Limb lengthening by callus distraction (Callotasis)

Abstract

Background Limb length discrepancy is not uncommon; however, the earlier attempts of limb lengthening surgery were hampered by high complication rates. As a result, most orthopedic surgeons focused their attention on shortening the normal limb or the use of shoe lifts. The authors of this paper introduced a new technique called "callotasis" which involved limb lengthening by slow distraction of the callus formed at bone corticotomy. Their initial experience with lengthening was not satisfactory. They performed diaphyseal lengthening on 27 patients with a limb length discrepancy (LLD) in 1976. There was a high complication rate (26 %) and 89 revision operations. As a result, they refi ne their technique and searched for additional ways that were less traumatic and associated with fewer complications. In this paper, they presented their subsequent experience in 100 lengthening procedures between 1983 and 1984. Methods This is a retrospective series of 100 lengthening procedures on 73 patients using the technique of callotasis (56 femora, 41 tibia and 3 humeri). The indications were LLD in 54 instances (congenital 26 segments; acquired 28 segments) and achondroplasia in 46. The dynamic axial fi xation system (mono-planar) was used. A corticotomy was performed in the proximal area of the diaphysis. In the femur, this is just distal to the iliopsoas insertion, in the tibia, just distal to the patellar tendon insertion and in the humerus distal to the deltoid muscle insertion. Distraction was started when callus was visible (about 10-15 days postoperatively). The rate of distraction was 0.25 mm every 6 h. Results The average increase in length achieved was 6 cm. The duration of the treatment from the day of surgery to the removal of the screws ranged from 90 to 300 days for patients with LLD and 243 to 416 days in achondroplastic patients. Complications occurred in 14 segments: precocious consolidation of femur (4), fusion of fi bula (3), osteolysis around screw entry holes (2), fracture of femur (4) and fracture tibia in one patient. Conclusions The author's conclusion was callotasis was the safest and simplest method for limb lengthening.