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Limb lengthening in pediatric patients with ollier's disease

Background: Ollier's disease is a non-hereditary skeletal disorder. Orthopedic management of limb length discrepancy could be complex given the nature of bone pathology, the significant amount of length discrepancy and the difficulty to predict it. The goal of the study is to identify the outcomes and complications associated with surgical management of limb length discrepancy. Methods: This is an IRB approved, retrospective review of patients with Ollier's disease who had limb lengthening. The age at the time of surgery, amount of total length discrepancy and discrepancy for each individual bone, amount of lengthening and as a ratio to the length of the bone itself, type of fixator, duration of the fixator, complications are recorded. Unpaired T-tests evaluated the effect of simultaneous versus single-bone lengthening and tibia vs. femur being lengthened on the external fixator index. One-way ANOVA test was used to evaluate the effect of osteotomy location on mean External Fixator Index (EFI). Results: 14 patients with 40 segmental limb lengthening procedures are identified. The mean LLD was 7.1 cm and mean amount of length gained was 7.8 cm. Follow up was minimum 2 years and maximum 18 years 2 months. The average fixator duration was 178.6 days. The average percent of lengthening through each bone was 19.2. The average EFI was 36.5 days/cm. There was no difference between tibia vs. femur and between simultaneous vs. single bone on EFI. There was no difference among osteotomy type. There were 3 cases of nonunion, one delayed union, 5 cases of premature consolidation. One case had fixation failure. There were 7 cases of knee stiffness of which 3 cases required surgery. Conclusions: Our study shows that Enchondromal bone appears to respond to lengthening with a structurally proper regenerate. Premature consolidation needs to be always kept in mind and appropriate adjustment should be made in the rate of lengthening.