V Goldman1, T H McCoy2, M D Harbison3, A T Fragomen2, S R Rozbruch2. 1. Limb Lengthening and Complex Reconstructions Service, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021 USA ; Orthopedic Surgery Department, Hadassah Medical Center, Jerusalem, Israel. 2. Limb Lengthening and Complex Reconstructions Service, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021 USA. 3. Pediatric Endocrinology Service, Mount Sinai Hospital, New York, NY USA.
Abstract
INTRODUCTION/ BACKGROUND: Russell-Silver syndrome (RSS) is the combination of intrauterine growth retardation, difficulty feeding, and postnatal growth retardation. Leg length discrepancy (LLD) is one of four major diagnostic criteria of RSS and is present in most cases. We aimed to ascertain whether pediatric RSS patients will adequately consolidate bony regenerate following leg lengthening. MATERIALS AND METHODS: We retrospectively reviewed pediatric RSS patients who underwent limb lengthening and compared them to a similar group of patients with LLD resulting from tumor, trauma, or congenital etiology. The primary outcome measurement was the bone healing index (BHI). RESULTS: The RSS group included seven lengthened segments in five patients; the comparison group included 21 segments in 19 patients. The groups had similar lengthening amounts (3.3 vs. 3.9 cm, p = 0.507). The RSS group healed significantly faster (lower BHI) than the control group (BHI 29 vs. 43 days/cm, p = 0.028). Secondary analysis showed no difference between RSS and trauma patients in terms of the BHI (29 vs. 31); however, the BHI of the RSS group was significantly lower than both of the other congenital etiologies (29 vs. 41, p = 0.032) and tumor patients (29 vs. 66, p = 0.019). The RSS patients had fewer and less significant complications than the controls. DISCUSSION: The limb lengthening regenerate healing of RSS patients is faster than the healing of patients with other congenital etiologies and tumor patients, and is as fast as the regenerate healing of patients with posttraumatic LLD. Although all RSS patients were treated with human growth hormone (hGH), we are unable to isolate the hGH contribution to the regenerate bone healing. We conclude that RSS patients can have safe limb lengthening.
INTRODUCTION/ BACKGROUND:Russell-Silver syndrome (RSS) is the combination of intrauterine growth retardation, difficulty feeding, and postnatal growth retardation. Leg length discrepancy (LLD) is one of four major diagnostic criteria of RSS and is present in most cases. We aimed to ascertain whether pediatric RSSpatients will adequately consolidate bony regenerate following leg lengthening. MATERIALS AND METHODS: We retrospectively reviewed pediatric RSSpatients who underwent limb lengthening and compared them to a similar group of patients with LLD resulting from tumor, trauma, or congenital etiology. The primary outcome measurement was the bone healing index (BHI). RESULTS: The RSS group included seven lengthened segments in five patients; the comparison group included 21 segments in 19 patients. The groups had similar lengthening amounts (3.3 vs. 3.9 cm, p = 0.507). The RSS group healed significantly faster (lower BHI) than the control group (BHI 29 vs. 43 days/cm, p = 0.028). Secondary analysis showed no difference between RSS and traumapatients in terms of the BHI (29 vs. 31); however, the BHI of the RSS group was significantly lower than both of the other congenital etiologies (29 vs. 41, p = 0.032) and tumorpatients (29 vs. 66, p = 0.019). The RSSpatients had fewer and less significant complications than the controls. DISCUSSION: The limb lengthening regenerate healing of RSSpatients is faster than the healing of patients with other congenital etiologies and tumorpatients, and is as fast as the regenerate healing of patients with posttraumatic LLD. Although all RSSpatients were treated with humangrowth hormone (hGH), we are unable to isolate the hGH contribution to the regenerate bone healing. We conclude that RSSpatients can have safe limb lengthening.
Entities:
Keywords:
Bone healing index; Human growth hormone; Limb lengthening; Russell–Silver syndrome
Authors: Maurizio A Catagni; Makram Radwan; Luigi Lovisetti; Francesco Guerreschi; Nabil A Elmoghazy Journal: Clin Orthop Relat Res Date: 2010-10-21 Impact factor: 4.176
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