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Background During lower limb lengthening, poor bone regeneration is a devastating complication. Several local or systemic applications have been used to promote osteogenesis, and biologic stimulations are gaining attention, but their utility has not been proven in this setting. Questions/purposes In patients undergoing bilateral tibial lengthening, we compared those receiving an osteotomy site injection of autologous bone marrow aspirate concentrate (BMAC) plus platelet-rich plasma (PRP) with those not receiving such an injection in terms of external fixator index (time in external fixation divided by amount of lengthening), full weightbearing index (time until a patient was permitted to do full weightbearing divided by amount of lengthening), four cortical healing indexes (time until each cortical union divided by amount of lengthening), and callus shape and type. Methods Twenty-two patients (44 tibias) undergoing bilateral tibial lengthening enrolled in this randomized trial. Two patients were excluded, one due to insufficient radiographic evaluation and one who was lost to followup, leaving 20 patients (40 segments) for inclusion. Ten patients (20 segments) received BMAC combined with PRP injection (treatment group) and 10 patients (20 segments) received no injection (control group). All patients underwent stature lengthening for familial short stature with the lengthening over nail technique. Autologous BMAC combined with PRP was injected at the tibial osteotomy site at the end of the index surgery. Mean distraction rates were similar between groups (0.75 mm/day in the treatment group versus 0.72 mm/day in the control group; p = 0.24). Full weightbearing was permitted when we observed radiographic evidence of healing at two cortices; this assessment was made by the surgeon who was blinded to the treatment each patient received. Minimum followup was 24 months (mean, 28 months; range, 24–34 months). Results There was no difference in mean external fixator index between groups. However, mean cortical healing indexes (anterior/posterior/medial/lateral) were 1.14/0.81/0.96/0.88 months/cm in the treatment group and 1.47/1.26/1.42/1.22 months/cm in the control group (all p < 0.001), showing faster healing in the treatment group at each cortex. Full weightbearing was permitted earlier in the treatment group than in the control group (index: 0.99 months/cm and 1.38 months/cm, respectively, p < 0.001). Callus shape and type were not different between groups. Conclusions Autologous BMAC combined with PRP injection at the osteotomy site helped improve bone healing in distraction osteogenesis of the tibia, although the effect size was small. Level of Evidence Level I, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

The work aimed to evaluate the effectiveness of the developed distraction system based on the rod external monolateral fixation mechanisms by comparing it with the classical technique of long tubular bones distraction based on the circular multi-axial system. The study included patients with a genetically confirmed diagnosis of achondroplasia. The experimental group consisted of 14 patients who underwent surgical limb lengthening by the rod monolateral external fixator with a distraction system developed by the authors. The lengthening was performed on 28 segments of tubular bones. The majority of the experimental group patients achieved the lengthening value close to the planned one and the deformation correction. The fixation period was averagely 83.8 ± 3.7 days, the regenerate length was 8.5 ± 0.6 cm, and the mechanical strength of the distraction regenerate was 10.3° ± 2.18°. The rod external fixator with a control distraction system developed by the authors has small dimensions and low weight of the external supporting elements of high durability. It is reported to provide a good psychological tolerance of the treatment process and significantly outperforms the circular multi-axis system. Considering the aforementioned, the proposed apparatus can grant good orthopedic care to patients with achondroplasia.

