Abstract
Compression-distraction techniques (or circular external fixation methods) are a good alternative to other surgical methods based on bone grafts or bone substitutes, allowing “bone regeneration” through distractional osteogenesis and leading to a substantial advantage in the correction of long bone deformities, in selected bone tumours and in many types of non-unions.
Monofocal compression-distraction osteosynthesis is applied to correct long bone deformities in orthopaedics, basically through distraction epiphyseolisis, in which a gradual elongation of the epiphysis at the growth plate level is produced, and corticotomy-distraction, in which the gradual distraction is performed at metadiaphyseal level, after cortical osteotomy. In cases of hypertrophic non-unions (usually associated with limb shortening) the use of monofocal osteosynthesis basically relies on osteosynthesis with gradual distraction of the non-union site. These are cases where the fibrous or fibrocartilaginous tissue lying between the bone fragments is biologically active and gradual distraction highly affects its potential for regeneration.
Bifocal or plurifocal compression-distraction osteosynthesis is applied to correct wide bone defects through the technique of “internal lengthening” or “bone transport”. A corticotomy is performed at one of the two metaphyses of the affected long bone and the bone segment obtained by this corticotomy is gradually moved to fill the gap. In orthopaedics this technique shows its highest advantages in cases of bone tumours treated with segmentary resection, and in traumatology in atrophic non-unions and in infected non-unions with bone loss.
Between 1986 and 2003, distraction osteogenesis techniques were applied in 753 cases (638 patients) for several orthopaedic or traumatological problems. There were 430 men and 323 women. The average age was 24 years (min 3 years, max 48 years). The anatomical and functional results have been highly satisfactory, with a very low complication rate, and confirm the effectiveness of these techniques in selected cases in orthopaedics and traumatology.
