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Is there an Increase in Valgus Deviation in Tibial Distraction Using the Lengthening Over Nail Technique?

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dc.contributor.author김현우-
dc.contributor.author류근정-
dc.contributor.author박훈-
dc.contributor.author이동훈-
dc.contributor.author한준우-
dc.contributor.author황진호-
dc.date.accessioned2017-02-24T11:07:20Z-
dc.date.available2017-02-24T11:07:20Z-
dc.date.issued2016-
dc.identifier.issn0009-921X-
dc.identifier.urihttps://ir.ymlib.yonsei.ac.kr/handle/22282913/146653-
dc.description.abstractBACKGROUND: During tibial lengthening, the soft tissues of the posterolateral compartment produce distraction-resisting forces causing valgus angulation. Although this occurs with the classic Ilizarov method, whether a valgus deformity develops with the lengthening over nail (LON) technique is questioned, because the intramedullary nail is thought to resist deforming forces and adequately maintain alignment of the distracted bone. QUESTIONS/PURPOSES: The purposes of this study were to (1) determine the amount of valgus deviation during tibial lengthening with the LON technique; and (2) analyze the factors that may be associated with valgus deviation with the LON technique. METHODS: Between June 2009 and September 2013, we performed 346 tibial lengthenings using the LON technique, lengthening and then nail technique, or lengthening with an intramedullary lengthening device. Sixty patients (120 tibias) who underwent bilateral lower leg lengthening with the LON technique were enrolled in this retrospective study. To limit the number of variables, we analyzed only the right tibia in all patients (60 tibias). The mean followup was 42 months (range, 26-71 months). The mean age of the patients was 25 years (range, 18-40 years). There were 36 male and 24 female patients. The mean final length gain was 67 ± 9 mm. The mean time for distraction was 100 ± 25 days. The overall valgus deviation was assessed by measuring the change in the medial proximal tibial angle and mechanical femorotibial angle on radiographs obtained before and after surgery and after completion of lengthening. Several demographic, surgical, and distraction-related variables were considered possible factors to prevent valgus deviation: proximal fixation method; presence of a blocking screw; diameter and length of the intramedullary nail; degree of nail insertion; length of the nail in the distal segment after completion of distraction; final length gain; and patient's BMI. During the period studied, the blocking screw was to maintain the mechanical axis in patients who had neutral or valgus alignment preoperatively, or to prevent more valgus change in patients who underwent acute correction of varus deformity intraoperatively. Uni- and multivariate analyses were conducted. RESULTS: Valgus deviation occurred during the tibial LON. The medial proximal tibial angle increased from 86° (95% CI, 85°-86°) to 90° (95% CI, 89°-91°) (p < 0.001). The mechanical femorotibial angle changed from 2.2° varus (95% CI, 3°-1.4° varus) to 2.6° valgus (95% CI, 1.8°-3.4° valgus) (p < 0.001). Valgus deviation was evident in proximal and distal segments. In the multivariate regression model, use of a blocking screw was the only factor that was associated with decreased valgus deviation, and its effect size, although detectable, was small (-2.62; 95% CI, -4.65 to -0.59; p = 0.013). CONCLUSIONS: We found that valgus deviation does occur during tibial lengthening using the LON technique, but that blocking screw placement may help to minimize the likelihood that severe valgus deviation will occur. Future prospective studies should be conducted to confirm this preliminary finding. LEVEL OF EVIDENCE: Level III, therapeutic study.-
dc.description.statementOfResponsibilityrestriction-
dc.format.extent1283~1291-
dc.languageEnglish-
dc.publisherSpringer-
dc.relation.isPartOfCLINICAL ORTHOPAEDICS AND RELATED RESEARCH-
dc.rightsCC BY-NC-ND 2.0 KR-
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/2.0/kr/-
dc.subject.MESHAdolescent-
dc.subject.MESHAdult-
dc.subject.MESHBiomechanical Phenomena-
dc.subject.MESHBone Nails*-
dc.subject.MESHBone Remodeling*-
dc.subject.MESHCoxa Valga/diagnosis-
dc.subject.MESHCoxa Valga/etiology*-
dc.subject.MESHCoxa Valga/physiopathology-
dc.subject.MESHFemale-
dc.subject.MESHHumans-
dc.subject.MESHLinear Models-
dc.subject.MESHMale-
dc.subject.MESHMultivariate Analysis-
dc.subject.MESHOsteogenesis, Distraction*/adverse effects-
dc.subject.MESHOsteogenesis, Distraction*/instrumentation-
dc.subject.MESHOsteogenesis, Distraction*/methods-
dc.subject.MESHRadiography-
dc.subject.MESHRetrospective Studies-
dc.subject.MESHRisk Factors-
dc.subject.MESHTibia/diagnostic imaging-
dc.subject.MESHTibia/physiopathology-
dc.subject.MESHTibia/surgery*-
dc.subject.MESHTime Factors-
dc.subject.MESHTreatment Outcome-
dc.subject.MESHYoung Adult-
dc.titleIs there an Increase in Valgus Deviation in Tibial Distraction Using the Lengthening Over Nail Technique?-
dc.typeArticle-
dc.publisher.locationUnited States-
dc.contributor.collegeCollege of Medicine-
dc.contributor.departmentDept. of Orthopedic Surgery-
dc.contributor.googleauthorHoon Park-
dc.contributor.googleauthorKeun Jung Ryu-
dc.contributor.googleauthorHyun Woo Kim-
dc.contributor.googleauthorJin Ho Hwang-
dc.contributor.googleauthorJoon Woo Han-
dc.contributor.googleauthorDong Hoon Lee-
dc.identifier.doi10.1007/s11999-016-4712-8-
dc.contributor.localIdA01124-
dc.contributor.localIdA01321-
dc.contributor.localIdA01775-
dc.contributor.localIdA02741-
dc.contributor.localIdA04700-
dc.contributor.localIdA04491-
dc.relation.journalcodeJ00602-
dc.identifier.eissn1528-1132-
dc.identifier.pmid26825816-
dc.identifier.urlhttp://link.springer.com/article/10.1007/s11999-016-4712-8-
dc.contributor.alternativeNameKim, Hyun Woo-
dc.contributor.alternativeNameRyu, Keun Jung-
dc.contributor.alternativeNamePark, Hoon-
dc.contributor.alternativeNameLee, Dong Hoon-
dc.contributor.alternativeNameHan, Joon Woo-
dc.contributor.alternativeNameHwang, Jin Ho-
dc.contributor.affiliatedAuthorKim, Hyun Woo-
dc.contributor.affiliatedAuthorRyu, Keun Jung-
dc.contributor.affiliatedAuthorPark, Hoon-
dc.contributor.affiliatedAuthorLee, Dong Hoon-
dc.contributor.affiliatedAuthorHan, Joon Woo-
dc.contributor.affiliatedAuthorHwang, Jin Ho-
dc.citation.volume474-
dc.citation.number5-
dc.citation.startPage1283-
dc.citation.endPage1291-
dc.identifier.bibliographicCitationCLINICAL ORTHOPAEDICS AND RELATED RESEARCH, Vol.474(5) : 1283-1291, 2016-
dc.date.modified2017-02-24-
dc.identifier.rimsid47399-
dc.type.rimsART-
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers

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