Background Fronto-orbital advancement and remodeling (FOAR) is among the most common surgical approaches for unicoronal craniosynostosis (UCS), although some data demonstrate failure to achieve long-term aesthetic normalcy, leading some to seek alternative treatment paradigms such as fronto-orbital distraction osteogenesis (FODO). This study compares long-term aesthetic outcomes of patients with UCS treated with FOAR and FODO. Methods Twenty patients (four males) with non-syndromic UCS presenting to our institution and undergoing distraction were compared to a matched cohort of 20 patients (six males) undergoing FOAR. Clinical photographs and ImageJ were used to quantify periorbital anatomy including palpebral fissures, pupil-to-brow distance (PTB), and margin-reflex distance (MRD 1 ) in pixels. Whitaker classification was blindly assigned by craniofacial surgeons. Results Photogrammetric analysis and Mann–Whitney U tests demonstrated significantly improved postoperative symmetry in distraction patients for palpebral width ( p  = 0.020), MRD 1 ( p  = 0.045), and canthal tilt ( p  = 0.010). Average Whitaker classification scores between FOAR (1.94) and distraction (1.79) cohorts were similar ( p  = 0.374). Conclusions UCS patients demonstrated significant postoperative improvements in periorbital symmetry, with distraction patients demonstrating superior results in palpebral width and canthal tilt. FOAR and FODO patients achieved similar Whitaker classification scores. These cohorts will be followed until craniofacial maturity prior to making any definitive conclusions.

Background Congenital pseudoarthrosis of the tibia (CPT) is a rare, sinister condition that is often associated with neurofibromatosis type 1 (NF1). Even after achieving union, patients frequently present with significant leg length discrepancy (LLD) due to growth disturbance and repeated reconstructive surgeries. Tibial lengthening using distraction osteogenesis is commonly performed, yet outcomes and complications remain poorly understood. Objective To systematically map the available literature on tibial lengthening in CPT, describe surgical techniques, summarize reported outcomes, and identify research gaps. Methods A scoping review was conducted following Arksey and O’Malley’s framework and the PRISMA-ScR guidelines. The PubMed, Embase, Scopus, Web of Science and Cochrane Library databases were searched. Eligible studies included those reporting tibial lengthening during CPT. Data on patient demographics, surgical techniques, length achieved, union rates, complications, and follow-up were extracted. Results Thirty-one studies involving 486 patients were included. All studies were retrospective. The mean age at lengthening ranged from 3.2 to 33.7 years. NF1 was present in 70% of the patients. The Ilizarov external fixator in isolation or with hybrid techniques was the most frequently reported lengthening modality. The mean lengthening achieved was 5.5 cm (range 1.5–10.2 cm). The most common site of lengthening was through proximal tibial osteotomy followed by physeal distraction. Complications such as pin tract infection, regenerate fractures and tibial bowing deformities were commonly encountered. The follow-up period ranged from 1.6 to 24 years. Conclusions Tibial lengthening is feasible in CPT and can achieve meaningful limb length equalization. However, complication rates remain high, and evidence is limited by the small number of retrospective studies. Standardized outcome reporting and prospective multicenter collaboration are needed to optimize care.

Abstract BACKGROUND There is no agreement on frequency of distractions of magnetically controlled growing rods (MCGRs) but more frequent and smaller amounts of distractions mimic physiological spine growth. The mid- to long-term follow-up and management at skeletal maturity is unknown. OBJECTIVE To analyze patients with mean 6 yr of follow-up and describe the fate of MCGR graduates. METHODS Early onset scoliosis (EOS) patients treated with MCGRs with minimum 4 yr of follow-up and/or at graduation were studied. Parameters under study included Cobb angle, spine and instrumented lengths, and rod distraction gains. Relationship between timing of rod exchanges with changes in rate of lengthening was studied. RESULTS Ten EOS patients with mean 6.1 yr of follow-up were studied. The greatest Cobb angle correction occurred at the initial implantation surgery and was stable thereafter. Consistent gains in T1-12, T1-S1, and instrumented segment were observed. Rate of lengthening reduced after the first year of use but improved back to initial rates after rod exchange. Seven of the ten patients experienced complications with reoperation rate of 40% for rod distraction failure and proximal foundation problems. Only mild further improvements in all radiological parameters were observed pre- and postfinal surgery. No clinically significant curve progression was observed for rod removal only. All postfinal surgery parameters remained similar at postoperative 2 yr. CONCLUSION This study provides an outlook of the end of MCGR treatment. Although this is a fusionless procedure, instrumented segments do experience stiffness limiting further correction and length gain during final surgery whether fusion or rod removal is performed.