Long-term functional and quality of live assessment following post-traumatic distraction osteogenesis of the lower limb

Niels Willem Luitzen Schep, Esther M M van Lieshout, Peter Patka, Lucas M M Vogels, Niels Willem Luitzen Schep, Esther M M van Lieshout, Peter Patka, Lucas M M Vogels

Abstract

Limb length discrepancy and segmental bone defects can be difficult problems to manage after fractures of the lower limb. Distraction osteogenesis can be applied to lengthen bone or to bridge intercalary defects by segmental bone transport. The purpose of this study was to assess the functional outcome and long-term quality of life after distraction osteogenesis of the lower limb when applied for post-traumatic problems. Three patients were treated with segmental transport for bone loss secondary to infection and debridement after a tibia fracture. Leg lengthening was performed in 12 patients with consolidated fractures (eight femurs and four tibias). Long-term functional outcomes were evaluated with the Short Form-36 Health Survey (SF-36) and the Lower Extremity Functional Scale (LEFS) in all patients. The mean follow-up was 9 years. Functional outcomes indicated moderate difficulty in patients after segmental transport and a little difficulty in patients after lengthening of consolidated fractures. The SF-36 scores varied two points for physical functioning and one point for bodily pain as compared to the SF-36 norm-based scores. In all other six domains, patient scores were comparable with the general population. In conclusion, the quality of life and functional outcome returned to normal after post-traumatic distraction osteogenesis of the lower limb.

Figures

Fig. 1
Fig. 1
A subperiosteal corticotomy was performed by connecting the drill holes with an osteotome
Fig. 2
Fig. 2
The bone segment was distracted with a distraction rate of 1 mm per day. As soon as the bone segment had reached the docking site, a plate fixation with autogenous bone grafting was performed
Fig. 3
Fig. 3
Median SF-36 scores leg lengthening in comparison with US population norms. Physical functioning (PF); role limitations due to physical health (RP); bodily pain (BP); social functioning (SF); vitality, energy, or fatigue (VT); general health perceptions (GH); role limitations due to emotional problems (RE); general mental health (MH); physical component score (PCS); and mental component score (MCS). Horizontal lines within boxes, boxes, error bars represent median, interquartile range, and range, respectively

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Source: PubMed

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