Page 4 - Introduction Continued
All patients were available for followup at a minimum of 1 year (mean, 5.75 years; range, 1–14 years). The mean height gained was 6.9 cm (range, 2–13 cm); 7.3 cm (range, 3.5–13 cm) in males and 6.5 cm (range, 2–13 cm) in females. The associated bilateral proximal tibial varus in nine patients was corrected. The mean duration of distraction and maintenance phases were 79 days (range, 17–168 days) and 116 days (range, 31–301 days), respectively. The mean duration of fixator wear was 215 days (range, 71–390 days). The mean lengthening index was 12 days/cm (range, 4.3– 24 days/cm), the mean maturation index was 19 days/cm (range, 5.2–63 days/cm), and the mean external fixator index was 31 days/cm (range, 12–78 days/cm).

Results
There were 37 soft tissue complications (28%) of which 17 (46%) needed reinterventions. The soft tissue complications were significant pin tract infections (n = 5; 3.82%), common peroneal neuropathy (n = 6; 4.58%), equinus of the ankle (n = 12; 9.16%), and fixed flexion deformity of the knee (n = 14; 11%). Other than minor pin tract infections treated with dressings, antibiotics, and removal of wires without affecting fixator stability, major infection that needed changes of wires with the patient under anesthesia occurred in five patients (3.82%). The infections were controlled. Common peroneal neuropathy occurred in six patients (4.58%) while undergoing distraction and was treated by reducing the amount of distraction, physiotherapy, and pharmacologic supplementation (intramuscular injection of neurotropic medications such as prozerin or galantamine and vitamins B1, B6, and B12 for 10 to 14 days). All but one patient (despite exploration and neurolysis) achieved complete recovery. Twelve patients (9.16%) had equinus deformity while wearing the fixator. Ten of these patients had bilateral equinus deformities, and nine of these patients were treated by extending the frame to the foot and gradual stretching of the tendoachilles, with additional percutaneous lengthening in one patient. One patient had tendoachilles lengthening alone followed by bracing and physiotherapy. Two patients refused any surgery and underwent physiotherapy and prolonged bracing. Four patients had only 20 degrees ankle dorsiflexion at final followup. Fourteen patients (11%) had a fixed flexion deformity of the knee between 10 degrees to 40 degrees at various stages of treatment. Physiotherapy, exercises, and splinting helped in all but two patients. One of these patients had successful correction with Ilizarov distraction and the other had a residual deformity of 15 degrees.

There were 22 (17%) bone-related complications of which 16 (73%) needed reinterventions. These complications were technical issues (n = 2; 1.53%; one incomplete corticotomy of the tibia that needed osteoclasis, and premature fibular consolidation requiring reosteotomy with the patient under anesthesia), osteomyelitis (n = 3; 2.29%), delayed regeneration (n = 6; 4.58%), deformity of the regenerate while wearing the fixator (n = 5; 3.82%), deformity of the regenerate after removal of the fixator (n = 4; 3.05%), subluxation of the knee (n = 1; 0.76%), and late fracture through the regenerated bone (n = 1; 0.76%). Pin tract infection progressed to deep infection in three patients (2.29%) and needed exploration, de´bridement, removal of sequestrum, and exchange of wires. None of these infections progressed to a chronic infection. Poor regeneration occurred in six patients (4.58%), and two of these patients had crossed oblique olive wires applied through the regenerate to stimulate osteogenesis. Consolidation occurred in the other four by expectant management and continued rehabilitation. None of these patients experienced nonunion. Four patients had substantial deformities of the tibial regenerate develop while they were wearing the fixator (varus of the proximal tibia [n = 1], valgusrecurvatum of the proximal tibia [n = 1], varus of the distal tibia [n = 2]) that needed correction and realignment with the patients under anesthesia. Another patient had his femoral fixator realigned twice for deformity of the regenerate. Four patients had deformities develop after removal of the fixator (valgus-recurvatum of the proximal tibia [n = 3], varus of the proximal tibia [n = 1]), two of whom had a corrective cast applied and two had reapplication of the fixator. None of the patients had residual deformity greater than 5. One patient had lateral subluxation of the knee during distraction, which was reduced by modifying the fixator. One patient had delayed posttraumatic fracture through the new bone region 1 year after fixator removal and was treated successfully with Ilizarov osteosynthesis.

On the basis of the established criteria, treatment outcome was excellent in 72 patients (55%) (Fig. 1), good in 52 (40%), satisfactory in six (4.58%), and poor in one (0.77). One patient discontinued lengthening after achieving 2 cm because of her concerns regarding the prolonged duration of treatment. At completion of treatment, all but this last patient stated on our questionnaire that they were satisfied with the outcome of treatment, felt improvement of self-esteem, they would undergo the procedure again, and they would recommend it to another person having short stature.