a feasible strategy. Compared with isolated femoral or tibial lengthening, distributing the lengthening between the femur and tibia decreases total external fixator time.

ACS Style

Lior Shabtai; Julio J. Jauregui; John E. Herzenberg; Martin G. Gesheff; Shawn C. Standard; Philip K. McClure. Simultaneous Bilateral Femoral and Tibial Lengthening in Achondroplasia. Children 2021, 8, 749 .

AMA Style

Lior Shabtai, Julio J. Jauregui, John E. Herzenberg, Martin G. Gesheff, Shawn C. Standard, Philip K. McClure. Simultaneous Bilateral Femoral and Tibial Lengthening in Achondroplasia. Children. 2021; 8 (9):749.

Chicago/Turabian Style

Lior Shabtai; Julio J. Jauregui; John E. Herzenberg; Martin G. Gesheff; Shawn C. Standard; Philip K. McClure. 2021. "Simultaneous Bilateral Femoral and Tibial Lengthening in Achondroplasia." Children 8, no. 9: 749.

Short communication
Published: 09 August 2021 in Journal of Pediatric Orthopaedics B
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Congenital pseudarthrosis of the tibia (CPT) is characterized by anterolateral tibial bowing and hamartomatous periosteum that predisposes it to fracture. Fassier–Duval telescopic rods can improve the structural integrity of bone segments after reconstruction. We present our experience treating CPT with the Fassier–Duval rod and a novel technique for Fassier–Duval exchange that was developed after extraction failed in one patient. Patients were identified who underwent treatment with Fassier–Duval rods for CPT between 2007 and 2016 and had undergone their first rod exchange. Medical records were reviewed, and complications were classified using the system of Cherkashin. Four patients had an average age at the initial insertion of 6 years 4 months (4–9 years). The average follow-up duration after initial Fassier–Duval implantation was 5.4 years (2.7–8.1 years). Seven Category 2 complications were associated with the Fassier–Duval rod: interlocking K-wire migration (2), lengthening failure (2), explant failure (1), distal migration of female rod through physis (1) and male rod portion proximally migrating through physis (1). Three patients underwent one rod exchange [average 3.2 years after implantation (range, 2.7–3.9 years)]. One patient underwent two rod exchanges (2.9 and 6.9 years after initial implantation). The second attempt at exchange failed; this failure prompted the development of custom trephines to remove the hard bone that can encase the distal male segment. The use of custom trephines was made necessary by dense sclerotic bone at the previous pseudarthrosis site. We recommend that custom trephines be available during Fassier–Duval rod extraction to avoid failed retrieval. Level of evidence: Level IV (Case series).

ACS Style

Philip K. McClure; Jeanne M. Franzone; John E. Herzenberg. Challenges with Fassier–Duval rod exchanges in congenital pseudarthrosis of the tibia. Journal of Pediatric Orthopaedics B 2021, Publish Ah, 1 .

AMA Style

Philip K. McClure, Jeanne M. Franzone, John E. Herzenberg. Challenges with Fassier–Duval rod exchanges in congenital pseudarthrosis of the tibia. Journal of Pediatric Orthopaedics B. 2021; Publish Ah ():1.

Chicago/Turabian Style

Philip K. McClure; Jeanne M. Franzone; John E. Herzenberg. 2021. "Challenges with Fassier–Duval rod exchanges in congenital pseudarthrosis of the tibia." Journal of Pediatric Orthopaedics B Publish Ah, no. : 1.

Technical trick
Published: 28 December 2020 in Journal of Orthopaedic Trauma
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Supplemental Digital Content is Available in the Text.

ACS Style

Jessica C. Rivera; Philip K. McClure; Austin T Fragomen; Samir Mehta; S. Robert Rozbruch; Janet D. Conway. Intramedullary Antibiotic Depot does not Preclude Successful Intramedullary Lengthening or Compression. Journal of Orthopaedic Trauma 2020, Publish Ah, e309 -e314.

AMA Style

Jessica C. Rivera, Philip K. McClure, Austin T Fragomen, Samir Mehta, S. Robert Rozbruch, Janet D. Conway. Intramedullary Antibiotic Depot does not Preclude Successful Intramedullary Lengthening or Compression. Journal of Orthopaedic Trauma. 2020; Publish Ah (8):e309-e314.

Chicago/Turabian Style

Jessica C. Rivera; Philip K. McClure; Austin T Fragomen; Samir Mehta; S. Robert Rozbruch; Janet D. Conway. 2020. "Intramedullary Antibiotic Depot does not Preclude Successful Intramedullary Lengthening or Compression." Journal of Orthopaedic Trauma Publish Ah, no. 8: e309-e314.